2010 - TTS International Congress


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Organ Donation and Allocation I

88.6 - Family approach – retrospective analysis of family refusals

Presenter: Guenter, Kirste, Frankfurt/Main, Germany
Authors: Schaub F., Norba D., Kirste G.

FAMILY APPROACH – RETROSPECTIVE ANALYSIS OF FAMILY REFUSALS

ORGAN DONATION AND ALLOCATION I

F. Schaub1, D. Norba2, G.R. Kirste2
1, Deutsche Stiftung Organtransplantation, Frankfurt am Main/GERMANY, 2, Deutsche Stiftung Organtransplantation, Frankfurt/GERMANY

Body: Introduction The approach of the family in order to obtain consent for organ donation is a very challenging situation. It is essential to find the right balance between empathy and understanding for the relatives on one side and advocacy for the recipients in need of a transplant on the other. Since January 2009 the German Organ Transplantation Foundation (DSO) is operating an information system for a detailed documentation of the family approaches for analysis purposes in order to enhance and improve the professional family approach. Methods Up till now 2449 family approaches have been analysed. Results Only in 5.9 % of the cases the deceased has documented his will to donate in written form. 23.7 % of the family decisions were based on the orally expressed will and 43.2 % on the assumed will of the deceased. In 25.7 % of the cases the family made up its own decision. Main reasons for refusal were as a negative attitude of the deceased towards organ donation (35,6 %) or the lack of knowledge of the will of the deceased (26,8 %). Further reasons for refusal were the disagreement between the relatives (10,4 %), the fear of violating the physical integrity (8,8 %) and not being able to accept the death of the relative (5,1 %). Religious reasons or doubts regarding the concept of brain death did not play a noteworthy role. Reasons in favour of organ donation and consent were altruistic motives (25.6 %), the knowledge about the positive attitude of the deceased towards organ donation (44.6 %), the feeling that the sudden death should not be completely in vain (26.6 %). 71. 1 % of the 2449 families were approached by the attending physician only. In 29.0 % of the family approaches the DSO-coordinator was engaged. The consent rate was 56.6 % in the case the attending physician was not accompanied by a coordinator whereas it amounted to 75.1 % with the participation of a trained coordinator. Conclusions Further raise of public awareness is required in order to ensure the persons make up their mind during life time and thus take of the pressure from the relatives. The low consent rate is one of the mayor factors influencing organ donation rates in Germany. Apparently the participation of a coordinator who has profound knowledge about organ donation and enough time during the decision process but also afterwards.

Disclosure: All authors have declared no conflicts of interest.


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