Solid organ transplantation is the therapy of choice for patients with end-organ failure. Despite numerous advances in the field, the number of individuals awaiting solid organ transplantation continues to exceed the supply of organs.
One approach to increasing the supply of organs is to maximize donation rates of eligible patients. Family consent rates for donation are currently only 30% to 40%.
Although families decline donation for many reasons, it is indisputable that there are myths believed to be true by families that do not aid in increasing the donation rate: patients will be prematurely declared dead to ‘get better organs’, the solid organ transplantation organ allocation system is corrupt, and rich people ‘get the good organs’.
Particularly damaging is the perception that the physician caring for a loved one may have allegiance to a future organ recipient. This can compromise the trust necessary for increasing donation rates. Therefore, it is important that physicians caring for the potential donor do not discuss donation with the family.
During the last hours of life, the physician caring for the potential donor must continue to provide aggressive care. The donor family must understand and believe that everything has been done for their loved one.
However, all families of potential donors must be approached for consent. For heart-beating donors, discussions should be initiated in a private setting as early as possible after declaration of brain death.
A member of the hospital team should be present to answer medical questions after and a trained organ procurement organization (OPO) representative should approach the family.
Many states have enacted legislation that requires health professionals to notify their regional organ procurement organization of potential candidates and very likely the organ procurement organization representative will be familiar with the possible donor several hours before death is declared.
Organ procurement organization representatives are trained to effectively communicate with donor families, and studies clearly demonstrate their success in increasing procurement rates over those of physicians on the care team.
In addition, these representatives exercise innovative approaches to minority families, who are historically less likely to agree to donation.
Razek T, Olthoff K, Reilly PM. Issues in potential organ donor management. Surg Clin North Am 2000;80:1021.
Siminoff LA, Gordon N, Hewlett J, et al. Factors influencing families’ consent for donation of solid organs for transplantation. JAMA 2001;286