Brown Carlos V R, Foulkrod Kelli H, Dworaczyk Sarah, Thompson Kit, Elliot Eric, Cooper Hassie, Coopwood Ben
Department of Surgery, University of Texas Southwestern Medical School-Austin, Trauma Services, University Medical Center Brackenridge, Austin, Texas 78701, USA.
J Trauma. 2010 Feb;68(2):447-51. doi: 10.1097/TA.0b013e3181caab8f.
Our country suffers from a chronic shortage of organ donors, and the list of individuals in desperate need of life-saving organ transplants is growing every year. Family consent represents an important limiting factor for successful donation. We hypothesize that specific barriers to obtaining family consent can be identified and improved upon to increase organ donation consent rates. The purpose of this study was to compare families who declined organ donation to those who granted consent, specifically to identify barriers to family consent for successful organ donation.
We performed a 4-year (2004-2007) retrospective study of potential organ donors covered by our regional organ procurement organization (OPO). Variables collected included age, gender, race, cause of brain death (trauma vs. medical) of the potential organ donor, and elapsed time from declaration of brain death to family approach by OPO. Potential organ donors whose family declined organ donation (DECLINE group) were compared with potential organ donors whose family consented to organ donation (CONSENT group). Groups were compared using univariate and multivariate analysis.
There were a total of 827 potential organ donors during the 4-year period within our OPO region. Overall, 471 families (57%) consented to organ donation, whereas 356 families (43%) declined. Although there was no difference in male gender between the DECLINE and CONSENT groups (59% vs. 53%, p = 0.12), the DECLINE group had more medical brain deaths (73% vs. 58%, p < 0.001), more potential donors aged 50 years or older (43% vs. 34%, p < 0.001), as well as more potential organ donors of Hispanic (67% vs. 43%, p < 0.001) and African American (10% vs. 4%, p < 0.001) descent. In addition, time from declaration of brain death to family approach by OPO was longer for the DECLINE group (350 minutes vs. 112 minutes, p = 0.001). Logistic regression identified race, older age, and death from a medical cause as independent risk factors for failure of obtaining consent.
Several barriers exist to family consent for successful organ donation. Family members of minority populations, medical brain deaths, and older potential donors more often decline consent for organ donation. Family education and resource utilization toward these specific populations of potential organ donors may help to improve organ donation consent rates. In addition, delayed family approach by OPO seems to be associated with decreased consent rates. System improvements to expedite family approach by OPO may likewise lead to improved consent rates.
我国长期面临器官捐献者短缺的问题，急需进行挽救生命的器官移植的患者名单逐年增加。家属同意是成功捐献的一个重要限制因素。我们推测，可以识别并改善获得家属同意过程中的特定障碍，以提高器官捐献同意率。本研究的目的是比较拒绝器官捐献的家属与给予同意的家属，特别是识别成功器官捐献过程中家属同意的障碍。
我们对本地区器官获取组织（OPO）覆盖的潜在器官捐献者进行了一项为期4年（2004 - 2007年）的回顾性研究。收集的变量包括潜在器官捐献者的年龄、性别、种族、脑死亡原因（外伤与疾病），以及从宣布脑死亡到OPO与家属沟通的时间间隔。将家属拒绝器官捐献的潜在器官捐献者（拒绝组）与家属同意器官捐献的潜在器官捐献者（同意组）进行比较。采用单因素和多因素分析对两组进行比较。
在我们OPO地区的4年期间，共有827名潜在器官捐献者。总体而言，471个家庭（57%）同意器官捐献，而356个家庭（43%）拒绝。虽然拒绝组和同意组的男性比例没有差异（59%对53%，p = 0.12），但拒绝组因疾病导致脑死亡的比例更高（73%对58%，p < 0.001），50岁及以上的潜在捐献者更多（43%对34%，p < 0.001），西班牙裔（67%对43%，p < 0.001）和非裔美国人（10%对4%，p < 0.001）血统的潜在器官捐献者也更多。此外，拒绝组从宣布脑死亡到OPO与家属沟通的时间更长（350分钟对112分钟，p = 0.001）。逻辑回归分析确定种族、年龄较大以及因疾病死亡是获得同意失败的独立危险因素。
成功进行器官捐献时，家属同意存在若干障碍。少数族裔群体的家庭成员、因疾病导致脑死亡的情况以及年龄较大的潜在捐献者更常拒绝器官捐献同意。针对这些特定潜在器官捐献者群体进行家庭教育和资源利用可能有助于提高器官捐献同意率。此外，OPO与家属沟通延迟似乎与同意率降低有关。加快OPO与家属沟通的系统改进同样可能提高同意率。
