Difficult Consent Scale for Organ Procurement in Practice

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Abstract

Introduction

In Iran, seeking consent for organ procurement after brain death follows an opt-in system that engages all first-degree relatives. Reaching to any consensus (sometimes among different generations) may be challenging. Retrospective study of 150 brain dead cases in Massih Daneshvari Organ Procurement Unit, Tehran, Iran, had led the author to invent a scale (difficult Consent Scale, DCS)[1] to predict the degree of difficulty of each family interview before venturing into it. DCS has 17 determinants extracted from the real family approaches, 2 majors and 15 minors, and ascribes a 3-level scale to each minor, from 1, easiest, to 3, most difficult. Its predictive power, however, should be tested in real contexts.

Materials and Methods

In a prospective study (September 2016 to April 2017), 3 professional consent-seekers were asked to apply DCS to 115 family approaches before venturing into it. The final scores, then, related to two categories, donate and not-donate. Both groups showed normal distribution using Kolmogorov-Smirnov test (p<0.001). The average score of each minor determinant in two groups were compared by independent-t-test and more significant determinants in not-donate group were identified. To each major determinant, 10 score (plus or minus) was ascribed.

Results

Of 115 family approaches, 87 were successful and 28 were failed (75.6% success rate). The average score in donate group was 21 and in not-donate group was 31. 11 minor determinants (ethnicity, number of family members, socioeconomic status, family values, previous experience & knowledge of organ donation, trust to medical system, waiting for miracle, problem in gathering relatives, hospital staff and time & place) were significantly different in two groups, while the other 4 were not. {{AbstractFigure.2}}

Conclusion

Difficult Consent Scale could significantly differentiate the successful and failed family approach and act as a predictive tool. In the multi-factorial context of family approach in Iran, some determinants have more significant effect on the final result and must be ascribed more scores to make the modified DCS a better predictive tool. However, our study needs a bigger sample volume and DCS must be applied to other cultures to be generalized to them too.

References:

1. Difficult Consent Scale: An Assessment Scale for Anticipated Difficulty in Obtaining Consent for Organ Donation, Experimental and clinical transplantation. 2017; 15: 57–59.

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