An Examination of Organ Donation in the News: A Content Analysis From 2005-2010 of the Barriers to Becoming an Organ Donor

Transplantation succeeded in prolonging the lives of those fortunate enough to have received the gift of a body organ. Alongside this life-saving development, there lies another sadder side to the story - there are not enough organs to meet the ever increasing demand. This not only places an increasing emotional and physical burden among the waiting patients and families but heaps a great financial burden upon health services. This book provides an analysis and overview of public policy developments and clinical developments that will hopefully ensure an increased availability of organs and greater graft survival. Medical, policy, and academic experts around the world the book.

The fourth key feature of the HBM concerns perceived barriers. Perceived barriers are factors that would prevent a person from taking the preventive action. Morgan and colleagues (Morgan, Miller, Arasaratnam, 2003;) discovered various barriers preventing individuals from joining an organ donor registry including what they called noncognitive factors, such as medical mistrust, the jinx factor, and the ick factor. Fifth, the HBM examines the role of perceived benefits of performing a specific task. Benefits refer to the positive consequences of performing healthy behaviors or, conversely, not performing unhealthy acts. Parisi and Katz's (1986) work suggests that individuals often join an organ donation registry because they want to be a hero by saving or improving the lives of others (Parisi & Katz, 1986;Quick et al., in press). Finally, cues to action are the strategies that allow a person to feel that they can act. Research shows that various media such as newspaper (Feeley & Vincent, 2007), television dramas (Morgan, Harrison, Chewning, DiCorcia, & Davis, 2007) and television news (Quick, Kim, & Meyer, 2009) can serve as integral sources of organ donation information for individuals. These sources may provide consumers with cues to action or with inaccurate information.
With respect to the current chapter, television coverage serves as an external cue to prompt viewers to join a registry. Each of these concepts is important in predicting whether or not an individual is likely to engage in a behavior. In short, the HBM suggests that if a person believes they are at risk, the associated consequences of that risk are substantial, and there is something the individual can do to prevent that negative effect, he/she will act, especially following exposure to an internal or external persuasive cue such as a news story.
The current investigation examines television news coverage under the guidance of the HBM. Horton and Horton (1990) suggested that it was important for researchers to acknowledge other variables in organ donation studies instead of relying on a "simple assessment of awareness, attitudes, and behaviors" (p. 791). Scholars have since sought to address this limitation by addressing general benefits and barriers to organ donation (Horton & Horton, 1991), the role of communication with families (Afifi, et al., 2006;Morgan, et al., 2005), as well as the influence of sociocultural factors on organ donation (Kim, Elliot, & Hyde, 2004).
Despite literature that has examined media coverage of organ donation (Feeley & Vincent, 2007;Morgan, Harrison, Chewning, Davis, & DiCorcia, 2007;Quick, Kim, & Meyer, 2009), www.intechopen.com An Examination of Organ Donation in the News: A Content Analysis From 2005-2010 of the Barriers to Becoming an Organ Donor 13 no research to the authors' knowledge has accounted for the ability of news media to shape perceptions of organ donation using the HBM as a theoretical lens. As such, the following research questions draw from the HBM to describe the content of news articles.
A major tenet of the HBM is that the need for changing a health behavior is communicated (Rosenstock, 1974). Moreover, according to the HBM, individuals weigh the benefits and barriers prior to making a decision and are likely to engage in a behavior only if the rewards outweigh the drawbacks. Assuming the threat is clearly communicated, if one is aware and confident that he/she can perform the recommended behavior, and the benefits outweigh the barriers, HBM researchers would expect that individual to perform the advocated behavior. In the spirit of better understanding television news coverage with respect to the organ shortage, the process of joining an organ donor registry, along with the benefits and barriers to registering as an organ donor, we advance the following research questions:

