Moral and educational motives of kidney donors (Hebrew)

In the field of research there are a large number of theories dealing with altruism. The  current study focuses on examining the motives of people who chose to donate an organ from their body to a person in need, using the Moral Development Theory of Kohlberg (Kohlberg & Power, 1981).

The purpose of the present study is to examine the motives, the discretions and the educational background of kidney donors. Do the motives stem from a tendency to help others, expressed in kindness and behavior doing a favor for someone else without compensation, or for additional / other discretions? In the present study, the level of moral thinking beyond Kohlberg's six stages (1958) to the seventh stage was examined in comparison to Kohlberg's model (Kholberg & Power, 1981).

Theoretical Background

In the professional literature dealing with education, there are studies examining the degree of influence of the parents' home / the environment / the formal and informal educational institutions in his life, the characteristics and tendencies of the student in his maturity. Many studies deal with the effect of education at a young age on the value and moral world of the adult person Etzion & Shapira, 1969). Rest and Thoma (1985) also claim that education at a young age is a major factor that affects a person's life in adulthood (Rest & Thoma, 1985). Naturally, the most significant influence on a person is his childhood education, in his parents' home (Cohen 1987), where there is a continuous and long-term educational interaction. It was found that educational institutions also have a significant impact on the values and morals of adults (Kohlberg, 1958). (Rest & Thoma, 1985) One of the well-known channels of influence are meetings with exemplary figures, when the mere acquaintance with significant people may bring about a value change in the student (Abuhav, 2006).  Another significant channel of influence are various educational experiences, sayings or educational activities, which are engraved in the memory and hearts of the students. It also appears that the youth movements have a great influence on the value and moral world of man as well (Freund, Blit- Cohen, Cohen& DAhan, 2012).

Many studies engaged in examining the altruistic motives of human beings, in their relationships with others. Some doubt the existence of altruism and claim the personal interest behind every act of giving to another (Ghiselin, 1974). Another approach to altruism believes that there is a personal motive of genuine concern for others (Baston & Coke, 1981). Another comprehensive study deals with the question of how to relate to the good feeling caused to the donor, by the very act of giving, whether and to what extent it damages the value of altruism (Anderoni, 1989). There are various theories, among them the claim that the degree of altruism can be placed on a scale (McConnel, 1997) and others that specify different distinctions concerning degrees of truth and reliability of the altruistic actions (Harrison& Suh,2006).

According to Lawrence Kohlberg's theory ((Kohlberg, 1958), there is a moral development scale that includes six stages. The characteristic of these six stages is built on a cognitive axis, that is: moral thinking develops at the same time as cognitive development. Further on in his research (Kohlberg, 1973), Kohlberg believed that there is a possibility to identify another level on the scale which is the seventh stage. This stage differs from its predecessors in that it emphasizes doing good out of a sense of belonging. Distinction of the factors that make up this stage refers to a high level of thinking. Characteristics of SEL such as: religious beliefs, a world view that advocates cosmic unity, as well as experiences and feelings that emphasize the fact that man is a part of an integrated being.

The Research Method

In the present study a qualitative methodology was used, the choice of the qualitative approach was intended to allow an in-depth look at the experience of the interviewees, (Tzabar Ben-Yehoshua 1999). During the research, semi-structured in-depth interviews were held. Discretions and motivations for donating a kidney to another person, who is not a family member were examined while referring to the experiences of the donors and the educational ecosystem that led them to donate. As part of the study, 20 donors were interviewed 12 men, 8 women, 15 from the national religious sector, 4 from the general sector and 1 from the ultra-orthodox sector from diverse ages from 28-64. The interviewees were recruited through a "snowball" and with the assistance of the "Notnim Haim" Association.

 The analysis of the findings was done according to the Gross Method, (Gross,1995) which includes 4 steps -word- locating repeating words, category- from the words the construction of a category relevant to the research topic, finding a connection between categories and from that, building a coherent theoretical model.

The study examined the educational characteristics that kidney donors indicated as a background for the donation itself. In this framework, the various factors of influence and the relationship between them were examined: educational institutions and youth movements. At the same time additional influence channels were examined such as the parents' home and other factors. All this while trying to characterize the educational background that leads kidney donors to the act of donation. The current study sought to examine the altruistic characteristics and considerations for donation, the feelings and emotions of the donors and to what extent these factors influenced the level or nature of the altruism, in the act of donation. This, with a thorough reference to the contributor's answers in regard to the variety of motives and discretions for donating. In order to identify donors whose motives stemmed from and matched the seventh stage and proved its existence. Although defined by Kohlberg himself (1990) as a "possible" stage and not proven.

Findings

 From the findings, it emerged that education in the parents' home had an immeasurably greater impact than the educational institutions according to Cohen's Method (Cohen, 1987). The influence at home was expressed through various channels: such as in small actions that evoked emotions, everyday conversations and special experiences. In addition, it was found that the educational institutions had a significant influence on the moral decisions of the interviewees as well. Many donors mentioned the educational institutions as having had an influence that shaped their world of values and morals and brought them to the decision to donate. These findings are consistent with the research literature (Rest & Thoma, 1985). Main influencing factors in the educational institutions were divided into three channels: practical experiences of giving made within the educational institution; meeting with role models when the educator influenced the donor with his personality; as well as sayings and educational activities that were engraved in the hearts of the students. Among the interviewees there were also those who claimed that the educational institutions had no influence on their moral world and the decision to donate. Furthermore, it emerged from the findings that the youth movements also had an impact, albeit mostly marginal. A number of interviewee replied that the youth movement was part of the general educational atmosphere that began in the parents' home, integrated with moral values in the educational institutions and youth movements and were even part of the public atmosphere. That is, beyond a specific and one-point educational effect, an "ecosystemic" effect emerged that includes all the components of the educational effect together, including the public atmosphere, which formed a valuable and moral educational background for the decision to donate.

