Correlates of willingness to consider organ donation among blacks

Willingness for Solid-Organ Donation in Saudi Arabia: A Skyscape View

OBJECTIVES

The number of patients with organ failure in Saudi Arabia is increasing annually, and transplantation offers the best outcome for these patients. However, the number of donors does not meet these needs.

MATERIALS AND METHODS

A questionnaire was distributed to assess the behavior of participants in Saudi Arabia toward different types of organ donation. The questionnaire examined general willingness to donate, deceased donation, living donation, and refusal to donate, as well as paired-exchange donation and next-of-kin consenting.

RESULTS

Of the 1099 participants, most were men (64%) and middle-aged (46%, 31-45 years old), with 36% of participants currently willing to donate or already registered as donors. Although 592 participants (54%) were not yet willing to donate, they believed they could consider making donations in specific circumstances (eg, when a relative is in need). In all circumstances, 10% (n = 108) of the participants refused to donate. With regard to deceased donation, 74% of participants accepted this, but only 29% (n = 322) agreed to consent for donation as next of kin. Of 1099 participants, 143 (13%) were willing to accept altruistic donation. Paired-exchange donation was widely accepted in a cohort study (n = 725, 65%), as opposed to list exchange (n = 540, 49%). Religious beliefs were the main reason behind the refusal of donation in the study cohort (n = 37, 37%). Female participants were less likely to refuse organ donation (odds ratio: 0.562; 95% CI, 0.407-0.775; P < .001), whereas older participants (> 60 years) were more likely to refuse organ donation (odds ratio: 5.457; 95% CI, 1.894-15.722; P = .002).

CONCLUSIONS

This study described the willingness of the Saudi population to donate organs in general and under special conditions, such as deceased donation, living-unrelated donation, altruistic donation, paired-exchange donation, list exchange donation, and next-of-kin consent.

Understanding the pros and cons of organ donation decision-making: Decisional balance and expressing donation intentions among African Americans

Increasing public commitment to organ donation is critical to improving donor kidney availability for end-stage renal disease patients desiring transplant. This study surveyed (N = 1339) African Americans, measuring perceived pros relative to cons of organ donation, to evaluate an existing Transtheoretical Model decisional balance scale and associations between decisional balance and expressing donation intentions. Findings supported the existing scale structure. More positive decisional balance ratios were associated with 1.76 times the odds of expressing intentions (95% confidence interval = 1.52-2.04). Pros were more strongly linked to donation intentions than cons. Greater understanding of organ donation decision-making is valuable for informing interventions that encourage donation.

Promoting Organ Donation among High School Students: An Educational Intervention

Objective—

To evaluate the impact of a high school education program to promote organ donation awareness. The primary outcomes were intention to discuss organ donation with family or friends and actual discussion behavior.

Design—

Longitudinal, observational study.

Methods—

665 high school students filled out evaluations at the beginning and at the end of a 1-hour education program. One month later, the students were asked to report whether they had discussed donation.

Results—

After the program, knowledge and attitude scores and the proportion of students who intended to discuss donation increased ( P < .05). At 1-month follow-up, 48% of students reported actual discussion. Intention has a strong, positive relationship with discussion behavior (odds ratio, 8.27; 95% CI, 3.18–21.51). Ethnicity, sex, and attitude of the students were also predictors of donation discussion behavior.

Conclusions—

This program appears to be effective in prompting discussion of organ donation among high school students.

Racial Differences in Attitudes toward Euthanasia

This article examines racial differences in attitudes toward euthanasia. Many researchers assert distrust of medicine as a substantive explanation for less favorable attitudes toward euthanasia among African Americans, although quantitative measurement has been unsuccessful in showing this. In this article, spiritual meaning, perceived capacity for discrimination (distrust), individual experiences with physicians, and access to healthcare are hypothesized as intervening variables in the relationship between race and attitudes toward euthanasia. With a distinction between individual and collective experiences with discrimination we use path analysis to test previous assertions that African American distrust of medicine leads to more negative attitudes toward euthanasia. Results indicate that while African Americans exhibit higher levels of distrust of medicine, this is not related to attitudes toward euthanasia, which seem predominantly to be a spiritual matter. Our findings have implications for legislative policy, treatment interventions, doctor-patient relations, and sociological understanding of the interaction of race, spirituality, experience, and attitudes.

