Spiritual Meaning of Cadaveric Organ Donation among Protestant Korean Immigrants in the United States

Abstract

This qualitative study investigated Protestant Korean immigrants’ views on cadaveric organ donation through the analysis of in-depth interviews with thirty-two Protestant Korean immigrants in the United States. The interviews show a meaning-making process of cadaveric organ donation among study participants. They describe participants’ complex sentiments on cadaveric organ donation, based on a blend of Protestant, Confucian, Shamanistic, and Daoist views. This study shows how Protestant Korean immigrants can overcome potential fears of organ procurement, stemming from indigenous Korean contexts, and describes their religious views on the afterlife. The findings indicated that most participants held positive views of cadaveric organ donation because they considered organ donation to be an altruistic, life-giving, Christian spiritual practice for the benefit of others. I argue that Protestant Korean immigrants’ lived religion can lead them to overcome fear of indigenous Korean beliefs and to choose organ donation as a spiritual practice.

1. Introduction

The issue of cadaveric organ donation is strongly impacted by ethno-cultural factors, the donor’s spiritual beliefs about the afterlife, and their perception of the human body (Lam and Mccullough 2000; Kim et al. 2004; Bresnahan et al. 2007). Some studies have pinpointed Confucian tradition as a cause of low organ donation rates in East Asian contexts (Oliver et al. 2011; Kim et al. 2004). Furthermore, Asian Americans have shown significantly lower rates of cadaveric donation compared with White Americans. According to Trompeta et al., only 2.1% of Asian Americans’ organs were procured, compared with 68.2% from White Americans in 2005 (Trompeta et al. 2010).

Researchers have argued that the Confucian teaching on filial piety is one of the primary factors hindering organ procurement (Lam and Mccullough 2000; Cai 2013). Confucians believe that the entire body should be maintained intact, even after death; therefore, the removal of organs can elicit guilt in Koreans, who feel that they are breaking the rules of filial piety and profaning their parents (Kim et al. 2004; Oliver et al. 2011). Koreans have strictly followed Confucian teaching on filial piety from the Book of Filial Piety that states, “Body, hair, and skin are gifts from parents, let no one damage them” (Oliver et al. 2011). Agreeing to the removal of an organ even after brain death could potentially be disrespectful to their parents (Bresnahan et al. 2007).

Until the late 19th century, as part of Korean filial practice, Koreans made an explicit effort not to damage or change their physical appearance, such as hair, because their body comes from their parents. For example, Korean men tied their hair up in a topknot to maintain its length over their lifetime. In 1895, when the Japanese government pressured the Korean king Kojong into forcing Korean men to cut their long hair, Korean people were strongly against it because they would fail to fulfill their filial duty. The practice of long hair does not exist in Korean society today; however, many Koreans do refrain from “hurting” their body through organ procurement (Yeun et al. 2015).

Moreover, according to Korean Shamanistic belief, missing organs can negatively affect the afterlife because the donor could become a malevolent spirit. To ensure that malevolence is avoided, the human body should be kept intact after death; furthermore, removing an organ can cause suffering to the deceased’s spirit, which could turn the spirit vengeful, bringing misfortune or specific harm, such as illness, to the deceased’s family (Kim et al. 2004). As a result of persistent Shamanistic cultural influence and Confucian tradition, Koreans believe that the care one takes with a dead body significantly influences the subsequent relationship between the deceased’s spirit and their family.

In addition, in the Daoist worldview, removing organs can seriously disrupt the balance of chi between the body and nature by changing the natural flow of chi and negatively impacting the donor (Bresnahan et al. 2007; Oliver et al. 2011). Organ procurement is considered an unnatural process that can ruin physical and spiritual harmony with nature (Oliver et al. 2011). Overall, traditional Korean contexts comprise elements of Confucianism, Shamanism, and Daoism, all of which present obstacles to cadaveric organ procurement.

