An exploration of consent issues in Victorian potential donors after brain death (DBD) and cardiac death (DCD)

Hugh Stephens¹, David Pilcher², Helen Opdam³, Gregory Snell⁴, Jeffrey Rosenfeld⁵

¹MBBS/PhD Candidate, Monash University / The Alfred Hospital, Melbourne, Australia, ²Department of Intensive Care, Alfred Hospital, Melbourne, Australia, ³DonateLife Victoria, Melbourne, Australia, ⁴AIRmed Lung Transplant Service, Alfred Hospital, Melbourne, Australia, ⁵Department of Surgery, Alfred Hospital, Melbourne, Australia

Background & Aim

Consent remains one of the greatest barriers to increasing the donor pool [1]. International centres have found family consent rates to be associated with brain death status, age, and ethnicity [2].

Methods

From a database of 18,949 deaths occurring in 22 Victorian hospitals between 1 January 2010 and 30 June 2012, we selected cases where organ donation was discussed with the family or guardian. Examination of patient and family wishes; donor type and whether donation was successful was completed using univariate analysis.

Results

A total of 623 family discussions occurred. Of these, 115 were unsuitable for donation due to a medical contraindication, were considered unsupportable to facilitate donation or were not ventilated in the 6 hours prior to death. There were a total of 175 successful donations (130 DBD donations and 41 DCD donations (n=4 unknown), from 508 potential donors, 34%), and one patient survived to discharge (n=4 data missing). Donation was raised by staff in 73% (n=372) of cases and family in 24% of cases (n=123). The patient was recorded as a consent on the organ donation registry in 54 cases out of 256 checks (remainder not listed). In one of these cases, the family subsequently declined donation. Of those not listed on the registry, 45% of families subsequently consented to donation (n=201), with n=242 refusals and n=5 not asked. Family consent was more likely in patients with confirmed or probable brain death (50% vs 40%, p=0.03), whether the patient died of non-neurological causes (69% vs 50%, p=0.04) and whether families initially raised donation (76% vs 42%, p<0.01). This suggests a potential lack of understanding from patient families of DCD programs. There was no association with age (p=0.40) or gender (p=0.80).

Conclusions

Brain death status, cause of death and who initially raised organ donation were factors predicting consent.