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“Effective” Requesting

A Scoping Review of the Literature on Asking Families to Consent to Organ and Tissue Donation

Chandler, Jennifer A. LLM1,2; Connors, Matthew JD1; Holland, Giles MSc1; Shemie, Sam D. MD3,4

Author Information
doi: 10.1097/TP.0000000000001695


Families are often asked for their consent to donation of their deceased relative’s organs or tissues. This request is made at a time of loss and trauma for the family. It is important both for the well-being of the family as well as for benefit to potential transplant recipients that the request for family consent be conducted well. This scoping review of the literature was conducted to support the work of a Canadian expert group sponsored by Canadian Blood Services to develop consensus on leading practices for end-of-life conversations with families of potential donors. One of the purposes of a scoping review, and the one we pursue here, is to examine the extent, range, and nature of research activity in a particular field to provide a map that aids in visualizing the issues, arguments, and evidence available in the field.1

This scoping review addresses the following question: What are the main themes and conclusions in the recent literature on asking families to consent to organ or tissue donation by a deceased family member. Our objective is to offer an organized and comprehensive overview of the diverse literature on this topic, which includes ethical commentary, qualitative and quantitative empirical research, and a small number of systematic reviews on specific questions.


Our scoping review followed 5 main steps: (1) identify the research question, (2) identify relevant studies, (3) select studies for inclusion, (4) extract the data, and (5) summarize and present the results.1

Research Question Identification

Our objective is to provide a comprehensive map of the research activity surrounding the topic of making an “effective” request for family consent to deceased organ and tissue donation. We take this to include discussion of the meaning of “effective” in this context, as well as all consideration of factors that make requests effective or ineffective.

Identifying Relevant Studies

We conducted a search of the research databases MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL between January 1, 2000, and February 20, 2015, restricting the search to peer-reviewed journal articles in English. We searched for articles that satisfied the following search criteria in any field:

(“organ don*” OR “tissue don*”) AND (family OR families OR familial OR relative OR relatives) AND (consent)

After the automatic removal of duplicate results using Endnote reference manager software and manual removal of a few remaining duplicate results, the search of these 5 databases generated a set of 957 citations.

Selecting Studies for Inclusion

Two authors screened the starting set of 957 citations on the basis of title and abstract according to the inclusion and exclusion criteria set out in Table 1. Where only a title was available, we screened on the basis of the title alone if it was sufficient for us confidently to apply the inclusion and exclusion criteria. Otherwise, we reviewed the full text of the article to screen the citation. This screening process generated a final set of 168 articles, which were retained for this review.

Article selection criteria

Data Extraction and Analysis

Two authors reviewed the 168 articles retained after screening to identify the points raised in each article that were relevant to “effective requesting.” For example, the impact on consent rates of “decoupling” (or separating the declaration of brain death from the discussion of donation) was identified as a relevant point in several articles. Another example, addressed mainly in the commentary articles rather than empirical studies, is whether the primary objective of the request to the family is to secure consent and/or to promote family well-being. We viewed this as relevant given that an “effective” request is one that achieves its objectives. Once the points raised by all the included articles were identified, we worked to create a useful conceptual map that grouped related points together. We refer to these 2 levels of organization as subtopics and topics. In a second phase, we grouped the resulting topics into 6 overarching themes (described later in the results) to make the presentation of the detailed information more useful and comprehensible. Finally, we reread all of the articles addressing a given subtopic to produce a narrative description of each subtopic.


Our sample consisted of 168 articles that contained a substantial discussion of (a) whether, when and how to ask families to consent to organ or tissue donation, or (b) the characteristics of families or decedents that affect families’ decisions or family satisfaction with their decisions. We have divided the topics, issues, and evidence contained in these articles into 6 main themes:

  • The objectives of requesting and encouraging family consent to donation (Table 2).
  • The effect of the donation decision on family well-being (Table 3).
  • The process of requesting family consent (Table 4).
  • The impact of the quality of the care for the deceased and for the family (Table 5).
  • The content and manner of the request for family consent (Table 6).
  • Characteristics of the family and deceased that affect the request for family consent (Table 7).
The objectives of requesting and encouraging family consent to donation
The effect of the donation decision on family well-being
The process of requesting family consent
The impact of the quality of care for the deceased and for the family
The content and manner of the request for family consent
Selected characteristics of the family and deceased that affect the request for consent

The results are organized by theme in tables below, indicating major topics and subtopics relevant to the theme that are addressed in the literature. We include an introduction to each table indicating how the theme is related to the topic of “effective requesting” from the authors' perspectives. The tables integrate information from a heterogeneous set of articles (including both ethical commentary and professional opinion as well as data-supported studies). Basic information about the type of article referenced below (commentary or empirical study), study date and country are included in a supplementary table, SDC, to this article.