Sample and procedure
This study examined television news coverage of organ donation from January 2005 through December 2010. Television news transcripts were collected using Lexis Nexis. A total of 743 stories were selected and analyzed from ABC (n = 161), CBS (n = 126), CNBC (n = 2), CNN (n = 402), FOX (n = 30), and MSNBC (n = 22). Each news transcript was the unit of analysis for the present investigation. Certainly, many of these storied appeared in various forms across these networks. We were interested in reviewing all transcripts that mentioned organ donation and for this reason we employed a broad search term to garner a wide range of news transcripts. Our interest in analyzing stories that explicitly discussed organ donation or the transplantation process led us to use search terms that would find these statements in the text of the article. Following previous research we used "organ don! or organ transplant!" as key terms (Quick, et al., 2009).
After the news transcripts were identified and retrieved, a codebook was developed by the authors using the core assumptions outlined by Rosenstock (1966) in the HBM. Then, following extensive training, two coders independently coded 10% (n = 100) of the news transcripts (Lacy & Riffe, 1996;Lombard, Snyder-Duch, & Bracken, 2002). After establishing respectable intercoder reliabilities across the coded categories, the authors worked through their disagreements and then proceeded to code the remaining news transcripts. Reliability between the trained coders was established with a Brennan & Prediger's kappa for each category (Brennan & Prediger, 1981). We selected to employ Brennan and Prediger's kappa over Cohen's kappa because the chance agreement term in Cohen's kappa increases with increasing levels of marginal agreement. In other words, coders are penalized for achieving high rates of marginal agreement. Brennan and Prediger's kappa corrects for this by disregarding the marginal altogether and assumes chance agreement is determined solely by the number of categories in the coding scheme.

Categories
The categories investigated in this study emerged from a careful review of literature on the benefits and barriers of organ donation (Feeley, 2007;Feeley & Vincent, 2007;Morgan, et al., 2007;Quick, et al., 2009) and the core assumptions of the HBM (Glanz & Bishop, 2010).

Perceived susceptibility and severity
Because the shortage of organs in the United States (severity) is directly related to the need for organ donation (susceptibility) we collapsed these two constructs of the HBM. Specifically, we coded whether or not news coverage communicated the organ shortage (SA = .97, Κ B & P = .94), and more specifically, we coded whether the stories provided statistical evidence (

Perceived benefits
News stories framing organ donors as good people (heroes) (SA = .98, Κ B & P = .96) or simply presented successful stories about organ donors (SA = .97, Κ B & P = .94) or recipients (SA = .96, Κ B & P = .92) were coded to understand how television news programs describes the benefits of organ donation.

Perceived barriers
Literature on organ donation has identified a number of barriers to organ donation Stephenson, Morgan, Roberts-Perez, Harrison, Afifi, & Long 2008;Salim et al., 2010;Siminoff, Burant, & Ibrahim, 2006). We coded for seventeen barriers to organ donation. These barriers are broadly categorized in terms of their relation to barriers to a person becoming a donor and barriers to a person agreeing to receive a donation. Barriers for those considering organ donation include: religious barriers (

Cues to action
We coded cues to action by noting if the coverage encouraged the audience to become an organ donor (SA = .99, Κ B & P = .98). We also looked for whether or not a celebrity endorsement was used (SA = 1.0, Κ B & P = 1.0).

Self-efficacy
Finally, we coded for whether or not news coverage communicated how audience members could become an organ donor (SA = .99, Κ B & P = .98). If the article did communicate how to become a donor, we noted the method advocated [e.g., driver's license (

Data analysis strategy
For the current study, chi-square goodness-of-fit statistics were used to determine if the major categories differed in frequency. For many of the categories, the options were nonindependent because a news transcript can and often contained multiple categories. Therefore, Cochran's Q tests were run to demonstrate global differences whenever there were more than two related coded variables. Following a statistical significant Cochran's Q, McNemar tests were conducted to specify where statistically significant differences occurred. In order to reduce the likelihood of committing a type I error, Bonferroni corrections were made to reduce the likelihood of falsely rejecting the null hypothesis.

