What's stopping people from donating their kidneys? And a marketing strategy to increase public participation...

Over 110,000 people are currently waiting for an organ transplant, and approximately 18 people die every day because they did not receive a needed organ donation (Donate Life, 2011).

With this in mind, the central theme of perceived risk will be addressed in conjunction with sound consumer behaviour theory relating to motivation, personality, perception, learning and attitude toward kidney donation in South Africa.

Consumer behaviour can be defined as the behaviour that consumers display in searching for, purchasing, using, evaluating, and disposing of products and services that they expect will satisfy their needs (Schiffman & Kanuk, 2010). There are three parties involved with the donation process, i.e. donors (living), relatives of people pronounced dead, and medical professionals (trauma doctors, kidney specialists, and General Practitioners) and institutions.

Using consumer behavioural theory, an analysis of living donors will be made so as to devise a marketing strategy for the Organ Donation Foundation of South Africa to increase public donations of kidneys. Opinion leaders will be employed as strategic targets so as to motivate the general public toward thinking beyond the self, in consideration of saving the lives’ of others. It is hoped that this will attain higher living donor participation from the South African public.

Many people who need organ transplants cannot get them due to shortages. As a result, some of these people die while waiting for that "Gift of Life" (National Kidney Foundation, 2011). In South Africa, there are currently 3 500 people waiting for a life-saving organ transplant (Organ Donor Foundation, 2011). With a weighted world average of 299.6 kidney transplants, South Africa’s conduction of 276 kidney transplants thus far is impressive (Nation Master, 2011).

While this is a good contribution compared to global statistics, there are thousands more who could benefit from increased kidney donor participation. Due to a critical shortage, less than 1 000 people in South Africa will receive the transplants they so desperately need within the next year (Human, 2011). Potential kidney transplant recipients are only those people who are identified as having end-stage or irreversible kidney disease or failure (eMedicine Health, 2011).

Therefore, a donor would be saving a life as the other option, haemodialysis is more expensive, less effective and debilitating (NIDDK, 2010). Kidney transplanting is a relatively routine, generally successful, and relatively non-invasive technique (Encyclopedia of Surgery, 2011). Furthermore, medical research has shown that humans can live a relatively normal and healthy life with just one kidney (Health Theater TV, 2007).

Recent medical developments have shown a new operation with the potential to alleviate the kidney donor shortage in South Africa (MatieLand, 2008). Therefore, due to budgetary allowances, the strategic focus of this paper will be toward living kidney donor participants’ abilities to make a life-changing difference in the lives of people in need of kidney transplantation and devising a marketing strategy for this identified group of people.

The socio-cultural environment impacts significantly on the learning as well as the formation of perceptions and attitudes of people (Schiffman & Kanuk, 2010). South Africa is exceptionally diverse in terms of heritage, culture, race, and religion. Kidney donation has been illustrated as a cultural and religious barrier for many South Africans and thus, these groups will not be the core focus for the marketing strategy proposed for the Organ Donation Foundation of South Africa.

Motivation is the driving force – produced by a state of tension as a result of an unsatisfied need within individuals – that impels them to act (Schiffman & Kanuk, 2010). Maslow’s hierarchy outlines human needs (Schiffman & Kanuk, 2010) as the motivating force behind behaviour. The model is centred on the self, thus insinuating that need motivations are primarily for the self. As a result, public motivation toward kidney donor participation will take place through the use of a long-term and public marketing strategy to be outlined later.

Personality refers to the psychological characteristics inherent in an individual that determine and reflect how she/he responds to their environment (Schiffman & Kanuk, 2010). As individual personalities differ it is essential to carefully utilise the correct personality type as an opinion leader. Consumers who are open-minded and generally perceive less risk than others in trying new things are likely to be consumer innovators. That is, they are more likely to try new ideas and technologies (Schiffman & Kanuk, 2010).

If personality tests also discover that innovators tend to score higher on exhibition, then the promotion of kidney donation at this group should encourage the innovators to initiate positive word of mouth through informing others about the operation. This is highly likely to occur as innovators are typically successful, take-charge people, with high self-esteem and thus change leaders (Schiffman & Kanuk, 2010). Employing consumer innovators as opinion leaders into the marketing strategy designed for the Organ Donation Foundation of South Africa, should help as a promotional strategy, by encouraging willingness from further members of the public. As personality affects ones receptivity toward something, it would be easiest to begin claiming ambassadors from people most receptive toward kidney donation.

Perception is the process by which an individual selects, organizes, and interprets stimuli’s into a meaningful and coherent picture of the world (Schiffman & Kanuk, 2010). Consumer realities are subjectively based on the consumers’ perception of their world. Hence, their learning is subjective to the messages that they have been exposed to. Perception is important for marketers because consumers base decisions on perceptions rather than reality.

