Family approach – retrospective analysis of 6617 donation requests

Franz Schaub¹, Carl-Ludwig Fischer-Froehlich¹, Guenter Kirste²

¹Deutsche Stiftung Organstransplantation (DSO), Frankfurt am Main, Germany, ²Universitätsklinik Freiburg, Freiburg, Germany

Introduction: The German Transplantation-Legislation was modified in November 2012 with promoting voluntary decision of people about organ donation. Despite the current national transplantation-scandal, citizens have a positive attitude towards organ donation. Even though the law now requires every citizen to enter their decision about organ donations in the minutes, the decedent’s written consent is missing most of times. Therefore donor families have to be approached about this specific issue. Thereby the refusal rate of 40% exceeds the ones of other countries. It was evaluated which factors might influence consent rate beyond personal decisions during donation requests.

Methods: 6.617 documented donation requests between the years 2009 and 2011 were analysed for factors that could influence the decisions beyond personal values.

Results: The decedent’s was often unknown (67.4%) and then the family’s decision was based on assumptions about the patient’s will. This resulted in 4.097 (61.9%) consents and 2.520 (38.1%) refusals. 4.669 (70.6%) of these donation-requests were done by the physician in charge only and 1.948 (29.4%) with a coordinator present additionally. Predictive (p<0.001) for consent were the presence of a specially trained transplantation coordinator and the timing of the request for organ donation (especially when the donation request was initiated in the time period when measures for certifying death by neurologic criteria were started, p<0.001).

Conclusion: There is a big difference between the attitude displayed in surveys and the real rate of consent to organ donation. The major challenge is that improved caregiving of donor family members is required. Donation requests should be done by trained physician as well as coordinators. Waiting until the finalized certification of brain death may not be appropriate nowadays: A transparent description of all detail contributes to build up a therapeutic relation to donor families and this allows them to have a proper timeframe for a stable decision about organ donation.