Causes of organ donation refusal in southern Iran

Background

Family refusal is an important factor that limits the number of organ donations. Some studies from different centers have reported various reasons for family decisions of organ donation refusal. This study evaluated the reasons for organ donation refusal by family members covered in our organ procurement organization.

Methods

This cross-sectional study was performed among families of potential organ donors who satisfied brain death criteria as identified between March 2009 and March 2010.

Results

Among 125 potential donors 73 (58.4%) families refused donation. Their main reasons were as follows: lack of acceptance of brain death n = 26 (35.6%), belief in miracle and patient recovery (n = 22; 30.1), fear of gossip regarding sale rather than autonomous organ donation (n = 11; 15.1%), and fear about deformation of the donor's body (n = 9; 12.3%).

Conclusion

Family members play an important role in the final decision for organ donation. The general public should be encouraged to register their donation preferences in the case of brain death.     

Increasing family consent for organ donation: findings and challenges

There is a growing disparity between the number of organs and tissues needed for transplantation and the number available for donation. As a result, thousands of people die every year while waiting for a transplant. Much of the shortage can be explained by the failure of families to consent to donation. This paper reviews the research that has been conducted to elucidate reasons why families deny consent. This research, together with theoretically motivated research in the areas of persuasion and behavior change, can be used to inform the design of educational and promotional campaigns and to guide policy decisions.     

Factors associated with refusal of organ donation in France from 1996 to 1999]

OBJECTIVE: The demand for organ transplantation exceeds organ donation in France and refusal to organ donation remains close to 30%. This study analysed risk factors associated with refusal of organ donation. STUDY DESIGN: Retrospective study. PATIENTS: All potential organ donors registered by the French transplantation agency between 1996 and 1999 were included, excepted those with a contraindication to organ procurement or a logistic problem: 5,911 donors were included. METHODS: Data analysed were those collected routinely on the French database. A logistic model was used to identify statistically significant factors and a stepwise procedure was performed to identify independent factors linked with refusal. RESULTS: In univariate analysis, age > 60 years and age < 13 years, stroke, lack of suicide, localisation in an university hospital and in others regions than the Centre-East of France were associated with a higher refusal rate. Year of harvesting, low level of organ procurement activity were not associated with refusal. In multivariate analysis, factors independently associated with refusal were age > 60 years [Odds-Ratio (OR) = 1.2)] or age < 13 years (OR = 1.5), stroke (OR = 1.2), meningitis and cranial tumour (OR = 1.4), suicide (OR = 0.5) and others French regions than Centre-East. CONCLUSION: The risk factors described should be taking into account when family's members are approached for donation. They represent the interactions between the history of the donors, harvesting organisation, and sociocultural factors.     

A plea for uniform European definitions for organ donor potential and family refusal rates

Conversion of potential organ donors to actual donors is negatively influenced by family refusals. Refusal rates differ strongly among countries. Is it possible to compare refusal rates in order to be able to learn from countries with the best practices? We searched in the literature for reviews of donor potential and refusal rates for organ donation in intensive care units. We found 14 articles pertinent to this study. There is an enormous diversity among the performed studies. The definitions of potential organ donors and family refusal differed substantially. We tried to re‐calculate the refusal rates. This method failed because of the influence caused by the registered will on donation in the Donor Register. We therefore calculated the total refusal rate. This strategy was also less satisfactory considering possible influence of the legal consent system on the approach of family. Because of lack of uniform definitions, we can conclude that the refusal rates for organ donation can not be used for a sound comparison among countries. To be able to learn from well‐performing countries, it is necessary to establish uniform definitions regarding organ donation and registration of all intensive care deaths.     

Consent for organ donation

Improving the consent rate for solid organ donation from deceased donors is a key component of strategies in the UK and other countries to increase the availability of organs for transplantation. In the UK, the law is currently clear on what forms consent may take, with the views of the individual expressed previously in life taking priority. Such views may have been expressed prospectively, via membership of the Organ Donor Register or by talking to family members. The factors determining such actions include both positive altruistic motives and negative psychological responses. Studies have examined why some families of potential donors refuse consent, while others have demonstrated a key set of 'modifiable' factors relating to the family approach. These include ensuring the right timing of a request in an appropriate setting, providing emotional support, and imparting specific information, particularly concerning the nature of brain death. If these are optimized and the right personnel with adequate training are involved in a planned process, then consent rates may be improved as reported in other countries with organized donation systems.     