Television news coverage organ shortage
The first research question examined how much attention was devoted to the organ shortage across the six networks. Results indicate that a minority of news stories cited the organ shortage (n = 153). Of those stories mentioning the organ shortage, the majority used statistical evidence to support the need for additional potential donors (n = 110). Of the statistical evidence cited, a Cohran Q test revealed statistical differences in how much attention was devoted to the number of individuals waiting for an organ transplant and the number of individuals that die daily and annually waiting for an organ transplant, Q(2, N = 743) = 57.68, p < .001. Specifically, McNemar tests showed that more attention was given to the number of individuals on a waiting list (n = 84) compared with considerably less attention given to the number of deaths daily (n = 30) and annually (n = 28) due to the organ shortage at p < .001. The McNemar test showed no statistical difference between attention given to the number of deaths daily and annually, p = .07.
In addition to documenting the organ shortage by sharing statistical evidence, several news stories used narratives to communicate the organ shortage (n = 142). Of the narratives present, statistical differences emerged between stories told from various vantage points, Q(2, N = 743) = 63.13, p < .001. McNemar tests showed more stories were aired from the vantage point of an organ recipient (n = 250) than stories from the vantage point of a donor (n = 58) or person on a waiting list for an organ transplant (n = 25), p < .001. Additionally, tests revealed a statistical difference between news stories shown from the vantage point of a donor compared with those shown about individual(s) on a waiting list.
It is also worth noting that several news stories specifically mentioned organs in particular with kidneys receiving the most attention (n = 266), followed by hearts (n = 140), livers (n = 115), lungs (n = 56), pancreases (n = 20), and intestines (n = 10), Q(4, N = 743) = 366.79, p < .001. Clearly, the majority of news attention is devoted to talking about kidney transplants which is not surprising considering the majority of organs transplanted are kidneys.

Television news coverage of benefits and barriers to organ donation
RQ2 asked about the amount of coverage to the benefits and barriers of registering to become an organ donor. With respect to the benefits of organ donation, our results found frequent coverage portraying organ donors as heroes (n = 174). In addition to framing organ donors as heroes, several news stories told successful stories about organ donation from the vantage point of the donor (n = 144) and recipient (n = 250), with statistical differences emerging between the them, Q(1, N = 743) = 81.42, p < .001.
With respect to barriers, differences were found across these television networks, Q(12, N = 743) = 131.28, p < .001. The McNemar tests revealed greater attention to potential for organs to be purchased on the black market (n = 27), the rich and famous get organs first (n = 25), organ rejection (n = 18), and the doctor will not try to save the donors life (n = 17) than cultural barriers (n = 7), fear of body being mutilated (n = 5), religious barriers (n = 4), the doctor will take all organs (n = 4), problems with side effects from medication (n = 4), financial costs to family (n = 1), delay funeral (n = 1), and undeserving or ungrateful recipients (n = 1) at p < .05. No coverage was given to superstitions regarding bad luck following registering as an organ donor, unable to have an open-casket funeral, or fear that the donor recipient or family may learn the donor's identity.

Television news coverage of joining the organ donor registry
The third research question examined how much television news coverage is devoted to informing viewers about how to become an organ donor. The results suggest very limited attention is devoted to informing viewers of ways to join the registry (n = 45). Of the most common ways to enroll in a statewide registry, our findings suggest variability in the amount of coverage regarding the various ways to join, Q(5, N = 743) = 40.44, p < .001. McNemar tests showed that attention given to indicating one's wish on an organ donor card (n = 18), driver's license (n = 17), and talking with family (n = 13) was significantly more likely to be mentioned than the organ donation registry (n = 3), telephone hotline (n = 1), and talking with a friend (n = 1). No statistical differences emerged between an organ donor card, driver's license, and talking with family. Additionally, no differences were observed between attention to the organ donation registry, telephone hotline, and talking with a friend about intentions to be an organ donor.

Television news coverage of endorsing organ donation registry
The final research question assessed whether television news transcripts endorse organ donation. Not surprisingly, our results revealed that news stories rarely encourage viewers to join an organ donor registry. infrequently did these stories feature a celebrity endorsing organ donation (n = 52), χ 2 (1, N = 743) = 549.56, p < .001

