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A Qualitative Analysis of South African Health Professionals’ Discussion on Distrust and Unwillingness to Refer Organ Donors

Introduction: South Africa is faced with very low deceased organ donor numbers. Often, sociocultural practices, which are thought to be fundamentally opposed to deceased organ donation, are hailed as the cause. However, other factors such as context, social perceptions, and clinical environment may play a role. Aim: The aim of this article is to present research that explored communication in organ transplant and identified barriers to organ donation decisions in a province of South Africa. Methods: Qualitative methods were used. Thirty semistructured interviews with transplant professionals and 2 focus groups with transplant coordinators took place across 6 health institutions in Gauteng Province. Results: Barriers that may prevent transplant professionals from referring potential donors were identified: The wider public and transplant professionals may be suspicious of biomedicine and have a perception that people could be killed for their organs. Organ donation was sometimes framed as “murder,” “killing,” or a “bunch of vultures.” Doctors may be unwilling to refer brain-dead patients, as this was seen as failing in one’s professional duty to cure the patient. The role of sociocultural practices was inconclusive, with the sample divided based on the extent of their influence. Conclusion: Low donor numbers may be a manifestation of barriers to referral in the clinical setting. These barriers interplay in a context of suspicion and are framed by a clinical transplant discourse that is sometimes loaded with negative connotation. Sociocultural practices are influential, but they may not be the overriding cause of low donor numbers.