The Objectives of Requesting and Encouraging Family Consent to Donation

One fundamental question has to do with the primary objective of requesting family consent to donation. This could be to secure consent and to maximize donation. Instead, it could be to assist the family to make the decision that is most conducive to their longer-term well-being or reflects the decision they would have made under less stressful conditions. The position taken on this question may lead to differences of opinion on the permissibility of persuasive communication techniques.

The Effect of the Donation Decision on Family Well-Being

The psychological impact of the donation decision on families in the short term and long term is relevant to the topic of how to request family consent to donation. Obligations to protect the family could limit requestors’ efforts to overcome family reluctance if it were known that this could inflict psychological harm. Conversely, if the evidence showed that donation tended to comfort grieving families and that refusing families had a greater tendency to regret their decisions, efforts to encourage family consent would be consistent with care for the family’s well-being. However, in addition to analysis based on the ethical principle of beneficence (promotion of the family’s well-being), manipulative communication techniques might cause an independent ethical harm to family autonomy.

The Impact of the Process of Requesting Family Consent

Various aspects of the process of the request have been explored for their effects on consent rates and family satisfaction. Not surprisingly, careful planning, an unhurried approach, a comfortable and private location, and experienced requestors are all beneficial. Divergences in opinion do appear, however, on whether decoupling of the notification of death and the discussion of organ donation are necessary, as well as on whether it is better for the request to be made by a member of the health care team or professional organ donation personnel.

The Impact of the Quality of the Care for the Deceased and for the Family

The family's perceptions of the quality of care, compassion, and respect shown for the deceased, as well as the empathy and care shown toward the family affect not just the likelihood of family consent, but also family satisfaction with the process.

The Content and Manner of the Request for Family Consent

The content of the discussion with families also influences consent rates and family satisfaction. Particular points are known to impede consent or to increase the psychological harm to the family and should be addressed. In addition, the manner of the requestor influences consent rates and family satisfaction. Although confident, prodonation attitudes are preferable to apologetic or hesitant ones, requestor behavior that is perceived as focused primarily on organ procurement may offend and distress families.

Characteristics of the Family and Deceased That Affect the Request for Family Consent

A broad range of demographic and other characteristics of both family decision makers (the literature reviewed raises the following characteristics of families as associated with consent or refusal to donate: ethnicity, culture, religion, values and beliefs, psychological factors, gender, age, education, socioeconomic status, marital status, relationship to the deceased, residential location family structure and dynamics, and the number of family members present at the request) and the deceased (the characteristics of the deceased patient that have been examined for possible associations with family willingness to consent are: age, sex, religion, medical insurance status, nature of the death (trauma, illness), donation protocol, marital status, residential location, education, and existence of prior expressed wish to donate) are addressed in the literature on family consent rates. In Table 6, we summarize the discussion of selected characteristics that are most relevant to the question of how best to request family consent. In particular, certain reasons for family reluctance have to do with social, cultural, or psychological factors that are not easily amenable to change, raising the question of the appropriateness of aggressive attempts to overcome that reluctance. On the other hand, reluctance may flow from erroneous factual beliefs that can and should be corrected to allow families to make an informed decision.


This scoping review reveals that there is a large body of peer-reviewed journal literature addressing the question of how to modify the process and manner of the request to increase rates of family consent to maximize donation. Another important line of inquiry has been the impact on family well-being of the decision to donate, the prevalence of decision regret, and features of the donation experience that enhance or undermine family well-being. The literature is heterogeneous, encompassing ethical commentary and professional opinion as well as empirical studies of a wide range of qualitative and quantitative designs from a range of countries (see Table S1, SDC, for basic details). A scoping review does not attempt to synthesize or assess the quality of evidence, but instead to map the nature of research activity on a question or topic that may otherwise be difficult to visualize. Taking into account these limitations, the authors' impression is that the literature generally supports the intuitive expectations that compassionate and respectful care for the deceased and family, listening for and addressing family concerns, and an attitude to donation that is positive (but not solely procurement-focused) is best for both consent rates and family well-being.