When Koreans migrate to the US, most Korean immigrants join Protestant Korean immigrant churches, which have become community centers among Korean immigrants. According to the Pew Research Center in 2012, Christians comprise 71% of the total Korean American population; of those, 61% are Protestant and 4% are Catholic (Pew Research Center 2012).

As the literature review suggests, previous studies have largely focused on Chinese–American adults or utilized quantitative methods that overlook various religious and cultural dimensions of cadaveric organ donation (Bresnahan et al. 2007; Cai 2013; Kim et al. 2004; Trompeta et al. 2010). These quantitative studies merely show Korean immigrants’ end-of-life preferences without investigating why participants prefer cadaveric organ donation. Qualitative data were sparse on first-generation Korean immigrant views on this issue; this study focused on first-generation native Korean speakers. The purpose of this study is to analyze participants’ religio-cultural views on end-of-life care and the afterlife and to elucidate participants’ meaning-making process of cadaveric organ donation as a spiritual practice. The study answers the following research question: How does lived religion shape Korean immigrant perspectives on cadaveric organ donation?

2. Methods

This qualitative study includes semi-structural, in-depth interviews that are useful to describe meaning and experiences. The inclusion criteria of participants were as follows: “Participants will be Korean American Protestant adults who have experienced the death of a close Korean or Korean American family member or friend(s) while living in the U.S.” The researcher worked with some key informants who shared certain aspects of Korean immigrant life and culture; these informants distributed recruitment flyers to their friends. Thus, snowball sampling was used. The researcher made announcements at some regular social gatherings for elderly Korean immigrants through the support of the key informants who hold leadership positions at those meetings. The researcher also made an announcement during fellowship time after the Sunday church services and some staff passed out recruitment flyers to their members. The recruitment process was smooth, and the researcher received oral consent from each participant before the interview.

The researcher conducted semi-structured, in-depth interviews in Korean, although some participants occasionally used some English. During the in-depth interviews (55–120 min in length), an interviewer asked a specific question regarding their decisions and views on cadaveric organ donation, which was the focus of this study. All the recordings were recorded and preserved with digital voice recorders. The researcher also took field notes by hand by focusing on participants’ gestures, non-verbal signs, emotional expressions, and some key terms. These notes and key terms were helpful in the coding process. The audio recordings were transcribed in the Korean language by the researcher and other transcribers. All the participants’ names were replaced with American pseudonyms for protecting privacy. Identifiable information of the participants was removed, and quotes are reported with pseudonyms.

At the beginning of interviews, participants were asked to fill out a brief survey to collect demographic information (e.g., gender, residency duration in the U.S., education, the number of religious services that participants attend per week). The researcher used semi-structured, open-ended questions about their views on organ donation and views on the afterlife (e.g., Do you believe in life after death? Please explain why or why not?; Would you be willing to donate one of your organs immediately after your death? Why or why not?). Participants were encouraged to tell in-depth stories without interruption. Interviews were conducted at a time and location of the participants choosing such as homes, workplaces, or cafés.

Modified grounded theory was used to investigate complex perceptions of cadaveric organ donation among Protestant Korean immigrants (Patton 2015). Adopting modified grounded theory enabled one to focus on the raw data, identifying meaning-making processes from an empirical perspective of immigrants without preconceptions. The research adopted the naturalistic approach of transcription so that the transcription can resemble the actual interviews as closely as possible. The researcher codes a full verbatim, and themes emerged organically by identifying key words and phrases and finding some themes. The researcher created codes according to what she observed in the data through textual analysis, instead of applying preconceived codes to the data because the researcher, a first-generation immigrant, tried to avoid her own bias and preconceptions about immigrants’ behaviors. The researcher repeated active coding a few times. Then, themes were identified and categorized. The research was overseen by the Boston University Institutional Review Board (#4183E).

3. Results

Twenty-one female participants and eleven male participants were recruited in the greater Boston area. A total of 13 people declined to be interviewed, and of the 32 participants, 31 reported frequent church attendance. The study includes participants with various U.S. residency durations, education levels, and frequency to attend religious services per week (See

Table 1. Participants’ residency duration in the U.S.