Discussion
Individuals learn about organ donation from various sources, and these sources present this information with various degrees of accuracy. More and more, communication campaigns promoting organ and tissue donation have become effective mechanisms to enhance organ donor registrations across college campuses (Feeley, Anker, Watkins, Rivera, Tag, & Volpe, 2009), driver's license facilities Harrison, Morgan, King, & Williams, 2011), and in the workplace (Morgan, Harrison, Chewning, Di Corcia, & Davis, 2010). As these efforts have certainly played a pivotal role in educating individuals about the importance of organ donation, individuals still learn much about organ donation from newspapers (Feeley & Vincent, 2007), television dramas (Morgan et al., 2007), and news programs (Quick et al., 2009). The current study sought to reveal how recent news coverage on television depicts organ donation with respect to the organ shortage, the benefits and barriers to donation, the process of registering as an organ donor, and the overall estimate of news industries' endorsement of organ donation. We also gave attention to whether there was celebrity support for this issue. We discuss our findings with an eye for how they may shape public perception about organ donation.
The first research question inquired about attention given to the organ shortage in the United States. Previous research suggests modest attention is given to educating individuals about the organ shortage in newspapers (Feeley & Vincent, 2007) and television news (Quick et al., 2009). Our report is consistent with these studies in that approximately one in five stories explicitly mentioned the need for more organ donors. With respect to evidence used to back their claim, more news stories used narrative evidence than statistical evidence. More specifically, the majority of stories relying on narratives used stories from the vantage point of organ recipients as opposed to donors or persons on a waiting list for a transplant. With an emphasis on the positive outcomes of organ donation, it is likely viewers will be able to see the benefits arising from organ donation. However, by not highlighting stories about people who find themselves on a waiting list, viewers may not grasp the reality that people die each day due to the organ shortage. Presenting viewers with a realistic understanding of the organ shortage is critical if we want to begin seeing decreases in the number of people waiting for a transplant. Although used less than narratives, statistics were, with some regularity, presented to convey the number of people awaiting an organ transplant, as well as the number of individuals dying daily and annually due to the organ shortage. In their analysis of ABC, CBS, and NBC news transcripts, Quick and colleagues (2009) found that less than 5% of stories cited statistical evidence to support the need for more organ donors. The good news is that since their study, we found statistical evidence is used three times more often on television news programs (15%) across ABC, CBS, CNBC, CNN, FOX, and MSNBC. Fortunately, individuals are exposed to these statistics because organ donation campaigns continue to do a good job of emphasizing the need for more organ donors (Feeley et al., 2009;Harrison et al., 2010;Morgan et al., 2002).
The framing of organ donation remains a critical concern among organ donation researchers and practitioners alike. As Morgan and colleagues (2007) have found, television dramas run a successful counter-campaign  by featuring plots around various organ donation myths (e.g., doctor will not try to save an organ donors life). Thus, it is important to determine whether television new s c o v e r a g e i s a d d i n g t o t h i s c o u n t e rcampaign. A shortcoming of Quick and colleagues (2009) study was their inattention to coverage of various barriers preventing individuals from joining organ donation registries. The current study sought to extend their work by explicitly examining various barriers (e.g., medical mistrust). Our results revealed that television news rarely gives attention to barriers to organ donation. Specifically, of the four most commonly aired barriers including the black market, the rich and famous get organs first, organ rejection, and the doctor will not try to save the donors life, none of these barriers appeared in more than 5% of the news programs. This can be perceived as good or bad depending on how one interprets this finding. It is good in that television news is not perpetuating these barriers by devoting a fair amount of attention to them. Alternatively, given the fact that television dramas reinforce many of these barriers with regularity (Morgan et al., 2007), news programs have an opportunity to debunk many of these beliefs. This could be a missed opportunity to reduce the organ shortage because we know from recent reports that medical mistrust remains a key barrier to registering as an organ donor Salim et al., 2010;Siminoff et al., 2006).
Conversely, television news continues to emphasize the benefits of organ donation by producing successful stories from the vantage point of organ recipients and organ donors. Of the stories observed, one in three told a story of an organ recipient, one in four depicted organ donors as heroes, and one in five told a story of an organ donor. A recent study by Quick and colleagues (in press) discovered that high school students preferred promotional materials depicting organ donors as heroes. Certainly, if their study is generalizable to the broader public, then television news is providing a beneficial service by highlighting the benefits of organ donation and by portraying donors as heroes that save and significantly improve the quality of life for many individuals.
A concern noted in earlier studies examining television news coverage of organ donation was the inadequate attention regarding ways to register as an organ donor (Quick et al., 2009). They found that approximately 7% of stories informed individuals on how to register as an organ donor, with the majority of stories mentioning a driver's license and donor card as the most common methods for registry. Our findings are similar in that a mere 6% of stories explicitly stated how to register to become an organ donor. Again, indicating one's wish on a driver's license or donor card remain the most common ways to register as depicted in television news programs. Sadly, little attention is devoted to organ donation registrations online. To date, most states have an organ donation registration that ensures individuals' intentions to be organ donors are followed. Illinois was the first state to introduce a First-Person consent organ donor registry. Since then, most states have adopted a similar registry and as a result, more lives are saved and significantly improved due to organ transplantation.
A goal of journalism is to remain objective. For this reason, it is not surprising that few stories explicitly endorse organ donation. In our study, less than 4% of stories promote organ donation. Surprisingly, less than 10% of studies devoted attention to celebrity endorsements of organ donation. Relying on celebrity endorsements creates a double-edge sword. On one hand, celebrities attract attention and have the potential to raise awareness about the organ shortage and the importance of registering to become an organ donor. However, celebrity endorsement of organ donation can at the same time play into fears regarding beliefs that the rich and famous can purchase their way to the top of organ transplant waiting lists. Future research should investigate the persuasive appeal of celebrity endorsements in organ and tissue donation with various demographics.