In the articles reviewed, the objective of requesting family consent is usually presumed to be to secure consent and maximize donation. However, there is also widespread acceptance in this literature of a parallel obligation to protect family well-being. In our view, these 2 objectives are not necessarily in conflict, such as where a family that is initially reluctant to donate due to the stress of the moment is supported to reach a decision to donate that later provides solace. However, persuasion that overrides family misgivings may produce longer-term suffering, such as where the family worries about “giving up too soon,” or where the family faces internal dissension or disapproval from a cultural community. Attention to the types of risk factors associated with this type of longer-term harm is important to avoid this risk to families.

Another theme relates to persuasive communication strategies in requesting family consent to donation. Although some efforts to persuade appear to us to be justifiable and beneficial—such as correcting erroneous beliefs about donation—the appropriateness of others has been questioned (eg, by Truog7) particularly if they are manipulative or aggressive in ways that pose risk to family well-being, undermine family autonomy, or offend the public's sense of due care for the grieving family.

An important dimension for many Western countries is to respond appropriately to ethnic, cultural and religious diversity that may affect family willingness to donate. Further jurisdiction- and population-specific research should explore the ways in which approaches may be tailored to take into account these different attitudes given that they affect the balance of benefits and harms that a family may feel as a result of their donation decision.


Although we have aimed to be as comprehensive as possible, we had to draw lines that excluded some topics that we felt were not sufficiently central to our topic. These topics are indicated within the exclusion criteria (Table 1).

Scoping reviews do not typically include a data evaluation (or quality assessment) step, as the objective is to offer a comprehensive map of multidisciplinary research in a field rather than to offer evidence-based conclusions on narrower research questions.1 Quality assessment is made more challenging by the heterogeneity of the field—in terms of questions, methods, and populations studied. We included only peer-reviewed journal articles, excluding a range of informal publications, conference abstracts, case law and legislation, and editorials.

Another limitation is that cultural changes or changes in policy and practice over the period of the scoping review, such as an increase in donor registration in some jurisdictions, may have altered family perceptions and expectations in a way that affects the continuing relevance of earlier observations and recommendations about how to ask families to consent.

As indicated in Table S1, SDC, many of the empirical studies reviewed here are qualitative interview-based studies involving fairly small numbers of participants. Although this kind of study allows for rich and in-depth exploration of participant experience, it limits the generalizability of the results.

The term “authorization” rather than “consent” in relation to family decision making is favored in some jurisdictions, and it is possible that articles using only the term “authorization” may have been missed by our search strategy.


J.C. acknowledges the support of the Bertram Loeb Organ and Tissue Donation Institute, the Canadian Institutes for Health Research and the Canadian National Transplant Research Program, and Canadian Blood Services.

