Barriers to Obtaining Family Consent for Potential Organ Donors
Barriers to Obtaining Family Consent for Potential Organ Donors
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DOI：
10.1097/ta.0b013e3181caab8f
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发表时间：
2010-02-01
影响因子：
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通讯作者：
Coopwood, Ben
中科院分区：
文献类型：
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作者：
Brown, Carlos V. R.;Foulkrod, Kelli H.;Coopwood, Ben
背景：我国长期存在器官供体短缺的问题，迫切需要器官移植的人每年都在增加。家属同意是捐赠成功与否的重要限制因素。我们假设可以确定并改进获得家庭同意的具体障碍，以提高器官捐赠同意率。本研究的目的是比较那些拒绝器官捐赠的家庭和那些同意捐赠的家庭，特别是确定家庭同意器官捐赠成功的障碍。方法：我们进行了一项为期4年（2004-2007）的回顾性研究，研究对象是我们地区器官采购组织（OPO）涵盖的潜在器官捐献者。收集的变量包括潜在器官供体的年龄、性别、种族、脑死亡原因（创伤vs医疗）。以及从宣布脑死亡到OPO向家属求助所经过的时间。将家庭拒绝器官捐献的潜在器官捐献者（DECLINE组）与家庭同意器官捐献的潜在器官捐献者（CONSENT组）进行比较。各组采用单因素和多因素分析进行比较。结果：我区4年间共有827例潜在器官供体。总体而言，471个家庭（57%）同意器官捐赠，356个家庭（43%）拒绝。尽管在男性性别方面，DECLINE组和CONSENT组之间没有差异（59%对53%，p = 0.12），但DECLINE组有更多的医学脑死亡（73%对58%，p < 0.001），更多的50岁或以上的潜在捐赠者（43%对34W， p < 0.001），以及更多的西班牙裔（67%对43%，p < 0.001）和非洲裔美国人（10%对4%，p < 0.001）血统的潜在器官捐赠者。此外，DECLINE组从宣布脑死亡到OPO家属就诊的时间更长（350分钟比112分钟，p = 0.001）。Logistic回归发现，种族、年龄较大和医疗原因死亡是未能获得同意的独立风险因素。结论：家庭同意器官捐献存在几个障碍。少数民族人口的家庭成员、医学脑死亡和年龄较大的潜在捐赠者往往拒绝同意器官捐赠。针对这些潜在器官捐赠者的特定人群进行家庭教育和资源利用可能有助于提高器官捐赠的同意率。此外，OPO的延迟家庭方法似乎与同意率下降有关。改进制度以加快OPO的家庭处理方式也可能提高同意率。
Background: 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.Methods: 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.Results: 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. 34W 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.Conclusion: 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.