Update on Causes of Family Refusal for Organ Donation and the Related Factors: Reporting the Changes Over 6 Years

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Abstract

Introduction

After significant improvement of family consent rate to organ donation in recent years due to increase in cultural activities and social awareness, the plateau has been reached.[1] This study was performed to detect responsible causes of this plateau and also the related factors.

Methods

We reviewed exact causes of family refusal from July 2015 to December 2016. The expert coordinators responsible for handling the failed cases chose the cause of refusal from the previously prepared list which was rechecked by contacting the non donor families by phone. The results were compared to those obtained from similar group of families in 2009. roll of age and number of family members in consent rate were also evaluated.

Results

In the 18 months, 353 potential cadaveric donors referred to our organ procurement unit. Mean age was 42.6 and 62 % were male. Main causes of brain death were cerebrovascular accident and trauma (41.2% and 32.6%). Family consent rate was 84.4 % and 55 families rejected the request for organ donation. Leading cause of family refusal was religious believes which came from Islamic minorities families mainly. (43.6%). “Brain death denial” decreased significantly from 44.4% in 2009 to 12.7% in 2015-2016. “Opposite donor wishes”, “unstable family mood”, “belief of body integrity” and “expectation of a miracle” were the other causes which had no reportable change. Neither significant differences were noted for the average age, nor for the gender. In consent and refusal groups in both eras. However, when broken down into three age clusters, significant difference was seen in rate of refusal to donation among age clusters. (P <0.001). Middle-aged potential donors were less likely to be consented by their families in comparison to the two edges of the age spectrum. Besides overall difference of number of family members in consent and refusal groups, it was higher in the middle aged potential donors, using Kruskal-Wallis test. (6.6 ± 2.7 vs. 9.1 ± 3.1, P<0.001). On the contrary, family consent rate was lower in this group. Therefore, Kendall's tau-b test showed negative correlation between the variable and family consent status. (p<0.05 and correlation coefficient= −0.812)

Conclusion

Noticeable rise of consent rate, has made the little religious cause of family refusal prominent. Therefore, this cause seems to be the next barrier to fight against, which needs careful approach to religious leaders and societies.

Reference:

1. Vincent A, Logan L. Consent for organ donation. British journal of anaesthesia. 2012; 108: 80–87.

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