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1. Arksey H, O’Malley L. Scoping studies: toward a methodological framework. Int J Soc Res Methodology. 2005;8:19–32.
2. Williams MA, Lipsett PA, Rushton CH, et al. The physician's role in discussing organ donation with families. Crit Care Med. 2003;31:1568–1573.
3. Streat S. Clinical review: moral assumptions and the process of organ donation in the intensive care unit. Crit Care. 2004;8:382–388.
4. Metzger RA, Taylor GJ, McGaw LJ, et al. Research to practice: a national consensus conference. Prog Transplant. 2005;15:379–384.
    5. Donovan DW. Defending the donor's decision. An analysis of the ethical issues related to first-person declarations of organ donation. Health Prog. 2008;89:61–67.
      6. Rady MY, Verheijde JL, McGregor JL. Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine. Resuscitation. 2010;81:1069–1078.
      7. Truog RD. When does a nudge become a shove in seeking consent for organ donation? Am J Bioeth. 2012;12:42–44.
      8. Anker AE, Akey JE, Feeley TH. Providing social support in a persuasive context: forms of social support reported by organ procurement coordinators. Health Commun. 2013;28:835–845.
      9. Ashkenazi T, Klein M. A practical Israeli strategy for appealing for organ donation. Prog Transplant. 2013;23:173–179.
        10. Siminoff LA, Agyemang AA, Traino HM. Consent to organ donation: a review. Prog Transplant. 2013;23:99–104.
        11. de Wispelaere J, Stirton L. Advance commitment: an alternative approach to the family veto problem in organ procurement. J Med Ethics. 2010;36:180–183.
        12. Bramstedt KA. Family refusals of registered consents: the disruption of organ donation by double-standard surrogate decision-making. Intern Med J. 2013;43:120–123.
        13. Traino HM, Siminoff LA. Attitudes and acceptance of First Person Authorization: a national comparison of donor and nondonor families. J Trauma Acute Care Surg. 2013;74:294–300.
          14. Chon WJ, Josephson MA, Gordon EJ, et al. When the living and the deceased cannot agree on organ donation: a survey of US organ procurement organizations (OPOs). Am J Transplant. 2014;14:172–177.
          15. Whyte KP, Selinger E, Caplan AL, et al. Nudge, nudge or shove, shove-the right way for nudges to increase the supply of donated cadaver organs. Am J Bioeth. 2012;12:32–39.
          16. Black I, Forsberg L. Would it be ethical to use motivational interviewing to increase family consent to deceased solid organ donation? J Med Ethics. 2014;40:63–68.
          17. Shaw D, Elger B. Persuading bereaved families to permit organ donation. Intensive Care Med. 2014;40:96–98.
          18. Siminoff LA, Traino HM, Gordon NH. An exploratory study of relational, persuasive, and nonverbal communication in requests for tissue donation. J Health Commun. 2011;16:955–975.
          19. Siminoff LA, Mercer MB. Public policy, public opinion, and consent for organ donation. Camb Q Healthc Ethics. 2001;10:377–386.
          20. Cleiren MP, Van Zoelen AA. Post-mortem organ donation and grief: a study of consent, refusal and well-being in bereavement. Death Stud. 2002;26:837–849.
          21. Carey I, Forbes K. The experiences of donor families in the hospice. Palliat Med. 2003;17:241–247.
          22. Bellali T, Papadatou D. Parental grief following the brain death of a child: does consent or refusal to organ donation affect their grief? Death Stud. 2006;30:883–917.
          23. Siminoff L, Mercer MB, Graham G, et al. The reasons families donate organs for transplantation: implications for policy and practice. J Trauma. 2007;62:969–978.
          24. Merchant SJ, Yoshida EM, Lee TK, et al. Exploring the psychological effects of deceased organ donation on the families of the organ donors. Clin Transplant. 2008;22:341–347.
          25. Tavakoli SA, Shabanzadeh AP, Arjmand B, et al. Comparative study of depression and consent among brain death families in donor and nondonor groups from March 2001 to December 2002 in Tehran. Transplant Proc. 2008;40:3299–3302.
            26. Hogan NS, Coolican M, Schmidt LA. Making meaning in the legacy of tissue donation for donor families. Prog Transplant. 2013;23:180–187.
            27. Luo J, Rothnie A, Sanderson E, et al. Families’ knowledge, attitudes, and experiences of the tissue donation process. Prog Transplant. 2013;23:265–271.
              28. Hogan N, Schmidt L, Coolican M. The bereavement process of tissue donors’ family members: responses of grief, posttraumatic stress, personal growth, and ongoing attachment. Prog Transplant. 2014;24:288–293.
              29. Tong YF, Holroyd EA, Cheng B. Needs and experiences of Hong Kong Chinese cadaveric organ donor families. Hong Kong J Nephrol. 2006;8:24–32.