Increasing the acceptability and rates of organ donation among minority ethnic groups: a programme of observational and evaluative research on Donation, Transplantation and Ethnicity (DonaTE)

Background

Black, Asian and minority ethnic (BAME) groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks.

Objective

To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent.

Methods

Three-phase programme comprising (1) community-based research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; (2) hospital-based research examining staff practices and influences on family consent through ethics discussion groups (EDGs) with staff, a study on intensive care units (ICUs) and interviews with bereaved ethnic minority families; and (3) development and evaluation of a training package to enhance cultural competence among ICU staff.

Setting

Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts (three in London and two in Midlands).

Participants

(1) Community studies: 228 focus group participants; (2) hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and (3) evaluation: 66 health professionals.

Data sources

Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation.

Review methods

Systematic review and narrative synthesis.

Results

(1) Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. (2) Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation (SNOD) reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory (or cardiac) death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. (3) Evaluation: professional development package – a digital versatile disc-based training package was developed to promote confidence and skills in cross-cultural communication (available at:www.youtube.com/watch?v=ueaR6XYkeVM&feature=youtu.be). Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation.

Limitations

Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families.

Conclusions

The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS.

Future work

Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

African American organ donor registration: a mixed methods design using the theory of planned behavior

CONTEXT

A large racial disparity exists in organ donation.

OBJECTIVE

To identify factors associated with becoming a registered organ donor among African Americans in Alabama.

METHODS

Concurrent mixed methods design guided by the Theory of Planned Behavior to analyze African Americans' decisions to become a registered organ donor by using both qualitative (focus groups) and quantitative (survey) methods.

RESULTS

The sample consisted of 22 registered organ donors and 65 non registered participants from 6 focus groups completed in urban (n = 3) and rural (n = 3) areas. Participants emphasized the importance of the autonomy to make one's own organ donation decision and have this decision honored posthumously. One novel barrier to becoming a registered organ donor was the perception that organs from African Americans were often unusable because of the high prevalence of chronic medical conditions such as diabetes and hypertension. Another novel theme discussed as an advantage to becoming a donor was the subsequent motivation to take responsibility for one's health. Family and friends were the most common groups of persons identified as approving and disapproving of the decision to become a donor. The most common facilitator to becoming a donor was information, whereas fear and the lack of information were the most common barriers. In contrast, religious beliefs, mistrust, and social justice themes were infrequently referenced as barriers to becoming a donor.

CONCLUSION

Findings from this study may be useful for prioritizing organ donation community-based educational interventions in campaigns to increase donor registration.

Attitudes to deceased organ donation and registration as a donor among minority ethnic groups in North America and the U.K.: a synthesis of quantitative and qualitative research

OBJECTIVES

A systematic review and synthesis of quantitative and qualitative research were undertaken to examine attitudes to deceased donation and registration as an organ donor among ethnic minorities in the U.K. and North America.

DESIGN

A systematic search and assessments of relevance and quality were conducted. Parallel syntheses were then undertaken of 14 quantitative and 12 qualitative papers followed by their integration. The synthesis was organised around five barriers that emerged as key issues: (1) knowledge regarding deceased donation and registration as a donor; (2) discussion of donation/registration with family members; (3) faith and cultural beliefs; (4) bodily concerns including disfigurement and intactness; and (5) trust in doctors and the health care system.

RESULTS

In all countries, knowledge of organ donation and registration remained low despite public campaigns, with African-Americans and Black African and Black Caribbean populations in the U.K. often regarding organ donation as a 'white' issue. Each of the four attitudinal barriers was also more prevalent among ethnic minorities compared with the majority population. However, the significance of trust and uncertainties regarding religion/faith differed between groups, reflecting salient aspects of ethnic identity and experiences. Differences were also identified within ethnic groups associated with age and generation, although respect for the views of elders often influenced younger peoples' willingness to donate.

CONCLUSION

There is a need for a more nuanced understanding of ethnicity and of variations in attitudes associated with country of origin, age/generation, socio-economic status and area of residence, to inform public campaigns and promote sensitive discussions with bereaved ethnic minority families. The traditional focus on knowledge and attitudes also requires to be complemented by a greater emphasis on organisational and service-related barriers and changes required to enhance ethnic minorities' access to registration as a donor and consent to deceased donation.

