Is Altruism Always Sufficient For Organ Donation? Vroom's Expectancy Theory, for Expanding the Organ Donor Pool : Saudi Journal of Kidney Diseases and Transplantation

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Is Altruism Always Sufficient For Organ Donation? Vroom's Expectancy Theory, for Expanding the Organ Donor Pool

Monday, Osebor Ikechukwu

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Saudi Journal of Kidney Diseases and Transplantation 31(2):p 503-507, Mar–Apr 2020. | DOI: 10.4103/1319-2442.284026
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Organ transplantation is perhaps one area in which scientists have accomplished stunning outcomes in the 21st century. Nonetheless, the shortage of organs remains a major challenge of medical science, and worldwide, thousands of human organs are buried every day, especially from cerebrum-dead-injury victims. Using a method of philosophical analysis, this viewpoint study contends that the root cause of organ shortage is the dependence solely on altruistic organ donations. The unselfish organ donation is good, yet it is not enough. To close the gap between the demand and supply of organs, steps need to be taken to improve the organ donation pool. The Victor Vroom's expectancy theory, if applied, could expand the organ donor pool for transplantation.


Altruism is a philosophy founded on the contentment of others as the end of moral action.[1] Altruism is a traditional philosophy in many cultures, religion, and a secular understanding of morality.[2] Unselfishness may be important in order to donate an organ. Titmuss argued that unselfishness is a system of dependence on charitable organ donation. For Titmuss, organ harvesting should not be commercialized because it treats human beings as a means to an end.[123] Altruism is accepted as the basic principle for the management and expansion of the organ pool.[1234] The Nuffield Council on Bioethics reaffirmed the importance of unselfishness to expand the organ pool. Altruism is a philosophy of organ donation, and it provides a guideline for the donation of bodily material for clinical transplantation. Altruistic organ donation offers a unique opportunity for patients to receive organs from living or posthumous donors, with whom the donors have no emotional or genetic relationship with the recipients. However, Sharp and Randhawa argue that organ donation from the philanthropic point of view appears to be tricky, because it cannot inspire the potential organ donors to register with the organ pool, without the individual opting out.[12345] Altruism is a philosophy of benevolence, choice, and self-sacrifice. Self-sacrifice has long been madea guiding principle of ethical organ donation, and it has been used as justification for rejecting or allowing certain types of donation such as incentives and presumes organ donations. A study in the UK has highlighted that despite the prominent role of altruism for organ donation, it has been poorly defined in policy and position documents.[6] We contend that altruism alone has not mitigated the organ shortages. The appeal to one's good nature, such as incentives for organ donation, would close the gap between the demand and supply of organs.[7] In this sense, incentives are social support, conformity, recognition, independence, benevolence, encouragement, and interpersonal value, to saving others on the waiting list.

In the USA and Israel, the efforts of governments to raise organ donation failed, because they relied only on altruistic donors, without applying the business philosophy of motivations/incentives. According to Heather, in 1999, over 123,000 Americans and Israeli were on the waiting list, and the number continues to grow in geometric progression. In this case, over 22 patients die every day on the waiting list in the United States.[8] In this study, we contend that the Victor Vroom's expectancy theory, if applied, could help to close the gap between the demand and supply of organs for clinical transplantation.


Victor H. Vroom is a professor of management at the Yale School of Management. He was born on August 9, 1932, in Montreal, Canada. In 1968, he developed his own expectancy theory. Victor Vroom's expectancy theory of motivation is a cognitive philosophy, which explains individual distinction in work motivation.[9] The expectancy theory explains the behavioral patterns of people, to select a particular action among different alternatives. For Vroom, expectancy is the effort to select a particular action, and performance is the instrumentality for rewards (valence). Here, the individual believes that his/her efforts are in relationships between performance and the expected outcomes. The expectancy theory states that individuals have distinct sets of goals and can be motivated if they have certain expectations. The Vroom expectancy theory is a philosophy of choice; it explains the processes that an individual undergoes to make choices. The expectancy theory states that the level of effort individuals will exert in any task which can be computed from three variables: expectancy, instrumentality, and valence. This theory was proposed by Victor H. Vroom in 1964.


Valence refers to a predilection for one outcome over another. An outcome is said to be good when an individual prefers a particular outcome, to not achieving it. Valance is the desirability of the rewards on offers. In this sense, valence is the desire for reward upon performance. When valence is low, it a particular outcome has not been achieved. Motivation would lead to better performance. The“better performance” is the satisfactory rating (rewards), in recognition of performance. Vroom will say that valence is the value or strength, which individual/organization places on a noteworthy effort.[10]

Expectancy is the effort which is relative to reward. Furthermore, expectancy is the view that action or effort will lead to a successful outcome. The expectancy is a personal evaluation of effort, upon performance.[11] The factors that would affect expectancy include the self- esteem, the support of colleagues, the availability of information on work activities, and the available tools to perform a given task.[10]

Instrumentality is the view that success will bring rewards. The instrumentality is the“personal assessment that reward is the quality of performance.”[10] Instrumentality is the business objective, which an individual ought to achieve. Thus, Vroom's motivation theory can also be analyzed using equations thus, Motivation = Valence × Expectancy × Instrumentality.[123456789101112] However, human moti-vations boil down to the decision of how much effort, which is applied to a task. Instrumentality is a choice, built on a two- stage sequence of expectations (effort leads to performance and performance lead to a specific outcome/reward).