                30. Manzari ZS, Mohammadi E, Heydari A, et al. Exploring families' experiences of an organ donation request after brain death. Nurs Ethics. 2012;19:654–665.
                31. Shih FJ, Lai MK, Lin MH, et al. Impact of cadaveric organ donation on Taiwanese donor families during the first 6 months after donation. Psychosom Med. 2001;63:69–78. [Shih et al. 2001b].
                32. Exley M, White N, Martin JH. Why families say no to organ donation. Crit Care Nurse. 2002;22:44–51.
                33. Rodrigue JR, Scott MP, Oppenheim AR. The tissue donation experience: a comparison of donor and nondonor families. Prog Transplant. 2003;13:258–264.
                  34. Blok GA. The impact of changes in practice in organ procurement on the satisfaction of donor relatives. Patient Educ Couns. 2005;58:104–113.
                  35. Rodrigue JR, Cornell DL, Howard RJ. Pediatric organ donation: what factors most influence parents' donation decisions? Pediatr Crit Care Med. 2008;9:180–185.
                  36. Rodrigue JR, Cornell DL, Howard RJ. The instability of organ donation decisions by next-of-kin and factors that predict it. Am J Transplant. 2008;8:2661–2667.
                  37. Jacoby L, Jaccard J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of kin. Am J Crit Care. 2010;19:e52–e61.
                  38. Siminoff LA, Traino HM, Gordon N. Determinants of family consent to tissue donation. J Trauma. 2010;69:956–963.
                  39. Morais M, da Silva RC, Duca WJ, et al. Families who previously refused organ donation would agree to donate in a new situation: a cross-sectional study. Transplant Proc. 2012;44:2268–2271.
                  40. Jansen NE, Van Leiden HA, Haase-Kromwijk BJ, et al. Appointing ‘trained donation practitioners’ results in a higher family consent rate in the Netherlands: a multicenter study. Transpl Int. 2011;24:1189–1197.
                  41. Kesselring A, Kainz M, Kiss A. Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU. Am J Transplant. 2007;7:211–217.
                  42. Bellali T, Papazoglou I, Papadatou D. Empirically based recommendations to support parents facing the dilemma of paediatric cadaver organ donation. Intensive Crit Care Nurs. 2007;23:216–225.
                  43. Thomas SL, Milnes S, Komesaroff PA. Understanding organ donation in the collaborative era: a qualitative study of staff and family experiences. Intern Med J. 2009;39:588–594.
                  44. Smudla A, Hegedűs K, Miháy S, et al. The HELLP concept—relatives of deceased donors need the help earlier in parallel with loss of a loved person. Ann Transplant. 2012;17:18–28.
                  45. Frutos MA, Ruiz P, Requena MV, et al. Family refusal in organ donation: analysis of three patterns. Transplant Proc. 2002;34:2513–2514.
                    46. Marks WH, Wagner D, Pearson TC, et al. Organ donation and utilization, 1995-2004: entering the collaborative era. Am J Transplant. 2006;6:1101–1110.
                    47. West R, Burr G. Why families deny consent to organ donation. Aust Crit Care. 2002;15:27–32.
                    48. Weiss J, Coslovsky M, Keel I, et al. Organ donation in Switzerland—an analysis of factors associated with consent rate. PLoS One. 2014;9:e106845.
                    49. Martinez JM, Lopez JS, Martin A, et al. Organ donation and family decision-making within the Spanish donation system. Soc Sci Med. 2001;53:405–421.
                    50. Siminoff LA, Gordon N, Hewlett J, et al. Factors influencing families' consent for donation of solid organs for transplantation. JAMA. 2001;286:71–77.
                    51. Siminoff LA, Lawrence RH, Zhang A. Decoupling: what is it and does it really help increase consent to organ donation? Prog Transplant. 2002;12:52–60.
                    52. Rodrigue JR, Cornell DL, Howard RJ. Organ donation decision: comparison of donor and nondonor families. Am J Transplant. 2006;6:190–198.
                    53. Bogan LM, Rosson MW, Petersen FF. Organ procurement and the donor family. Crit Care Nurs Clin North Am. 2000;12:23–33.
                      54. Haddow G. Donor and nondonor families' accounts of communication and relations with healthcare professionals. Prog Transplant. 2004;14:41–48.
                      55. Aldridge A, Guy BS. Deal breakers in the organ donation request process. Health Mark Q. 2008;23:17–31.
                        56. Moraes EL, Massarollo MC. Family refusal to donate organs and tissue for transplantation. Rev Lat Am Enfermagem. 2008;16:458–464.
                          57. Vane DW, Sartorelli KH, Reese J. Emotional considerations and attending involvement ameliorates organ donation in brain dead pediatric trauma victims. J Trauma. 2001;51:329–331.
