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Policy, law and organ procurement; can behaviour and mentalities be modified by social engineering?

Final Activity Report Summary - ORGANPROCUREMENT (Policy, law and organ procurement. Can behaviour and mentalities be modified by social engineering?)

The point of departure of this project was the result, from a previous research conducted by the fellow, that the debate about organ procurement policies was going in circles because it was based on a wrong theoretical assumption known as legal centralism. Under this approach legal systems of consent (express / presumed or opting-in / opting-out) are put at the centre of discussions about explanations about geographical differences in organ procurement rates and thus about possible policy responses for improvement. Thus, most participants to the discussion tend to focus on the law as the unique, or by far most important, independent variable in this area of health policy.

The centrality of the law is thus assumed even though, as this research shows, if anything can be assumed about the relationship between law and organ donation rates is that it is more likely to be historically variable and weak than straightforward and strong. This, in turn, leads most of participants to the discussion to naturally neglect other factors which relevance - or lack of it - has not been submitted to empirical analysis. These factors are organisational and cultural and, as Nowenstein has shown, are crucial to the understanding of organ procurement rates in the French case. Such case study constituted the theoretical and empirical point of departure of this project, which is comparative and extends the analysis to Spain and the Netherlands.

The first aim of this project was to clarify and systematise the cultural variables that have an influence on organ donation rates, which (contrary to organisational ones) had never been subject to systematic sociological data production and analysis. The second was to develop a qualitative comparative approach to policy analysis. The third was to test the validity of Griffiths' theory of the social working of legal rules. Thus, this project had from the start three well-integrated lines of research: one empirical, one methodological and one theoretical.

Aim 1: The variables have been systematised and refined.
Aim 2: The approach has been developed and is expected to serve as a blueprint for future research.
Aim 3: Griffiths' theory has been submitted to examination and improved with a more cultural input.