The Vroom's theory for expanding the organ donor pool

The organ crisis around the world has serious implications on medical science. In this case, organ harvesting is motivated to save patients suffering from organ failure. Vroom's expectancy theory is a symbiotic philosophy because it helps to expand the organ donation pool. Motivation is significant because it provides alternatives for the organ procurement because the sole reliance on altruistic organ donation has failed. Although Titmuss argued that the financial reimbursement for organ donors might lead to the organ crisis. Therefore, organ harvesting should strictly base on altruism.[4] Titmuss views received drawbacks among economists and management scientists because it repudiates the philosophy of incentives for organ donation.

Organ donors are motivated by choices. Choice is the anticipation of how an expected outcome is desirable in terms of rewards. The question is, to what extend would incentive influence the desire to donate an organ? Motivation is a product of expectancy that effort will lead to reward. The instrumentality is the commitment of the potential organ donors. Valence is the desirability that impartial organ disbursement will not expand the organ pool.[13]

The question is, how would motivation lead to reciprocation among potential organ donors? Motivation represents a donor's intention to register with the organ pool.[14] Motivation is a psychotherapy and the ingredient to choose among alternatives.[13] The expectancy theory is absolutely impracticable, without active and sincere participation of all the stakeholders, policymakers, that effective disbursement of the donated organs will motivate the intending donors. Critics would say that Vroom's expectancy theory presented a narrow view about organ donation because it could not expand the scope of reward, to accommodate the unique choice of potential organ donors.[15] The expectancy theory seems idealistic and probabilistic, instead of a utilitarian philosophy, because the theory fails to accommodate discreet choice and direct approaches to inspire different potential organ donors.[16] The expectancy theory of motivation had gained support from several groups and individuals, including the American Medical Association and the United Network for Organ Sharing and Organ Procurement and Transplantation Network, because unmotivated organ donation could be seen as the rationale for the organ crisis worldwide.[1234567891011121314151617] The expectancy theory is an applied philosophy because it encourages synergies between potential organ donor and recipients. Titimus would say that organ donation for incentives would lead to“organ cannibalism.” Incentives for organ donation may backlash because it undermines moral responsibility of the potential organ donors.[3] We may not disprove the above assertions, but we contend that organ harvesting for incentive should be synchronized by law to avoid organ crisis. Furthermore, policy and regulation makers should help to narrow the gap between the demand and supply of organs, by encouraging organ donation for incentives. Within the past 30 years, the number of organs donated has not kept pace with the number of organs needed. Alas! The sole reliance on altruism for organ donations would lead to more human organs been buried without registration into the organ pool.[9101112131415161718]

Expectancy theory gives room for the potential organ donors, to make decisions among several alternatives. This theory affirms posthumous organ donations by expressed consent.[18] The expectancy theory motivates the intending organ donors to register, either as a living donor or as a postmortem organ donor. Unfortunately, living organ donation is controversial because of the risks associated with living organ donations.[19] The Nuffield Council on Bioethics argues that“sanctity of life,” all human lives are of equal (and possibly absolute). Living organ donation is a calculated exchange of life with another.[20] Upon reflection of the expectancy theory, we contend that it is a philosophy, which helps the potential organ donors to meet their private needs. In Iran, for instance, organ donation for incentive is encouraged to cushion the effects of organ crisis.[10] Organ donation for incentive should be legalized, in order to reduce organ cannibalism and save patients on the waiting list.”[21] Furthermore, organ cannibalism is illegal in the US, but incentives such as tax cuts or tax credit, medical care, travel expenses are offered to the intending organ donors to cushion the effects of the organ shortages. Incentives can be government palliatives to offset the costs of surgery and other medical expenses, which intending organ donor may face while still alive.[7] In addition, health-care organizations can provide a quality service only if organ donors perceive they are considered as valuable resources and they can be, in turn, attentive to patients’ needs.[11] However, the buyer or closeout of human organs is not permitted by law, as indicated by the National Organ Transplant Act and the Uniform Anatomical Gift Act. Currently, the type of incentives that is lawfully admissible is the repayment of potential organ donors’ costs related to their vital needs.[123456789101112131415161718192021] We argue that incentives for registered potential organ donors should be permitted by law to avert further organ crisis.

Concluding Reflections

The Vroom's expectancy theory is an incentive philosophy. It is a philosophy that motivates the potential organ donors, to register with the organ pool. With the insertion of motivation into the organ pool, potential donors are inspired to offer an organ. The policymakers around the world have roles to play, for the implementation of expectancy theory for organ donation.

In addition, the management of the organ donation pool should understand the reasons to enlarge the scope of organ donation through incentives. We argue that the application of the expectancy theory into the organ donor pool, potential organ donors, would be happy to participating in the project of organ donation, in order to save candidates on the waiting list.

Conflict of interest

None declared.


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