                          58. Eckenrod EL. Psychological/emotional trauma of donor families. Transplant Proc. 2008;40:1061–1063.
                          59. Brown CV, Foulkrod KH, Dworaczyk S, et al. Barriers to obtaining family consent for potential organ donors. J Trauma. 2010;68:447–451.
                          60. Jacoby LH, Breitkopf CR, Pease EA. A qualitative examination of the needs of families faced with the option of organ donation. Dimens Crit Care Nurs. 2005;24:183–189.
                          61. Bellali T, Papadatou D. The decision-making process of parents regarding organ donation of their brain dead child: a Greek study. Soc Sci Med. 2007;64:439–450.
                          62. Long-Sutehall T, Winstanley E, Clarkson AJ, et al. Evaluation of the experiences of family members whose deceased relative donated tissues at the NHSBT dedicated donation facility in Speke, Liverpool. Cell Tissue Bank. 2012;13:537–546.
                          63. Rodriguez-Villar C, Paredes D, Alberola M, et al. Perception of transplant coordinator regarding relatives' attitude toward tissue donation request. Transplant Proc. 2012;44:2525–2528.
                          64. Ebadat A, Brown CV, Ali S, et al. Improving organ donation rates by modifying the family approach process. J Trauma Acute Care Surg. 2014;76:1473–1475.
                            65. Muraine M, Menguy E, Martin J, et al. The interview with the donor's family before postmortem cornea procurement. Cornea. 2000;19:12–16.
                            66. Anker AE, Feeley TH. Why families decline donation: the perspective of organ procurement coordinators. Prog Transplant. 2010;20:239–246.
                            67. Stouder DB, Schmid A, Ross SS, et al. Family, friends, and faith: how organ donor families heal. Prog Transplant. 2009;19:358–361.
                            68. Wulff B, Heinemann A, Meins S, et al. A retrospective evaluation of informed consent for tissue donation within a year of the donor's death. Forensic Sci Int. 2013;231:240–243.
                              69. Marmisa G, Escalante JL. Organ donation interviews in community of Madrid, Spain. Transplant Proc. 2002;34:23–24.
                                70. Helms AK, Torbey MT, Hacein-Bey L, et al. Standardized protocols increase organ and tissue donation rates in the neurocritical care unit. Neurology. 2004;63:1955–1957.
                                71. ACRE Trial Collaborators. Effect of “collaborative requesting” on consent rate for organ donation: randomised controlled trial (ACRE trial). BMJ. 2009;339:b3911.
                                72. DuBay DA, Redden DT, Haque A, et al. Do trained specialists solicit familial authorization at equal frequency, regardless of deceased donor characteristics? Prog Transplant. 2013;23:290–296.
                                73. Lenzi JA, Sarlo R, Assis A, et al. Family informed consent to organ donation—who performs better: organ procurement organizations, in-hospital coordinators, or intensive care unit professionals? Transplant Proc. 2014;46:1672–1673.
                                74. Geissler A, Gerbeaux PR, Maitrejean C, et al. Cornea donation: evaluation of a training session to obtain consent by telephone. Transplant Proc. 2005;37:4634–4636.
                                  75. Maloney R, Altmaier EM. Caring for bereaved families: self-efficacy in the donation request process. J Clin Psychol Med Settings. 2003;10:251–258.
                                  76. Blok GA, Morton J, Morley M, et al. Requesting organ donation: the case of self-efficacy. Effects of the European Donor Hospital Education Programme (EDHEP). Adv Health Sci Educ Theory Pract. 2004;9:261–282.
                                  77. Collins TJ. Organ and tissue donation: a survey of nurse's knowledge and educational needs in an adult ITU. Intensive Crit Care Nurs. 2005;21:226–233.
                                  78. Elding C, Scholes J. Organ and tissue donation: a trustwide perspective or critical care concern? Nurs Crit Care. 2005;10:129–135.
                                  79. Howard DH, Siminoff LA, McBride V, et al. Does quality improvement work? Evaluation of the organ donation breakthrough collaborative. Health Serv Res. 2007;42(6 Pt 1):2160–2173.
                                  80. Cohen J, Ben Ami S, Ashkenazi T, et al. Attitude of health care professionals to brain death: influence on the organ donation process. Clin Transplant. 2008;22:211–215.
                                  81. Pelleriaux B, Roels L, Van Deynse D, et al. An analysis of critical care staff's attitudes to donation in a country with presumed-consent legislation. Prog Transplant. 2008;18:173–178.