Residency Duration in the US	Number of Participants
1–10 years	7
11–20 years	7
21–30 years	8
31–40 years	5
40 years or more	5

,

Table 2. Participants’ education qualifications.

The Highest Level of Formal Education	Number of Participants
Elementary school	2
Middle/junior high school	2
High school graduate	6
Associate’s degree or vocational training	3
Some college (no degree)	2
Bachelor’s degree	8
Master’s degree	8
Doctoral degree	1

and

Table 3. Frequency of religious services attendance per week.

The Number of Religious Services That Participants Attend Per Week (e.g., Sunday Service, Morning Prayer Service)	Number of Participants
1	8
2–3	16
4–5	1
6–7	5
8–9	2

). This study analyzed in-depth interviews with thirty-two Protestant Korean immigrants.

The transcribed interviews were analyzed into five themes (a. uncomfortable sentiments on cadaveric organ donation; b. meaningless dead body; c. altruistic spiritual practice; d. God’s sovereignty over human body; and e. overcoming fear through faith). Some participants express their uncomfortable sentiments and emotional distress on cadaveric organ donation. Many participants do not find meaning in the dead body because they believe, according to their Protestant faith, that the soul and the body would be separate in the afterlife. Some participants consider cadaveric organ donation as an altruistic spiritual practice for helping others. Many participants believe that their body belongs to God, and they can overcome fear through their religious faith.

The majority of participants would opt for cadaveric organ donation based on their Protestant values and beliefs, although a few participants would not, based on their traditional Korean religio-cultural worldviews.

A.

Uncomfortable Sentiments and Emotional Distress Based on Traditional Korean Religio-cultural Worldviews

In this study, a few interviewees were hesitant about cadaveric organ donation because of the emotional distress to themselves and/or survivors. For example, Irene expressed uncomfortable feelings about cadaveric organ donation. Koreans tend to impose eternal significance on a damaged dead body; thus, they may feel uncomfortable about cadaveric organ donation.

Interviewer: “Why do you feel uncomfortable with organ donation?”

Irene: “I want to leave this world with my body in the way how I was born. I don’t want my body to be messed up. I want to leave the world with the exact same body that I had.”

Followers of Confucianism are concerned about human relations and harmony. Confucian tradition strongly emphasizes filial piety as the most important moral duty in one’s interpersonal relationships. As mentioned in the Introduction, the human body is considered to be a gift from one’s parents. Therefore, the body should be preserved without change until the end of life to show respect in return.

Garrett signed up for organ donation and then later withdrew it because he was concerned about his family’s potential emotional distress.

Garrett: “I initially signed up for organ donation but I changed my mind. I don’t have any negative thoughts about organ donation. But I changed my mind by considering my family’s emotional difficulties from my organ donation. I only have my wife and my children… Donating my organs could be a burden to my family… If I suddenly die in an unexpected accident, I don’t want them to experience more emotional difficulties from organ donation on top of emotional difficulties from the loss of a family member… Right after my death, they probably need to think about the donation and choose whether they want to donate my organs or not. It would be great if they can be persuaded by understanding that donation is very meaningful and a way of giving a new life. However, I haven’t talked about it yet with my kids. Considering Korean sentiments, even though my kids can conceptually accept it, it would not be easy to accept the donation of my organs in real life.”

Interviewer: “What kind of Korean sentiments are you describing?”

Garrett: “For example, people [Koreans] often choose cremation now, but many people still think of cremation negatively… People don’t feel comfortable with an autopsy yet… People [Koreans] impose a very big meaning on damaging a corpse, so we need to deal with a cadaveric organ donation carefully. Although organ donation is meaningful and good, we need to consider how the family could accept it. When a family member’s organs are donated, Koreans may face emotional difficulties. So we need to be very careful by considering Korean culture.”

Interviewer: “Why do you think Koreans, in particular, deal with a damaged corpse with more difficulty? What kind of [Korean] culture or values cause that?”

