July 3, 2001 -- Families of potential organ donors are more likely to consent to organ donation if they better understanding who is eligible to donate and how the organ donation process works. It also helps to have a clear understanding of the potential donor's wishes, report researchers in the July 4 issue of Journal of the American Medical Association.
Improving public education about organ donation and thinking more about how healthcare providers and organ procurement organizations request donations from grieving families could help ease the nationwide shortage of donor organs, suggest Laura A. Siminoff, PhD, and co-researchers.
More than 75,000 Americans are waiting for a transplant -- that's a record high according to United Network for Organ Sharing, the nation's organ procurement agency. And 17 of these people die every day waiting for an organ that never shows up.
"I think it's really important for the public to stop thinking of potential donors [only] as 20-year-old motorcycle victims. They should think about the fact that these days, any relatively healthy person who dies largely of a head injury or has an injury that causes the brain to cease functioning is a potential donor," Siminoff, professor of medicine and of bioethics at Case Western Reserve University School of Medicine in Cleveland, tells WebMD.
In a study of the factors that influence families' decisions to consent to or refuse organ donation from a brain-dead relative, the researchers found that families of potential donors who were white, young, and male were almost twice as likely to consent to donation as other families, as were those whose loved ones died from trauma rather than other causes.
In some ways, transplant surgery is a victim of its own success, as made evident by the statistic that the number of patients on waiting lists for solid organs, like livers, hearts, and kidneys, have increased over the last 10 years. Several studies have shown that although nearly 90% of the families of donor-eligible families are asked to donate, only about half of the families actually do so. This is in contrast to a 1993 Gallup poll, in which more than 75% of respondents said they would donate their organs if asked, the authors note.
So how can the gap between the number of organs available and the number of people needing organs reduced?
Siminoff and colleagues found that the ideas and preconceived notions people have about organ donation play a significant role in their final decision. Another factor was the comfort level of the healthcare provider: "Families who met with healthcare providers who rated themselves as generally more comfortable about donation were more likely to donate."
They also found that families who are prepared to expect a request are more likely to donate than those who are surprised by the request.
How the request is framed is also important: "Our results suggest that asking apologetically or mentioning that one is legally required to ask is likely to result in a refusal," they write.
Norman Levinsky, MD, a professor of medicine at Boston University School of Medicine, has written about the ethical issues of organ donation. He confirms that the better-informed families are, and the more tactfully the request is made, the better the chances are that a family will agree to donate.
And in describing the donation process, family members of a potential donor need to understand that surgeons who remove organs for donation are "respectful of the brain-dead person as would be the case if we were doing the surgery as therapy for that person," Levinsky tells WebMD.
The way the request is stated, the actual process of requesting, when it's done, the skill of the requestor, and how the donation might help recipients, for example, by helping two people get off kidney dialysis -- Levinsky considers those the key components of a successful organ donation request.