When deciding on the value of service, consumers typically have a mental trade-off between the product’s perceived benefits, and the perceived sacrifice. Perceived risk can be defined as the uncertainty that consumers face when they cannot foresee the consequences of decisions (Schiffman & Kanuk, 2010). Many individuals are wary of kidney donation due to the perceived risk it holds (Shilling et al, 2006). It could therefore be inferred that this is due to their existing knowledge.

This is an important issue to tackle as medical professionals and hospitals can play a vital role in reshaping public perception and attitudes toward kidney donation through the provision of information and expert guidance. They hold much credibility in this regard given their status and recognition as medical experts. In this way, public trust regarding the transplantation process can be fostered.

The actual quality of services can vary despite efforts to provide consistency with regard to services, and consumers typically perceive service decisions as riskier than product decisions (Schiffman & Kanuk, 2010). In terms of an operation, one can never guarantee the outcome with undeniable confidence. However, one can speak with higher certainty of risk reduction with regard to the new operation, laparoscopic nephrectomy.

However, despite certainty, as services are consumed as they are produced, there is little opportunity to correct a service error (Schiffman & Kanuk, 2010). Thus, an operating mishap could leave a donor with lifelong consequences. More recently, there has been the risk of kidney exportation. Netcare have infused negative publicity around the issue of kidney donation due to a publicised scandal revolving around transplanting kidneys into foreigners as a way to procure more money (Barnard, 2011).

Existing public perception would therefore be influenced by the knowledge of this scandal. How a consumer perceives the price they have to pay for something (pain, inconvenience, possible health risk, risk of kidney exportation) has a strong influence on intentions (Schiffman & Kanuk, 2010). Therefore, through the use of learning, the perception around the sacrifices versus the gains of kidney donation can be changed.

Donors face a physical risk, which is, the risk to self through the donation process. Consumers typically lessen the likelihood of perceived risk through information searching and searching reassurance (Schiffman & Kanuk, 2010). This is where ambassador donors and medical professionals play a fundamental role in educating the general public and working toward changing perceptions and attitudes toward kidney donations.

Consumer perception of risk varies, depending on the person, the service, the situation, and the culture (Schiffman & Kanuk, 2010). Therefore, by attracting donors through cognitive learning, and then using those donors as opinion leaders, the perceived risk to the rest of the public is likely to lessen as consumers perceive much less risk on the basis of word of mouth (Schiffman & Kanuk, 2010).


Consumer learning is a process by which individuals acquire the purchase and consumption knowledge and experience that they apply to future related behaviour (Schiffman & Kanuk, 2010). Cognitive theorists view learning as a function of mental processing, and the consumer involvement model suggests that high-involvement purchases require extensive information processing and persuasive and high quality arguments to convince them (Schiffman & Kanuk, 2010).

It is thus assumed that for the donation of kidneys, which are of high involvement, much information will be needed for cognitive processing and decision making. Thus far, the public has learnt that this is typically risky in South Africa due to the Netcare scandal that has been widely publicised. Therefore, given the depth of the requirement expected from a donor, a potential donor would naturally require much information for them to make a confident and informed decision to willingly act upon learning. The major reasons for understanding how consumers learn are to teach them so as to change learning or attitudes, or to create attitudes where they do not exist (Schiffman & Kanuk, 2010).

In marketing for the Organ Donation Foundation of South Africa to increase public donations of kidneys, the public needs to be taught to ensure re-learning that will change perceptions around the issue of donating a kidney. By teaching the public that, by donating a kidney, you’re still left with two to three times the amount of kidney function that you need to live a healthy and normal life (Health Theater TV, 2007) much can be changed in terms of perceptions and attitudes as learning can change attitudes or behaviour (Schiffman & Kanuk, 2010). Public awareness needs to be heightened so as to gain empathetic understanding of kidney donation and transplantation so that people are aware of the possible impact they can have on another’s life (Rainsberry, 2009).

It is essential that accurate information is presented so as to combat existing misconceptions and myths about organ and kidney donation (Rainsberry, 2009). Additionally, the public needs to be educated that scandals such as the Netcare scandal will not be tolerated, nor will it be a future occurrence. Without adequate information for cognitive learning, it is likely that the public will form their own opinions based on skewed perceptions. It is thus critical that wide publicity takes place with regard to laparoscopic nephrectomy. Furthermore, through an analysis of all the attributes that people use to evaluate their decision to donate, a marketing strategy that addresses these attributes to counter existing perceptions will work well at changing perceptions.