Garrett: “[For Koreans], the spirit and body are so much closely attached whereas spirit and body are a bit detached in [American] thoughts… So, for Koreans, using the deceased’s organ sounds inhumane and immoral… If we approach organ donation issues with Western concepts, we [Koreans] can experience resistance deep inside of us in our sentiments although culturally Westernized Koreans can accept it.”

Garrett suggested that treating a corpse well is very important to Koreans; dead bodies should be handled with respect and with a Confucian sense of propriety. In Confucian culture, agreeing to the removal of organs can be interpreted as violating the physical integrity of the dead body (Kim et al. 2004). In Garrett’s opinion, this provides survivors with emotional comfort, and they feel more secure knowing that their dead body will also be treated respectfully.

Garrett: “If I can be buried, that would be better than cremation. But I am not so against cremation, either… When we handle a dead person with propriety (Li in Confucianism), we feel comfort because we assume that I can be treated with propriety after my death, too. So people can feel comfort and stable when they are alive. For example, when my co-workers are laid off due to various situations within the company, we feel unstable because we can be laid off just like that co-worker. But if the company tries to protect employees in a difficult situation, then an employee would feel protected and stable. So an employee’s integrity can be respected. What I think of death, related cultural aspects might be meaningless for the deceased. However, how people treat death can offer certain stable feelings to survivors.”

The preservation of a corpse’s physical integrity is an essential part of respecting the deceased and bringing good fortune to their descendants. These sentiments can be traced back to views on the afterlife, based on a blend of Confucian, Shamanistic, and Daoist views. Furthermore, there is no binary system of life and death in Buddhism; rather, a transitional time between life and death. From a Buddhist perspective, the body is infused with the spirit in this life, and the two are not immediately separated upon death. However, Western Christian traditions tend to recognize a dualism between the spirit and the body, where death means an immediate and eternal separation of the two.

As Garrett mentions, for Koreans, how to treat one’s corpse is an essential part of their lives: not only for a person who is dying, but also for a survivor who wants to commemorate the deceased appropriately based on their Confucian values. Garrett’s interview indicates that multi-faceted factors can influence cadaveric organ donation in a very complex way, in consideration of Korean religio-cultural factors. Some survivors may experience emotional distress and feel guilty if their deceased family member’s corpse is not treated with Confucian propriety.

B.

Meaningless Dead Body Based on Protestant Beliefs

However, the majority of participants considered cadaveric organ donation positively. Many participants believed that their souls go to heaven and their physical bodies are left on earth based on their Protestant beliefs. For them, a dead body is meaningless once their souls enter into heaven, based on their Protestant belief. Moreover, many participants imposed a spiritual meaning on organ donation and considered it to be a spiritual practice. Most participants held positive views of organ donation, regardless of whether they had signed up for organ donation themselves. Most participants wanted to donate their organs based on the Christian teaching that the soul and body would be separate in the afterlife, overcoming potential fear of organ procurement stemming from indigenous Korean contexts. For example, Cathy placed little importance in a dead body after its soul goes to heaven.

Cathy: “I signed up for organ donation…If I die, my body is already dead and my body itself doesn’t mean anything when my soul is next to the Lord… If somebody can have a life with my organs, I should do it… When I am dead, my soul already left my body. I should give them to others by being taken out of that body.”

Cathy believed that organ donation provides the gift of life to others, which aligns with Christian self-sacrificial giving. Similarly, Uma wanted to become an organ donor:

Interviewer: “If you sign up for organ donation, the medical team would come and procure your organs. Do you have any negative feeling about this?”

Uma: “Not really. We don’t need organs in heaven. Right?”

Heather also considered a dead body to be meaningless as long as the soul enters heaven, and also wanted to become an organ donor:

Heather: “…They can take my whole dead body. I don’t need to be cremated, either. It is meaningless to cremate my dead body.”

Cathy, Uma, and Heather firmly believed that their souls would go to heaven after their death, unlike Korean Buddhist teachings. Many non-Christian Koreans believe in the existence of reincarnation in an eternal cycle of life and death.