                                  82. Siminoff LA, Marshall HM, Dumenci L, et al. Communicating effectively about donation: an educational intervention to increase consent to donation. Prog Transplant. 2009;19:35–43.
                                  83. Mullins GC, Simes D, Yuen KJ. Approaching families for organ donation-intensivists' perspectives. Anaesth Intensive Care. 2012;40:1035–1039.
                                  84. Mulvania P, Mehakovic E, Wise C, et al. Successful international collaboration improves family donation conversations resulting in increased organ donation. Transplant Proc. 2014;46:2058–2065.
                                  85. Siminoff LA, Lawrence RH, Arnold RM. Comparison of black and white families' experiences and perceptions regarding organ donation requests. Crit Care Med. 2003;31:146–151.
                                  86. Patterson GM. The path not taken: Social and cultural barriers to thoracic transplantation. Clin Chest Med. 2006;27:503–509.
                                    87. Baughn D, Auerbach SM, Siminoff LA. Roles of sex and ethnicity in procurement coordinator family communication during the organ donation discussion. Prog Transplant. 2010;20:247–255.
                                    88. Rassin M, Lowenthal M, Silner D. Fear, ambivalence, and liminality: key concepts in refusal to donate an organ after brain death. JONAS Healthc Law Ethics Regul. 2005;7:79–83.
                                      89. Rodriguez-Villar C, Ruiz-Jaramillo MC, Paredes D, et al. Telephone consent in tissue donation: effectiveness and efficiency in postmortem tissue generation. Transplant Proc. 2007;39:2072–2075.
                                      90. Shih FJ, Lai MK, Lin MH, et al. The dilemma of “to-be or not-to-be”: needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition. Soc Sci Med. 2001;53:693–706. [Shih et al. 2001a].
                                      91. Hoover SM, Bratton SL, Roach E, et al. Parental experiences and recommendations in donation after circulatory determination of death*. Pediatr Crit Care Med. 2014;15:105–111.
                                      92. Neidlinger N, Gleason B, Cheng J. Honoring deceased donors with a unique family-designed statement followed by a moment of silence: effect on donation outcomes. Prog Transplant. 2013;23:188–193.
                                      93. Wilson P, Sexton W, Singh A, et al. Family experiences of tissue donation in Australia. Prog Transplant. 2006;16:52–56.
                                        94. Siminoff LA, Arnold RM, Hewlett J. The process of organ donation and its effect on consent. Clin Transplant. 2001;15:39–47. [Siminoff et al. 2001b].
                                        95. Dorflinger L, Auerbach SM, Siminoff LA. The interpersonal process in tissue donation requests with “undecided” next of kin. Prog Transplant. 2012;22:427–434.
                                          96. Sanner MA. Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event. J Crit Care. 2007;22:296–304.
                                          97. Weathersbee TE, Maynard DW. Dialling for donations: practices and actions in the telephone solicitation of human tissues. Sociol Health Illn. 2009;31:803–816.
                                            98. Verble M, Worth J. Overcoming families' fears and concerns in the donation discussion. Prog Transplant. 2000;10:155–160.
                                              99. Zink S, Wertlieb S. A study of the presumptive approach to consent for organ donation: a new solution to an old problem. Crit Care Nurse. 2006;26:129–136.
                                              100. Joule RV, Bernard F, Geissler A, et al. Binding communication at the service of organ donations. Int Rev Soc Psychol. 2010;23:211–238.
                                                101. Anker AE, Feeley TH. Asking the difficult questions: message strategies used by organ procurement coordinators in requesting familial consent to organ donation. J Health Commun. 2011;16:643–659.
                                                102. Anker AE, Feeley TH. Difficult communication: compliance-gaining strategies of organ procurement coordinators. J Health Commun. 2011;16:372–392.
                                                103. Verble M, Bowen GR, Kay N, et al. A multiethnic study of the relationship between fears and concerns and refusal rates. Prog Transplant. 2002;12:185–190.
                                                104. Lesoeurs G, Cossart J, Olivier C, et al. Transplant coordinators and communication with potential organ donor migrant families in France: an exploratory qualitative study. Transplant Proc. 2009;41:631–633.