In an overall view, it appears from the findings that the main educational channels of influence can be classified into the following categories:

Moral talks about identifying with someone else's pain.

Various acts of giving and altruism that expresses the value of giving, sometimes everyday acts.

Beliefs - talks and conceptual morals dealing with altruism and giving in a social and religious context.

These channels correspond to the channels of influence that also emerged in the literature review and theoretical background. In addition, it was found that all of these channels together with the various educational factors and the public atmosphere created a combination of the morals from home with the educational institutions and youth movements. All of these comprise an inclusive educational space (ecosystem) that had a significant impact on the decision to donate.

The Attitude to Altruism: The findings suggested three approaches to the question of altruism in donation. The first holds that the good feeling of the donor detracts from the value of altruism. However, when the good feeling is a marginal motive for the donation and there is also no material gain, it does not impair altruism. Another approach claims that when the donor senses tension between the desire to perform a true altruistic act and the fear that the "good feeling will distort the judgment, it can be argued that at the same time there are two levels of desire to donate "pure altruism" and "impure altruism". A third approach found claims that the good feeling actually strengthens altruism because it expresses the donor's complete identification with the donation.

Motives and Discretions for the Donation: The research findings raised a wide variety of motives and discretions, as well as experiences and supporting insights that strengthened the decision to contribute at different stages of the process. After classifying all the answers of the interviewees, the motives were divided into four types of motives and discretions for donating, starting from the stage before the decision to donate and throughout the process until the donation itself:

Emotions- feelings of identification with the patient's pain

Insights- cosmic worldviews that emphasize the value of giving

Experiences- feelings of transcendence, excitement and passion for giving

Cosmosophia – feelings of the intervention of a higher divine power or "karma" for the benefit of the donation

Many motives correspond to the characteristics that Kohlberg noted in the description of the seventh stage, (Kohlberg & Ryncarz, 1990) among them: a strong feeling of identification with another's pain to the point of being ready to suffer for him; a cosmic worldview that sees the entire world as a "family" and in any case giving to others is part of concern for the "expanded self", a high level of religious faith in which man perceives himself as G-d's partner in responsibility for the world as well as the perception of life as a mission and designation for the common good. All of these show that kidney donors are the moral level of the seventh stage and actually prove the existence of this stage.

The analysis of the findings and their classification into the various categories show that the channels of educational influence parallel and correspond to the unique structure of the seventh stage of Kohlberg's scale (Kohlberg & Ryncarz , 1990), which includes, besides high cognitive insights, other elements such as religious and cosmic experiences, feelings and beliefs that also correspond to the set of discretions and motivations for contribution. Thus, in an overall view, it was found that there are similar characteristics between the channels of educational influence and Kohlberg's seventh stage and the motivations for contribution.

This parallelism creates an overall picture in which the educational background on the multitude of educational channels constitutes an 'ecosystem" for a high moral level and contribution, Kohlberg's seventh stage, whose elements of S.E.L constitute the ground for the growth of motivations and discretions for the unique contribution.

Discussion and Conclusions

Much emphasis is placed on the "holistic" communal educational background, which produces a shared value language between the home, the educational institution and the youth movement so that the transmission of values becomes much more significant.

On the topic of altruism, two approaches were found in the findings that have no source in the research literature. First, the possibility of the existence of two altruistic layers that exist in man at the same time – "pure" and "impure" altruism. Second, the concept that altruism that causes a good feeling is altruism at a higher level because it teaches a deeper connection of the altruist to the altruistic act.

Regarding the question of Kohlberg's seventh stage, which he defined as a "possible" stage, the findings reveal that the set of discretions and motives for donation correspond to the characteristics of the seventh stage as described by Kohlberg (1990) and therefore it can be claimed that the kidney donors in the current study are proof of the existence of a seventh stage in Kohlberg's moral developmental scale.

Operative Recommendations and Suggestions for Follow-up Studies

As emerges from this study regarding the power of the "educational space", there is room for the development of a "holistic" educational approach, in which emphasis will be placed on the relationship between the parents' home, the educational institution and informal education.

Communication channels must be developed between the youth movements and the educational institutions, and between both of the above and the students' homes. Moreover, it is important to initiate activities and frameworks for volunteering and giving in the community in which the educational institutions and the informal education are integrated together with figures from among the population itself, all those who currently operate independently, will operate in synchronization, in a more efficient manner and especially create an "educational space" that, as presented in the findings, will significantly deepen the impact of the spirit of giving on the youth of the community.

There is also room for deepening the research in the areas that were raised in this study.

In the educational field, the centrality, influence and ways of building the "educational space" must be examined, which will make it easier to build a structured, explicit and well established educational system.

On the topic of youth movements, there is room for expanding and deepening the research to examine whether the findings in this study indicate a change in the trend in the importance and centrality of the youth movements nowadays.

Future research on the motivations for kidney donations can be both a complementary quantitative study to this research and additional studies that will diagnose the relationship between the various motivations and to what extent there is a relationship between specific motivations and various demographic or other variables. It is also possible to examine the power of social influence on the decision to donate. This study can be a basis for a starting point or comparison for all of the above and thus also its contribution.