C.

Altruistic Practice of Serving the Community and Helping Others

Some participants believed that donating their organs was an altruistic practice to serve their community and others as Christians. For example, Heather called herself “this sinner” and claimed that she had not really served her community; organ donation would be one last altruistic deed for her community before death.

Heather: “I haven’t really served my community. If I die and donate my organs, some people can get a skin transplant or a corneal transplant and they would have a happy life. This sinner who has been to church doesn’t want to be decomposed in the soil. If my grave is created, my children would have a hard time visiting the tomb and taking care of it. I want to donate not only my organs but also my whole body to a hospital… They can use my body for practicing anatomy or using it to help others.”

Similarly, Patricia wanted to donate her organs, which she believed would make her life more meaningful.

Patricia: “I would love to [donate my organs]. I die, but I can give a life to another person. With that meaning, it would be good to donate my organs. I will be rotted away. My flesh will be rotted away and gone. With the body that will be gone, I can help another to live. With this meaning, it would be better to donate my organs.”

Interviewer: “Do you feel uncomfortable about organ procurement or feel psychological repulsion about that?”

Patricia: “Nope, once I think of donating them, I don’t feel like that…”

D.

God’s Sovereignty over Human Body

Some participants decide to donate their organs because they believe that their body belongs to God. For instance, Olivia did not feel uncomfortable about donating her organs, and had already signed up as a donor.

Interviewer: “What made you decide to donate your organs?”

Olivia: “My organs are given by God. If I can help someone and somebody can enjoy the benefits from it until the last moment, why not [donate my organs]?”

Interviewer: “When you die, the medical team would harvest your organs right away. Do you feel uncomfortable with this?”

Olivia: “No, not at all.”

Olivia acknowledges that her organs “are given by God.” In Korean Confucian tradition, organs are “given by their parents”; however, the participants in this study saw organs as gifts from God that can help others after death. They acknowledged God’s sovereignty over the human body, and they wanted to fulfill God’s will as a Christian. The Calvinistic doctrine of God’s sovereignty has heavily influenced Korean Christianity; Presbyterianism is the largest denomination by number within the Protestant church in South Korea. Due to the influence of Presbyterianism, the sovereignty of God has strongly been emphasized in the faith and practice of Korean Protestants today.

Jerry also showed his belief in the sovereignty of God in his interview. He had signed up for cadaveric organ donation, and said that his body is not his own, but God’s; therefore, he wants to use his dead body for a godly purpose.

Interviewer: “What motivated you to sign up for organ donation?”

Jerry: “If I die, I don’t need any of my organs. If those organs are used by other people, I would love to give them all. Some people are strongly against organ donation, but I am not against it. Whatever others need, I would say that they can take any necessary parts.”

Interviewer: “When you imagine that a medical team would harvest your organs right after your death, wouldn’t you feel uncomfortable?”

Jerry: “No, not at all I don’t think my body is mine. It is God’s. If I die, I don’t need my organs at all. If I can give any organs, I would love to give them all…”

Similarly to Olivia, Jerry firmly believed in God’s sovereignty over his body. Donating their organs was their spiritual practices to show their belief in the sovereignty of God. Both of them demonstrated willingness to follow a Christian teaching by benefiting others before death through organ donation as a spiritual practice.

E.

Overcoming Fear of Organ Donation through Faith

Jerry also confirmed that he did not believe he would need his organs when he goes to heaven, similarly to other participants. He seemed to have overcome his fear of organ donation or the treatment of his dead body through his faith. Furthermore, he wanted his ashes to be scattered after cremation because he believed that his dead body would not have to be buried, unlike indigenous Korean spiritual beliefs. Burying a dead body at a site with sunlight is a popular custom based on Korean geomancy, influenced by Daoism. Koreans consider finding and taking good care of a good burial plot to be ways of respecting one’s parents. Many Koreans still believe that the burial of one’s ancestors at a good site can bring good health and fortune to the descendants. However, Jerry did not want to follow this custom, instead opting for cremation; he was not fearful of cadaveric organ donation, based on his Protestant view on the afterlife.

