Factors influencing families' consent for donation of solid organs for transplantation

Context Transplantation has become the therapy of choice for patients with organ failure. However, the low rate of consent by families of donor-eligib le patients is a major limiting factor in the success of organ transplantat ion. Objective To explore factors associated with the decision to donate among f amilies of potential solid organ donors. Design and Setting Data collection via chart reviews, telephone interviews with health care practitioners (HCPs) or organ procurement organization (OP O) staff, and face-to-face interviews with family for all donor-eligible de aths at 9 trauma hospitals in southwestern Pennsylvania and northeastern Oh io from 1994 to 1999. Participants Family members, HCPs, and OPO staff involved in the donation d ecision for 420 donor-eligible patients. Main Outcome Measure Factors associated with family decision to donate or n ot donate organs for transplantation. Results A total of 238 of the 420 cases led to organ donation; 182 did not. Univariate analysis revealed numerous factors associated with the donation decision. Multivariable analysis of associated variables revealed that fam ily and patient sociodemographics (ethnicity, patient's age and cause of de ath) and prior knowledge of the patients' wishes were significantly associa ted with willingness to donate (adjusted odds ratio [OR], 7.68; 95% confide nce interval [Cl], 6.55-9.01), Families who discussed more topics and had m ore conversations about organ donation were more likely to donate (adjusted OR, 5.22; 95% Cl, 4.32-6.30), as were families with more contact with OPO staff (adjusted OR, 3.08; 95% Cl, 2.63-3.60) and those who experienced an o ptimal request pattern (adjusted OR, 2.96; 95%,Cl, 2.58-3.40). Socioemotion al and communication variables acted as intervening variables. Conclusions Public education is needed to modify attitudes about organ dona tion prior to a donation opportunity. Specific steps can be taken by HCPs a nd OPO staff to maximize the opportunity to persuade families to donate the ir relatives' organs.