Improving consent in organ donation
Research published in the British Journal of Anaesthesia suggests that organ donation rates in the United Kingdom (UK) could be increased if the issues affecting declined consent are improved. At present, only 30% of the UK population is registered on the National Health Service (NHS) Organ Donor Register (ODR).
From 2003 to 2005, the overall consent rate for donation after brain death (DBD) was 59%. This figure remains largely unchanged with a consent rate of 63% for DBD in 2007-2009. The low consent rate for organ donation in the UK is the largest factor limiting actual organ donor.
Organ donation consent is established by views expressed prospectively via membership of the ODR or views expressed to a family member. However, when a patient is deceased and has not previously expressed a wish to their relatives about organ donation, the healthcare professional will discuss donation with the family. Up to 10% of families of potential donors who are on the ODR still refuse assent to donation. At present, it is accepted practice to respect the family's wishes despite the existence of valid legal consent.
The paper, "Consent for organ donation,"1 published in a special issue regarding organ donation for the British Journal of Anaesthesia, calls for action on the concerns and issues that affect consent.
Staff care and interaction
The relative's experience and interaction with staff can have a huge impact on the decision to consent or refuse donation. The basic principles of medical practice should always be in place. However, a wider treatment of care for the family itself can have a very positive or negative effect on consent. Provisions of physical support in the form of comfortable accommodation, staff availability throughout the patient's admittance, empathy to the family, and a respectful and dignified treatment are factors that can have a positive impact on donation rates.
Make sure the family understands
Understanding brain stem death is an important factor in organ donation. Studies have consistently found that an astounding amount of relatives do not fully understand brain death, even after it has been explained by the attending doctors. It is important that brain stem death is explained so that a relative can fully understand that their loved one is dead before donation takes place. Once this understanding has been reached discussion and consent for organ donation then can begin. In the UK, nurses that specialize in organ donation are trained and have the time to make sure families understand this condition. It has been suggested that allowing a family to witness tests or providing imaging or diagrams to explain concepts could help to improve a family's understanding of brain death.
Practical steps for improving consent:
- Promote the need for families to discuss their wishes regarding organ donation.
- Discuss donation at a time separate to that when the family are informed of the death or its inevitability, in an unhurried manner.
- Ensure the family is given specific information and that in particular, concerning DBD, the concept of brain stem death is fully explained.
- Use an approach pre-planned by the coordinator/specialist nurse and healthcare team that considers specific individual circumstances.
- Vincent A, Logan L. Consent for organ donation. Br J Anaesth 2012; 108:i80-i87.