The BMJ has just published an interesting paper on the factors that determine whether family agree to donate the organs of a brain dead relative.

According to the meta-analysis by researchers at the University of Oxford, careful timing and having a transplant coordinator make the request are key factors in whether relatives consent to organ donation.

This time last year, more than 7,500 people in the UK were listed as actively waiting for a transplant.  The biggest barrier to living organ donation is refusal of consent by the relatives of the donor. A 2006 audit of all deaths in nearly 350 intensive care units around the UK found that as many as 41% of relatives refused to allow organ donation.

The authors of the BMJ study analysed 20 observational studies and audits, and identified the following six categories of modifiable factors that apparently influence relatives’ decisions to allow organ donation:

• Information discussed during the request
• Perceived quality of care of the donor
• Understanding of brain stem death
• Specific timing of the request
• Setting in which the request is made
• Approach and expertise of the individual making the request

The most important factor, quite understandably, was whether the request for donation occurred at the same time as the notification of death or testing for brain stem death.  In addition, medical professionals are involved with the request process had a considerable effect on consent rates – a combined approach by hospital staff and coordinators from an organ procurement organisation improved consent, as did the use of race-specific requestors and a dose of common courtesy.

Unsurprisingly, there was a correlation between staff training in organ donation request and donation rates. In fact, the consent rate differed throughout the year in accordance with the training programmes of medical residents.

The fact that the authors of this study were looking at modifiable factors is important – it’s no good looking at whether factors like religion influence the likelihood of relatives consenting to donation as doctors can’t influence such beliefs.  In order to increase the number of people agreeing to donation researchers need to identify elements of the decision making that they can have an effect on.

Targeting these modifiable factors could have a huge effect donation rates and could save lives. The authors point out that “organ donation may be of sufficient benefit to society generally, and to organ recipients specifically, to justify the study and modification of organ donation requests to maximize consent”.

Let’s hope that doctors and hospitals take this information on board and start to approach the families of potential donors with a renewed appreciation of the delicacy of the task.

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Simpkin A et al. (2009) Modifiable factors influencing relatives’ decision to offer organ donation: systematic review. BMJ 21 April 2009 DOI: 10.1136/bmj.b991