                                                  105. Moraes BN, Bacal F, Teixeira MC, et al. Behavior profile of family members of donors and nondonors of organs. Transplant Proc. 2009;41:799–801.
                                                    106. Sgorbini M. Organ donation in the context of brain death in an Egyptian Australian. Transplant J Australasia. 2011;20:20–24.
                                                      107. Ashkenazi T, Klein M. Predicting willingness to donate organs according to the demographic characteristics of the deceased's family. Prog Transplant. 2012;22:304–310.
                                                      108. Dubay D, Redden D, Haque A, et al. Is decedent race an independent predictor of organ donor consent or merely a surrogate marker of socioeconomic status? Transplantation. 2012;94:873–878.
                                                        109. Siminoff LA, Traino HM. Consenting to donation: an examination of current practices in informed consent for tissue donation in the US. Cell Tissue Bank. 2013;14:85–95.
                                                        110. Yong BH, Cheng B, Ho S. Refusal of consent for organ donation: from survey to bedside. Transplant Proc. 2000;32:1563.
                                                        111. Cheng B, Ho CP, Ho S, et al. An overview on attitudes towards organ donation in Hong Kong. Hong Kong J Nephrol. 2005;7:77–81.
                                                          112. Wang M, Zhang W, Wang X. The principle of family determination in organ donation: the application of Confucian ethics. HEC Forum. 2008;20:183–196.
                                                            113. Xie WZ, Ye QF, Liu W, et al. Differences in willingness to donate cadaveric organ between young donor families and adult donor families: evidence from the Hunan Province, China. Chin Med J (Engl). 2013;126:2830–2833.
                                                              114. Bresnahan MJ, Mahler K. Ethical debate over organ donation in the context of brain death. Bioethics. 2010;24:54–60.
                                                                115. Siemionow MZ, Rampazzo A, Gharb BB. Addressing religious and cultural differences in views on transplantation, including composite tissue allotransplantation. Ann Plast Surg. 2011;66:410–415.
                                                                116. Randhawa G. Death and organ donation: meeting the needs of multiethnic and multifaith populations. Br J Anaesth. 2012;108(suppl 1):i88–i91.
                                                                117. Bilgel F. The effectiveness of transplant legislation, procedures and management: cross-country evidence. Health Policy. 2013;110:229–242.
                                                                  118. Singh P, Kumar A, Sharma RK. Factors influencing refusal by relatives of brain-dead patients to give consent for organ donation: experience at a transplant centre. J Indian Med Assoc. 2004;102:630.
                                                                    119. Sque M, Long T, Payne S, et al. Why relatives do not donate organs for transplants: ‘sacrifice’ or ‘gift of life’? J Adv Nurs. 2008;61:134–144.
                                                                    120. Krieglstein TR, Welge-Lüssen UC, Priglinger S, et al. Consenting to cornea donation: influencing factors. Graefes Arch Clin Exp Ophthalmol. 2002;240:816–821.
                                                                    121. Dodd-McCue D, Cowherd R, Iveson A, et al. Family responses to donor designation in donation cases: a longitudinal study. Prog Transplant. 2006;16:150–154.
                                                                      122. Lawlor M, Dobbins T, Thomas KA, et al. Consent for corneal donation: the effect of age of the deceased, registered intent and which family member is asked about donation. Br J Ophthalmol. 2006;90:1383–1385.
                                                                      123. Dodd-McCue D, Tartaglia A. African American consent and nonconsent cases: are there significant differences? Prog Transplant. 2007;17:215–219.
                                                                        124. Van Leiden HA, Jansen NE, Haase-Kromwijk BJ, et al. Higher refusal rates for organ donation among older potential donors in the Netherlands: impact of the donor register and relatives. Transplantation. 2010;90:677–682.
                                                                        125. Verble M, Worth J. Addressing the unintended adverse consequences of first-person consent and donor registries. Prog Transplant. 2012;22:25–32.

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