Consent rate for organ donation after brain death: A single center experience over 11 years
Kananeh M, Louchart L, Brady P, Mehta C, Rehman M, Lewis A, Greer D, and Varelas P. Consent rate for organ donation after brain death: A single center experience over 11 years. Neurology 2017; 88(16 Suppl 1).
Objective: To evaluate potential factors that played a role in the consent rate in a large tertiary hospital over a period of 11 years. Background: Many patient, family and hospital factors have been associated with obtaining consent for organ donation after brain death (BD), including decoupling, trained requester and translation. Design/Methods: We evaluated all BD declarations in our hospital between 2006 and 2016 regarding consent for donation. We cross-matched the hospital electronic medical records with the records of the local organ procurement organization to identify this population. Results: The Organ Procurement Organization (OPO) spoke to 199 families (58.7% African American (AA), 47.2% female, mean age of 48.2 years). Another 39 families were never approached. There was a 71.4% consent rate. There was no significant relationship between sex, admission diagnosis, ICU (neuro vs. medical vs. surgical), physician speciality (neurology vs. other), time from event to BD declaration or religion and decision to donate. Families were more likely to consent to donation if the patient was non-AA (87.3% vs 62% if AA, p<0.001), had developed diabetes insipidus (72.3% vs 27.7%, p=0.008), was younger (46.6±17.3 vs 52.1±15.6 years, p= 0.039), had a lower BUN at the time of death (17.7±16.7 vs 24.4±20.3 mg/dL, p=0.027), and had a higher PaO2 at the time of the apnea test (225.2±129.8 vs 185.9±111.8 mmHg, p=0.041). In a logistic regression model, only AA race and PaO2 independently predicted refusal of donation (odds, 95%CI, 4.9, 2-12.1, p=0.001 and 0.996, 0.993-0.999, p= 0.013, respectively). Conclusions: Although the majority of BD patients in this large series were AA, their families were almost 5 times less likely to consent for organ donation than non-AA families. There is an urgent need to explore the reasons for low donation rates in this population.
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