Mojtabaee M, Ghorbani F, Mohsenzadeh M, Beigee F S
Organ Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tracheal Diseases Research Center, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Transplant Proc. 2018 Jan-Feb;50(1):10-13. doi: 10.1016/j.transproceed.2017.11.021.
After significant improvement of the family consent rate to organ donation (OD) in recent years, owing to an increase in cultural activities and social awareness, a plateau has been reached. This study was performed to detect the causes for this plateau.
We reviewed exact causes of family refusal after providing a list of failed potential donors 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. The list was rechecked by contacting the nondonating families by phone. The results were compared with those obtained from a similar group of families in 2009.
In an 18-month period of OD practice, 353 potential brain dead organ donors were referred to our organ procurement unit. The mean age of the cases was 42.6, and 62% were male. The main causes of brain death were cerebrovascular accident and trauma (41.2% and 32.6%, respectively). The family consent rate was 84.4%, and 55 families rejected the request for OD. The leading cause for family refusal was religious beliefs, mainly from Sunni families (43.6% vs 8.6% in 2009). Brain death denial reduced significantly from 44.4% in 2009 to 12.7% in 2015 and 2016 (P < .001 for both causes). Opposite donor wishes, unstable family mood, the belief in body integrity, and expectation of a miracle were the other causes of no reportable changes.
After massive social activities in the media designed to enhance social awareness regarding brain death and OD, people currently do not doubt the irreversibility of death, as in the past. However, the noticeable increase in the consent rate has made the religious cause of family refusal prominent. Therefore, this cause seems to be the next barrier to fight against, requiring a careful approach to religious leaders and societies.
近年来，由于文化活动和社会意识的提高，家庭对器官捐赠（OD）的同意率有了显著提高，但目前已达到平稳状态。本研究旨在探寻出现这种平稳状态的原因。
我们通过列出2015年7月至2016年12月期间潜在捐赠失败的捐赠者名单，回顾了家庭拒绝捐赠的确切原因。负责处理失败案例的专家协调员从预先准备好的列表中选择拒绝原因。通过电话联系未捐赠家庭对该列表进行重新核对。将结果与2009年一组类似家庭的结果进行比较。
在18个月的器官捐赠实践期间，353名潜在脑死亡器官捐赠者被转介到我们的器官获取单位。这些案例的平均年龄为42.6岁，62%为男性。脑死亡的主要原因是脑血管意外和创伤（分别为41.2%和32.6%）。家庭同意率为84.4%，55个家庭拒绝了器官捐赠请求。家庭拒绝的主要原因是宗教信仰，主要来自逊尼派家庭（43.6%，而2009年为8.6%）。脑死亡否认率从2009年的44.4%显著降至2015年和2016年的12.7%（两种原因的P值均<0.001）。捐赠者意愿相悖、家庭情绪不稳定、身体完整性信念以及对奇迹的期望是没有明显变化的其他原因。
在媒体开展旨在提高社会对脑死亡和器官捐赠认识的大规模社会活动之后，目前人们不再像过去那样怀疑死亡的不可逆性。然而，同意率的显著提高使得家庭拒绝捐赠的宗教原因变得突出。因此，这一原因似乎是下一个需要克服的障碍，需要谨慎对待宗教领袖和社会。