Factors influencing the family consent rate for organ donation in the UK

The refusal rate for organ donation in the UK is 42%, among the highest in Europe. We extracted data on every family approach for donation in UK ICUs or Emergency Departments between 1st April 2012 and 30th September 2013, and performed multiple logistic regression to identify modifiable factors associated with consent. Complete data were available for 4703 of 4899 approaches during the study period. Consent for donation after brain death was 68.9%, and for donation after circulatory death 56.5% (p < 0.0001). Patient ethnicity, knowledge of a patient's wishes and involvement of a specialist nurse in organ donation in the approach were strongly associated with consent (p < 0.0001). The impact of the specialist nurse was stronger for donation after circulatory death than for donation after brain death, even after accounting for the impact of prior knowledge of patients' wishes. Involvement of the specialist nurse in the approach, encouraging family discussions about donation wishes and promotion of the organ donor register are key strategies to increase UK consent rates, and are supported by this study.     

Causes why organ donation was not carried out despite the deceased being positive to donation

Several studies have shown that over 70% of the population is positive to donate their organs after their death. Despite this it is not unusual for organ donation to be not performed. The aim of this overview was to identify factors that may have an influence on this failure despite the deceased being positive. This is a review of 343 abstracts and 23 scientific publications between 1977 and 2005 dealing with various aspects of donation. In the analysis there were some topics that were associated with the prevention of donation: medical contraindications, inability to identify a potential organ donor and provide optimal medical care, the treatment and care of next of kin, how the question of consent was addressed to the next of kin, the attitude of intensive care unit (ICU) staff toward the process, the behavior of the transplant team during organ recovery. The most crucial act to increase donation is early identification of a potential subject. Early identification and optimal medical care occur more frequent when there is a good, positive attitude of the ICU staff toward the process. A positive attitude of the questioner and good care of the next of kin frequently resulted in a positive attitude when the question of consent was raised. Transplant units could improve the attitude in the ICUs by serving as a good model, giving feedback and education to the ICU staff.     

Validation of the factors influencing family consent for organ donation in the UK

Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47–1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23–0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22–0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.     

The public's willingness to discuss their preference for organ donation with family members

We sought to assess the public's willingness to discuss their preference for organ donation with family members and to identify factors associated with willingness to discuss donation. We categorized individuals (N = 4365) with a preference for donation according to their willingness to discuss donation and used ordinal logistic regression analysis to identify factors related to their level of willingness. About half of those who want to donate have discussed this with a family member. Others were at various stages with respect to their commitment to discuss donation. Those in the more committed stages were more likely than others to have signed an organ donor card, to have seen information about organ donation, to be male, to be white or Hispanic, to know about donation issues, and to be comfortable with the idea of their own death. The decision to donate is ultimately made by family members of a suitable candidate for donation, yet nearly half of those who wish to donate have not made their wishes known. Interventions targeted to individuals at different stages of commitment are needed so that more family members can respond in accordance with their loved one's wishes.     

人类器官移植供体来源的发展历程

移植器官来源模式是科学技术发展和人文精神升华完美结合的产物.移植器官来源经历了异种动物、死刑遗体、亲属活体、脑死亡供体、亲属活体+非亲属活体、心死亡供体、多种来源这7个不同的历史阶段.异种移植离临床应用遥远;死刑来源倍受批评;活体移植伤害健康人.器官捐献移植发展史证明,公民逝世后器官捐献值得大力推广.以美国全脑死亡器官捐献和英国脑干死亡器官捐献为代表的美-欧模式,均为生前自愿同意,且绝对无偿.公民认为任何形式的补偿都会改变捐献行为本来的性质.心死亡器官捐献是脑死亡器官捐献的补充,适用于既不符合脑死亡标准又无法救治,同时家属又有强烈捐献意愿者.