Jerry: “…After my death, contact a person who can bring my dead body and allocate my organs if anybody needs my organs… Then cremate my left-over body and scatter the ashes near church or near this place [this church (where the interview was held)].”

Interviewer: “Do you have any specific reason why your ashes should be scattered near your church?”

Jerry: “Yes, yes, they can do that. They don’t have to bury me. Just scatter the ashes. We came from the dust so my ashes can be scattered to the dust. That’s it. I believe this 100% with my whole heart. We don’t have to consider any complicated things. If we believe in Jesus, we will go to heaven.”

Nathan had also already registered for organ donation, and his interview showed how he overcame the fear of organ donation through his faith.

Interviewer: “Why did you decide to donate your organs?”

Nathan: “My flesh will be rotted away. So if other people can enjoy any benefits from my organs, it would be better to share my organs, I think. I think it would be better for my body to be shared rather than being rotted away.”

Interviewer: “If you signed up for organ donation, the medical team would procure your organs right after your death. Do you feel uncomfortable about that?”

Nathan: “I can’t say that I don’t have any fear. For example, it is not good thing that my eyes or liver get harvested. But I assume that I would be unconscious after the death. So after the death, it does not matter. We will fear when we are alive, but fear should not matter after death.”

Although Nathan felt fear, he wanted other people to benefit from his organs because he wanted to follow a Christian way of benefiting others, and giving them a new life. Similarly to Nathan and Jerry, the majority of participants wanted to donate their organs and held positive views of organ donation based their Protestant faith in the afterlife.

4. Discussion

The interviews illustrate a complex meaning-making process as to how Protestant religious belief and indigenous Korean religious traditions influence participants’ views on cadaveric organ donation. They describe participants’ complex sentiments on cadaveric organ donation, based on a blend of Confucian, Shamanistic, and Daoist views. Some participants felt uncomfortable with cadaveric organ donation. However, the majority of participants would choose cadaveric organ donation drawing from their Protestant beliefs over the indigenous Korean religious tradition, which generally does not promote cadaveric organ donation. They would opt for organ donation because Protestant beliefs dictate that the body does not have much spiritual meaning in the next stage of life. Additionally, they impose spiritual meaning on organ donation and considered it to be an altruistic, life-giving spiritual practice for the benefit of others. The interviews illuminated the participants’ faith, and their spiritual views on the afterlife motivated them to overcome fears of cadaveric organ donation.

This qualitative study shows that Protestant Korean immigrants can overcome fear of indigenous Korean religious and cultural beliefs and choose organ donation as their spiritual practice. Unlike some previous studies, the interviews indicate that the majority of Protestant Korean immigrant participants hold positive views of organ donation as an altruistic, life-giving spiritual practice for the benefit of others. This study highlights the strong impacts of religious beliefs in the issue of cadaveric organ donation. Most previous studies on organ donation among Asian Americans conducted surveys using quantitative methodologies, which do not elucidate a meaning-making process of participants’ views (Frank et al. 1998; Dobbs et al. 2015).

Uncomfortable feelings about organ donation can be traced back to Confucius’ teachings on filial piety in The Classic of Filial Piety (Oliver et al. 2011). Preserving one’s body until the end of life is considered as “the beginning of being filial” (Ibid.). This teaching was later contextualized and re-established as a foundational moral duty by Confucian scholars of the Chosun Dynasty. Extreme emphasis was placed on filial piety during the Chosun Dynasty. Researchers have argued that the Confucian teachings on filial piety are a primary cultural factor hindering organ procurement (Cai 2013). Confucians believe that the entire body should be maintained intact, even after death; therefore, the removal of organs can elicit guilt in Koreans, who feel that they are breaking the rules of filial piety and profaning their parents (Ibid). Yeun et al. found that many young Korean participants are unwilling to inform their parents of their organ-donation decisions, and the participants expressed a fear of hurting their parents by informing them of the decision (Yeun et al. 2015).