The revolutionary new kidney transplantation operation, called laparoscopic live donor nephrectomy (Refer to Appendix: A) is a non-invasive procedure to harvest a kidney from a live patient through a tiny incision in the donor’s stomach (Fokazi, 2011). Laparoscopic nephrectomy could significantly reduce post-operatic pain, hospitalisation, and recuperation times (Fokazi, 2011). According to Dr Steyn (Fokazi, 2011), this will revolutionise kidney transplant surgery in South Africa. It is critically important that this information becomes widely available to the general public so as to tackle existing perceptions and attitudes, and so as to create new attitudes with regard to this medical revolution.

Attitudes are learned predispositions, formed as a result of direct experience, word of mouth information, or advertising exposure (Schiffman & Kanuk, 2010). As these form the basis for attitude formation, past donors can promote word of mouth information with regard to their experiences.

In this way, members of the public can be encouraged to contribute towards saving a life as well. Advertising exposure employing trusted professionals advice, that is, doctors, would be further effective in instilling more trust and confidence in people contemplating the option of organ or kidney donation. Marketers need to change people’s motivations from the self to consideration of other’s through marketing. As learned predispositions, attitudes have a motivational quality; they might propel a consumer toward a particular behaviour, or repel the consumer away from a particular behaviour (Schiffman & Kanuk, 2010).

With regard to addressing attitudes, marketers typically work at creating an attitude where one does not exist, reinforce and existing attitude, or change existing attitudes (Schiffman & Kanuk, 2010). With regard to kidney donor participation, marketers will have to focus on creating attitudes for people that have never considered donating, as well as changing attitudes of those that have decided not to donate due to perceived risk, or any other reasons based on existing attitudes.

A particular problem with attitudes is that one may have a positive disposition toward donating one’s kidney but yet still refrain from actually donating. That is because attitudes may result in behaviour, but are not synonymous with behaviour (Schiffman & Kanuk, 2010). To get people to act upon changed attitudes, an intensive and effective marketing strategy needs to be employed as attitudes cannot be relied upon to always predict behaviour. Therefore, through the use of motivation, new learning, changing perceptions and attitudes, coupled with an intensive marketing campaign strategy to get public participation, behavioural change can occur, which is, people actually donating kidneys.

The strategy that will be employed for the Organ Donation Foundation of South Africa would be that of associating kidney donation with a specific group of people, that is, people who care enough about others to make the difference they hope to see in the world by saving lives of people they know, and strangers. Medical professionals will all attend a medical seminar aimed toward actively and consistently promoting laparoscopic live donor nephrectomy to members of the public as a recourse to haemodialysis.

To identify public ambassadors, personality tests will take place to identify people receptive toward kidney donation, and who are also innovators who score high on exhibition. These people will be addressed by medical professionals at the seminar to consider the new laparoscopic live donor nephrectomy. Furthermore, past donors will be contacted personally to encourage their participation in this public marketing strategy.

This strategy, as mentioned earlier will be specifically implemented through extensive provision of information to the public that will lead to knowledgeable, informed, and rational decisions. To further entrench learning, expertise will be provided by medical professionals to instil trust and further confidence in the decision-making process toward donating a kidney to a donor match. Thereafter, to further penetrate the South African public, ambassadors will be employed so as to encourage participation in this life-saving and selfless transplantation.

The process leading from willingness to actual donation is the biggest issue as many people indicate their willingness to donate a kidney to someone, whilst only a select few show this through actively registering as a donor (Rainsberry, 2009). Therefore, kidney transplantations will be marketed through success stories of people that have saved lives which could be marketed as a public aspiration. Informal sources and word-of-mouth information from friends, relatives and so forth, are highly credible and has a strong influence on behaviour as they are perceived as having nothing to gain from recommendations (Schiffman & Kanuk, 2010).

Therefore, the above-mentioned strategy had been chosen so as to appeal to emotions and to tackle perceptions of risk and acts of selflessness through the promotion of people that have done this already, people that will go through the operation shortly, and through knowledge experts. It is thus critical that the medical community supports this initiative fully as they are key participants and change agents in influencing the public.

As the consequences are always somewhat uncertain with regard to operations, the theme of risk has been consistently discussed as affecting consumer behaviour. Marketers can only do their best in attempting to attain the largest possible donor participation through the use of understanding key consumer behaviour reasoning behind the lack of existing donor participation. Therefore, a market strategy for the Organ Donation Foundation of South Africa to increase public donations of kidneys would make use of informative advertising and publicity through opinion leaders such as past donors, trauma doctors, kidney specialists, and general practitioners. This will be essential in combating existing attitudes and behaviours with regard to kidney transplantation.

Key participation and influence from the medical community and the public will be influential in fostering public trust, intrigue and action toward making a life-changing difference in the lives of the 3500 South African currently in need of a life-saving organ transplant. Finally, laparoscopic live donor nephrectomy hopes to revolutionise kidney transplant surgery in South Africa and will assist in creating new attitudes if it becomes public knowledge.