Summary
Media coverage affects policy and debates around organ donation and transplantation. We performed a content analysis of stories in the Canadian popular press with a focus on organ donation and transplantation. We built a data set of articles published between Jan. 1, 2000, and May 7, 2019, that included 2082 articles, and we assessed their headlines and lead paragraphs to determine the stories’ focus and tone. The most common topics were recipients and donors (46.4%), policy (31.6%) and raising awareness/funds (26.6%). The tone of the articles was positive in 39.1%, neutral in 34.4%, and negative in 26.5%. The strong focus on patients in the reporting may be clouding critical policy discussions. Health communicators and policy-makers should continually assess how to create engaging messaging that remains accurate.
Important changes are taking place in the Canadian organ donation and transplantation landscape (e.g., presumed consent legislation in Nova Scotia, advancements in precision allocation, medical assistance in dying [MAiD]) that require policy-makers to consider issues of equity, trust and, as a result, public support. Media coverage affects policy and debates,1–3 influencing the Canadian public’s perception of organ donation and transplantation.3 We sought to analyze how donation and transplantation has been portrayed in the Canadian popular press over the past 2 decades, specifically with regards to which donation and transplantation stories receive the most focus.
Data collection and analysis
We built a collection of 2082 Canadian news articles covering relevant stories using the Dow Jones Factiva database. We searched for and downloaded English-language articles published between Jan. 1, 2000, and May 7, 2019, in Canada’s most popular print media sources with “organ” and various forms of “donate” or “transplant” appearing in the headline or lead paragraph. See Appendix 1 (available at www.canjsurg.ca/lookup/doi/10.1503/cjs.012721/tab-related-content) for further details on our data collection choices and procedures.
We designed a content analysis approach to determine the focus of newspaper stories by applying and adapting the methods and findings from a similar study conducted in the US.1 Our final story categorization list included 13 main focus categories, specific corresponding subcategories, and a secondary focus category to provide greater detail.
The content analysis coding process involved determining story type by analyzing the headline and lead paragraph, which was done as a means of replicating the general public’s reading trends. We coded for tone (positive, negative, neutral) on the basis that increased and more effective donation and transplantation was positive. Reliability testing of the coding demonstrated adequate agreement (81.4%). See Appendix 1 for details on data analysis procedures, including coding frame.
Article content and tone
The 2082 news articles in our analysis were published in 22 Canadian newspapers (average 107 per newspaper) (Table 1). Policy-related topics received considerable focus (492 [23.6%]) — only slightly less than patient-focused narratives (combining recipients and donors, 506 [24.3%]). Combining the main and secondary focus, articles focused on patients in a total of 966 (46.4%) articles, on policy in 657 (31.6%), and on raising awareness/funds in 554 (26.6%). The topic of donation rates received considerably less attention (200 [9.6%]), as did stories focused on medical procedures (139 [6.7%]) and research (121 [5.8%]). Only a very small number of articles focused on specific races/ethnicities or particular cultural/ethnic groups (2.1%), crowdfunding/public solicitation (1.8%), or social media (2.3%) (Table 2 and Table 3).
Total number of articles published by media source and by year
Main focus of all articles (n = 2082) and tone for each main focus topic
Secondary focus in all articles (n = 2082)
The 492 stories with a main focus on policy were primarily focused on the topics of presumed consent for donation (108 [22.0%]), system management (104 [21.1%]), and obtaining organs (e.g., determining death) (88 [17.9%]) (Table 4).
Main category focus including subcategory on all articles (n = 2082)
The 324 stories focused on recipients were more often positive stories about individuals recovering from and living with an organ transplant (208 [64.2%]) than negative stories of individuals waiting for an organ (80 [24.7%]) or of individuals who passed away while waiting (8 [2.5%]) (Table 4). Donor stories (182 [8.7%]) typically focused on deceased donors (101 [55.5%]) rather than live donors (59 [32.4%]). Considerable attention was given to the stories of Hélène Campbell and Logan Boulet (Table 3 and Table 4).
The 318 stories with a main focus on raising awareness/funds typically covered high-profile galas (e.g., David Foster Foundation) and smaller community events. Most stories on donation rates reported rates being “too low” (149 [74.5%]), with only some of those “too low” stories including specific policy initiatives to increase donation rates (54 [27.0%]). Some donation stories reported how donation rates were improving (37 [18.5%]) (Table 4).
The overall tone of the articles had only a slight positive trend (39.1% positive) (Table 2). Stories focused on donors were typically positive (60.4% positive v. 6.0% negative), as were stories focused on recipients (59.9% positive v. 18.5% negative). Stories about raising awareness/funds were typically neutral or positive (55.7% neutral v. 39.3% positive), whereas policy-focused stories leaned toward negative (45.3% neutral v. 33.1% negative v. 21.5% positive). Half of all stories about donation rates were negative (49.5%) (Table 2).
Discussion
The portrayal of organ donation and transplantation in the Canadian popular press from 2000 to 2019 typically had a slight positive-leaning tone (Table 2) and included a strong narrative focus on organ donors and recipients (46%). This raises questions about how these narrative elements might be influencing the understanding and evaluation of policies (e.g., changing to a presumed consent donation policy). Research shows, for example, that a patient/narrative focus, especially in the case of testimonials, can overemphasize anecdotes at the expense of facts, therefore potentially distorting systemic, population-based realities.2–5
The detailing of individual cases can help generate awareness of a positive donor response, but the question of which individuals’ stories receive attention deserves consideration. Indeed, our content analysis noted a focus on specific ethnic/cultural groups in only 2% of articles. Further, there is a trend of focusing on the positive stories of donors and recipients rather than on, for example, recipients-in-waiting, which might have negative consequences on communicating Canada’s organ donor shortages in an effective manner. Although low donation rates received some focus, they received less focus than fundraising and awareness-raising efforts and considerably less focus than patients.
While the high concentration of coverage on individuals might cloud critical policy discussions, news coverage focused strictly on policy or procedures without any narrative qualities might fail to capture readers’ attention or generate emotional responses. Policy-makers must continually consider this communication tension, balancing the need for scientific and statistical accuracy against the use of engaging and relatable personal narratives.5 Communicators should also consider how issues of utility and equality are presented. Maintaining trust and a perception of fairness in our health care system remains essential. This will require the careful monitoring of Canadian media and clear, accurate, and creative communication approaches. In this regard, future media research could focus on a range of donation and transplantation topics, including discourse on specific organs, specific contexts, (e.g., transplantation for patients with HIV) in French-language articles, or on popular social media platforms.
Footnotes
Competing interests: None declared.
Contributors: Both authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.
Funding: The authors acknowledge Genome Canada, Genome Alberta, the Canadian Institutes of Health Research, and Health Canada for their generous support of Precision Medicine CanPREVENT AMR: Applying Precision Medicine Technologies in Canada to Prevent Antibody Mediated Rejection and Premature Kidney Transplant Loss and Legislative Strategies to Improve Deceased Organ Donation in Canada: A Special Focus on Evaluating the Impact of Opt-Out Legislation in Canada LEADDeR.
Data sharing: The data from this analysis can be made available upon reasonable request.
- Accepted December 16, 2021.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
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