More than nation and knowledge: Cultural micro-diversity and organ donation in Switzerland Peter J. Schulz a, * , Kent Nakamoto b , David Brinberg b , Joachim Haes a a University of Lugano, Via G. Buffi 13, 6900 Lugano, Switzerland b Virginia Tech, USA Received 30 November 2005; received in revised form 3 March 2006; accepted 5 March 2006 Abstract Objective: While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation. Methods: We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings. Results: The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs—differences that persist even in the context of strong national identity, relatively homogeneous cultural background, and the public good nature of organ donation. Conclusion: The results demonstrate a need to consider and address cultural factors and barriers when designing organ donation campaigns. Practice implications: Centrally designed organ donation campaigns are not likely to be effective and efficient. Message strategies should rather be tailored to different (micro-) cultural groups. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Transplantation; Public attitudes; Organ donation; Switzerland 1. Introduction Medical advances have transformed organ transplanta- tion from an experimental treatment to the therapy of choice for patients with organ failure. This process is, however, hampered by the lack of donors. In Switzerland, as in most countries, the demand for organs and tissues exceeds their supply [1,2]. In 2004 almost 1130 people in Switzerland were waiting for an organ transplant and only 412 received one [3]. For the last 20 years, the major transplant centers in Switzerland have supported a coordinating organization— Swisstransplant—which seeks to publicize and organize support for organ donation. Swisstransplant also provides organ donor cards to people living in Switzerland who wish to designate themselves as organ donors. The cards are not recorded by Swisstransplant or any government agency. While the card provides information about the potential donors’ wishes, it has no legal force and the ultimate donation decision is made by the donor’s next of kin. Swisstransplant has also been the primary provider of information and promotional campaigns for organ donation in Switzerland. Campaigns and information have always been developed in all three official Swiss languages— German, French, and Italian. However, the message strategies and information content provided by Swisstrans- plant have been uniform throughout the country. Despite 20 years of work by Swisstransplant and other agencies in Switzerland to increase citizen acceptance of and participation in organ donation programs, public response www.elsevier.com/locate/pateducou Patient Education and Counseling 64 (2006) 294–302 * Corresponding author. Tel.: +41 58 666 4724; fax: +41 58 666 4647. E-mail address: peter.schulz@lu.unisi.ch (P.J. Schulz). 0738-3991/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2006.03.009