Objectives: We sought to assess consent rates for organ donation from potential brain-dead donors, and to identify factors associated with variation in consent for donation that could guide the development of targeted interventions to increase organ consent rates.
Design, Setting, and Subjects: We used data provided by the Organ Procurement and Transplantation Network to analyze the 35,823 organ procurement organization–reported eligible deaths (potential brain-dead donors ≤ 70 yr of age) from January 1, 2008, to October 31, 2011.
Measurements and Main Results: Excluding cases where donation authorization was based on prior patient documentation (e.g., donor registry), consent was obtained on 21,601 (68.9%), not obtained on 8,727 (27.8%), and not requested on 1,080 (3.4%) eligible deaths. There were substantial differences in consent rates among racial/ethnic groups (77.0% in whites, 67.5% in Hispanics, 54.9% in blacks, and 48.1% in Asians) and organ procurement organizations (median [interquartile range]: 72.4% [67.5–87.3]). In generalized estimating equation models, with whites and patients ages 18–39 yr as the respective reference groups, consent for donation was less likely to be obtained among Hispanics (odds ratio 0.54; 95% confidence interval 0.44–0.65), blacks (odds ratio 0.35; 95% confidence interval 0.31–0.39), Asians (odds ratio 0.31; 95% confidence interval 0.25–0.37), and eligible donors ages 55–64 (odds ratio 0.72; 95% confidence interval 0.67–0.77), and ≥ 65 yr (odds ratio 0.58; 95% confidence interval 0.52–0.64).
Conclusions: In presenting the first published analyses of consent rates among all eligible deaths, this study confirms smaller and regional studies that showed significant differences in consent rates between whites and racial/ethnic minorities (blacks, Hispanics, and Asians). The study also identifies considerable variation in consent rates between age groups and between organ procurement organizations. Critical care physicians are usually the front-line providers for potential brain-dead donors and their next-of-kin, and these data highlight the need for further research to identify the causes of variation in consent rates and mechanisms to increase rates where appropriate.
1 Department of Medicine, Division of Gastroenterology, University of Pennsylvania
2 Clinical Center for Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
3 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA.
4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
5 Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, PA.
*See also p. 678.
Dr. Reese is supported by NIH grant K23-DK078688-01. Dr. Goldberg is supported by NIH grant F32-DK089694-01. Dr. Halpern is supported by NIH grant K08-HS018406. Health Resources and Services Administration (contract 234-2005-370011C). The contents are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
The authors have not disclosed any potential conflicts of interest.
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