Conclusion
Overall, our findings suggest that there has been some improvement in the depiction of organ donation news stories since prior studies. Specifically, using narratives to highlight the positive aspects of donation, as well as the increase in statistical evidence to underscore the need for donors, may persuade some viewers to consider the registry. Further, the minimal attention given to organ donation myths and the representation of donors as heroes, both are findings that should have a positive effect on donor registration rates. However, there is still much left to be desired with respect to the framing and depiction of organ donation stories in the news. For example, more stories regarding waiting recipients might enhance the perceived severity of the shortage, and more stories featuring those who donated their organs might help to debunk donation myths or frame donations as heroic and selfless acts.
The depiction of organ donation in the news certainly needs continued attention and further investigation. Because prior studies have found that entertainment television often purports organ donation myths (Morgan et al., 2007), television news may play an important role in balancing those depictions and viewer perceptions regarding donation. Further, news is often perceived to be "accurate" and "realistic" by viewers, but television dramas are considered to be more entertaining. Thus, future research should examine whether television viewers give more weight to organ donation news stories or to entertainment television with respect to their beliefs, attitudes, and behaviors regarding donation. Finally, with the increase in media channels (e.g. internet), it is possible that people may not watch traditional news programming as much as they once did. Further, with the rapidly growing number of television stations, people may be more selective in what source, whether it is television or internet, they choose from which to derive their news. Therefore, future studies should examine a wider selection of news sources, as well as determine whether selective exposure to news sources and/or type of news source has any effect on the depiction or perception of organ donation.
In short, television news plays an important role in presenting what viewers see as "reality," and, thus, may have a substantial impact on how organ donation is depicted and how viewers perceive the issue. Although news outlets are supposed to remain "neutral," it is possible that organ donation campaigns may find an additional resource for promotion through these outlets. By presenting factual stories, news stations remain neutral, but by highlighting specific angles of those stories and featuring information on how to donate, they may help to increase organ donation rates. The findings of this study generally signal some hope for organ donation advocates with respect to television news coverage. However, there are certainly areas that need to be addressed and improved upon in order for the news media to depict and promote organ donation in a way that could potentially make a significant impact. Transplantation has succeeded in prolonging the lives of those fortunate enough to have received the gift of a body organ. Alongside this life-saving development, there lies another sadder side to the story -there are not enough organs to meet the ever increasing demand. This not only places an increasing emotional and physical burden among the waiting patients and families but heaps a great financial burden upon health services. This book provides an analysis and overview of public policy developments and clinical developments that will hopefully ensure an increased availability of organs and greater graft survival. Medical, policy, and academic experts from around the world have contributed chapters to the book.

How to reference
In order to correctly reference this scholarly work, feel free to copy and paste the following: