Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Gia Mudd-Martin


Organ donation shortage is a major international concern. Global data on organ donation and transplantation activities from the World Health Organization indicate that in 2019 organs were available for less than 10% of transplantations needed. In Saudi Arabia alone, the organ donation shortage accounts for 28.8% of deaths annually. Nearly 31% of donated organs are from donors outside of the country because many eligible donors in Saudi Arabia do not donate.

While post-mortem organ donation has the potential to increase available organs for transplantation, in many countries, including Saudi Arabia, hesitancy among candidate donors and their family members can present a significant barrier to donation. Nurses have a critical role in increasing post-mortem organ donation. As the most trusted professionals worldwide, they are the healthcare professional that potential donors and family members are most likely to seek out for support when making decisions about donation as well as throughout the peri-mortem period in-hospital. They also have the responsibility to provide care to donors awaiting organ procurement. Nurses’ readiness and ability to fully undertake these critical roles has great potential to impact post-mortem organ donation, increasing potential donors’ and family members’ willingness to consider post-mortem organ donation. Despite this important nursing role, few studies have been conducted to examine factors that influence nurses’ behaviors in the context of deceased organ donation. The purpose of this dissertation was, therefore, to better understand these factors, especially among nurses in Saudi Arabia where the need for organ donors is so great.

Because attitudes toward organ donation have been postulated to be among the most influential factors determining decisions related to organ donation, a systematic review of instruments available to measure attitudes toward donation was conducted. In chapter 2 of this dissertation, 15 original instruments relevant to the aims of the review were retained and their psychometric properties evaluated using the process outlined in the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. In-depth information for the 15 instruments is provided.

Given that there are few psychometrically sound instruments available to measure factors that influence nurses’ behaviors associated with post-mortem organ donation, the next 2 chapters report the findings of studies conducted to develop and psychometrically test an instrument for this purpose. Guided by the Theory of Planned Behavior (TPB), the purpose of the study reported in chapter 3 was to conduct the first phase of instrument development. This consisted of the generation of a pool of items based on an extensive review of the literature, to assess the content validity of the items through expert panel review and to pretest the instrument by conducting cognitive interview. This resulted in the development of 34 items to assess TPB constructs and 8 to test knowledge. In chapter 4, we report the findings from the second phase in the instrument development process: evaluation of the psychometric properties of the 34-item instrument to measure TPB constructs. For this purpose, the instrument was administered to nurses in Saudi Arabia who were in active hospital-based practice. Completed by 229 nurses, analysis of the psychometric properties using Principal Components Analysis (PCA) resulted in retention of 28 items that loaded onto 5 components. Two components included items that corresponded to (1) facilitators of and (2) impediments to perceived ability to provide care to potential donors and their family members (perceived behavioral control); (3) positive and (4) negative attitudes toward post-mortem organ donation and nursing responsibilities (attitude toward the behavior); and (5) influences of perceived expectations of others (subjective norm). Results indicated that the questionnaire is a psychometrically sound instrument that can be used to measure Saudi Arabian nurses’ attitudes, subjective norms, and perceived behavioral control related to post-mortem organ donation and nursing responsibilities. Although items were developed to measure intention, no component suitable to measure intention was identified as a result of the PCA.

The results of these studies provide a solid foundation for an instrument that can be used to measure TPB constructs to better understand influences on Saudi nurses’ intentions related to post-mortem organ donation and providing care to donors and family members. However, further development of the instrument is needed including addition of items that will better assess intention. As well, a future study to evaluate the instrument using Confirmatory Factor Analysis will be critical to providing evidence for the psychometric soundness of the instrument. The development of a valid and reliable instrument will be critical to understanding factors that influence behaviors of nurses that can enhance care in the context of post-mortem organ donation and thereby increase the willingness of patients and families to support donation, not only Saudi Arabia, but worldwide.

Digital Object Identifier (DOI)

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