In Confucian culture, the removal of a family member’s organ can cause uncomfortable feelings or emotional distress to another family member. A similar view has also been reported among Chinese medical students in Hong Kong, where Confucian tradition is likewise prevalent (Chung et al. 2008). In Chung et al.’s study, traditional Chinese beliefs in preserving one’s body intact after death and the family’s negative attitude towards organ donation are key factors that influence medical students’ negative views on organ donation (Ibid.).

Furthermore, because Buddhists consider death as the process of moving to the next stage of life, the concept of being brain dead does not align with Buddhist thought. Cadaveric organ procurements after declaring brain death can disturb a dead person’s process in this transitional time and adversely affect the dead person’s next stage of life (Oliver et al. 2011). In South Korea, brain death is recognized as a legal death; however, the concept of brain death has not been fully accepted amongst Korean people (Yeun et al. 2015; Oliver et al. 2011). For Koreans, organ donation at the end of life is complicated by many religious and cultural factors. Some participants emphasized indigenous Korean traditions in their lived religions, whereas others emphasized Protestant aspects.

In addition, preserving the dead body intact for a specific period of time is often crucial to Buddhist beliefs on the afterlife. The departure of the spiritual consciousness is considered to occur in the moment of actual death in Buddhism, and the dead body must remain undisturbed until the spirit has left the body (Oliver et al. 2011). Buddhist tradition teaches that spiritual consciousness does not reside in the brain, but throughout the entire body (Veatch and Ross 2015, pp. 4–5). Therefore, any external factors that impact the dead body, such as organ harvesting or aggressive medical procedures, may be a serious obstacle to the dying patient’s rebirth in the next life (Kim et al. 2004). Most non-Christian Koreans would hold this Buddhist view on death and dying. However, many participants such as Uma and Heather did not put focus on the dead body itself, because they believed that their dead bodies would not enter heaven. They considered death and dying to be a process of external disturbance, rendering the harvesting of organs unimportant because in their Protestant belief only their souls would enter heaven without the dead body.

Overall, regardless of the participants’ preferences, their lived religions significantly shaped their end-of-life preferences on organ donation. Some participants’ lived religion was more influenced by Protestant Christianity, whereas other participants’ lived religion was more shaped by Confucianism, Shamanism, and/or Daoism. It is not completely clear why some participants drew more from Christianity and others from Korean indigenous religions in deciding cadaveric organ donation. Participants’ decisions are likely simultaneously influenced by numerous factors, such as their family tradition, education, assimilation, etc. Participants recognized emotional and cultural uncomfortableness about cadaveric organ procurement; however, the majority saw it as a means to express the love of God and spiritual service to others up until their death. This study indicates that Protestant Korean immigrants’ lived religion can lead them to overcoming fears of indigenous Korean beliefs and to choose organ donation, because they believed that cadaveric organ donation was their spiritual practice. Based on the results of this study, Christian-faith-based organizations and religious leaders can effectively and positively promote organ donation among Korean immigrants based on their Christian faith. Although many participants decided to opt-in to organ donation, non-English-speaking immigrant participants lacked information about how to sign up for organ donation. Many of them had not discussed their decision with their family members. In order to overcome these barriers, religious leaders, healthcare providers, and policy administrators should work collaboratively to identify culturally sensitive strategies to encourage organ donation among immigrants.

5. Conclusions

The study shows that religio-cultural belief and spiritual practice can encourage cadaveric organ donation rather than become an obstacle in promoting it. It also indicates that Korean immigrants’ lived religions can be extremely complicated because their beliefs are well-blended; each participant exhibited distinctive features depending on their family background, cultural contexts, and the level of spiritual commitment to certain religious traditions. Therefore, healthcare providers should be careful to not over-generalize individual religious beliefs and worldviews among Asian immigrants. They should listen to individual patients’ religious and spiritual views on end-of-life care issues. Although East Asian Americans show a low level of cadaveric organ donation, many Protestant Korean immigrants may consider organ donation positively as their spiritual practice.