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.