Changing the way organ donation requests are made could prevent relatives denying consent

Timing and whether a transplant coordinator makes the request are key factors in whether relatives consent to organ donation, according to a study published on bmj.com today. Demand for organs far exceeds supply and in the UK this results in one patient on the transplant waiting list dying every day. One of the biggest barriers to increased donor rates is the refusal of consent by relatives.

A recent audit of 341 deaths in intensive care units in the UK revealed that 41% of relatives of potential donors denied consent. In an interview study a third of relatives who had refused donation said that they would not refuse again, whereas only a few of people who had given consent regretted their decision.

Lead author Dr Duncan Young, from John Radcliffe Hospital in Oxford, believes that given the refusal from relatives blocks so many transplants from going ahead, it is important to find out what factors would help them uphold the wishes of their next of kin.

The authors carried out a review of 20 studies on organ donation to investigate what factors either encouraged or discouraged relatives to consent. Two issues had the strongest effect on relatives: timing and the person making request. It is essential that a request for organ donation does not take place when notification of death is communicated to relatives or when brain stem death testing takes place – it is very important that there is a gap between 'bad news' and a request for donation, say the authors.

The person making the request is also key and the study concludes that in an ideal situation a donor transplant coordinator together with hospital staff would make the request.

The following issues were also significantly linked to relatives denying or allowing donation to go ahead: the level of information they were given, how they perceived the quality of care given to their loved one, understanding what brain stem death actually means, the setting for the request (a private location is best), the approach and expertise of the individual and giving families enough time to consider the request.

The authors conclude that although their findings may be "unsurprising," implementing them may increase donation rates and ultimately save lives. They argue that "organ donation may be of sufficient benefit to society generally, and to organ recipients specifically, to justify the study and modification of organ donation requests to maximize consent."

In an accompanying editorial, Teresa Shafer from the LifeGift Organ Donation Center in Texas, says that requesting consent for donation is not simply "popping the question" but rather "a dynamic process consisting of observation, collaboration, planning, and action that is based on family and hospital dynamics."

She argues that hospitals and organ procurement organisations need to work together to increase the number of organs available and that "the donation request is too important to delegate to those who are not expert, prepared and focused on a successful outcome."

Source: BMJ-British Medical Journal