The influence of social deprivation on bone donation: a 10 year retrospective study

An audit identifying all surgical bone donors over a 10 year period was conducted. Postcodes were used to link data from the index of multiple deprivation (IMD) 2007 to give each donor a deprivation score. An audit from 2000 to 2010 of primary total hip replacement (THR) patients was also conducted, and similarly a deprivation score was identified for each patient. IMD scores are split into quintiles. A high IMD score indicates a high degree of social deprivation. Conversely low IMD scores indicate a more affluent community. The mean IMD 2007 score was 13.36 (95% CI 13.12-13.60). The national mean IMD score is 21.7 (CI 21.52-21.88). The difference is significant (p < 0.0001). The mean IMD 2007 score of primary THR patients identified in the arthroplasty database was 19.19 (CI 19.00-19.38). The difference between the mean arthroplasty score and the mean score of donors is significant (p < 0.0001). The donation rate increases as social deprivation decreases from quintile to quintile in both: the older patients (CI 1.08-1.14; p < 0.0001) and the general population (CI 1.20-1.25; p < 0.0001). Bone donors are substantially less deprived than their donor pool of THR patients. Donor rates are consistently lower in quintiles which are more deprived.

Distrust in the healthcare system and organ donation intentions among African Americans

The purpose of this study is to further understanding of the association between distrust in the healthcare system and written and verbal expressions of donation intentions among African Americans. We hypothesize that distrust in the healthcare system will be significantly, positively associated with both verbal and written donation intentions. Five hundred and eighty five participants completed a 98-item survey that included scales on distrust in the healthcare system and donation intentions. Bivariate analyses (t-tests, ANOVA, chi-square tests and odds ratios) were used to explore the extent to which donation intentions and distrust in the healthcare system varied by demographic characteristics and the association between the distrust in the healthcare system scale and verbal and written donation intentions. Separate logistic regressions were performed with each of the dependent variables to see if significant associations remained while controlling for confounders. Findings based on the multiple regression indicate that when controlling the participant's education level, distrust in the healthcare system was not significantly related to written donation intentions (OR = 1.04; P = .12). When controlling for education level, health insurance status, Community Health Advocates group and marital status, distrust in the healthcare system was significantly associated with verbal donation intentions (OR = 1.08; P < 0.05). Our results suggest that distrust in the healthcare system varies in the way that it is associated with donation intentions. Future organ donation studies should be conducted to determine the pathways through which distrust in the healthcare system impacts different types of organ donation intentions.

Effects of classroom education on knowledge and attitudes regarding organ donation in ethnically diverse urban high schools

School-based health education is a promising approach for improving organ donation rates, but little is known about its efficacy among ethnically diverse youth. The impact of a classroom intervention was examined in a multicultural high school population where students' ethnicities were 45% African American, 30% Asian American, and 33% Caucasian (allowing for multiracial choices). A baseline survey was administered to all health classes within two wk prior to intervention. On the intervention day, classes randomly assigned to the intervention group received an educational session, followed by a second survey; in control classes, the second survey was taken before the educational session. At baseline, non-Caucasian ethnicity and male gender were each associated with lower levels of willingness to donate. Following the intervention, students in the intervention group demonstrated a significant increase in knowledge scores (p < 0.001), as well as positive movement of opinion regarding willingness to donate (p < 0.0001). Most importantly, the positive changes in opinion occurred independently of ethnicity and gender, in spite of these both being negative predictors of opinion at baseline. These results demonstrate that even a single classroom exposure can impact knowledge levels, correct misinformation, and effect opinion change on organ donation among an ethnically diverse adolescent population.

A qualitative analysis of a significant barrier to organ and tissue donation: receiving less-than-optimal medical care

A key reason for the shortage of transplantable organs and tissue in the United States is the degree of resistance among the public to donating organs and tissue after death. In this article, we explore a single barrier to donation: the concern that medical personnel might provide "less-than-optimal" care to intended donors. Using 2 qualitative methodologies-analysis of family discussions about donation and analysis of in-depth interviews about donation-we explore what participants' discourse reveals about the variations and texture of this concern. The analysis revealed 4 aspects of this concern: (a) Participants expressed different versions of less-than-optimal care, each reflecting different assumptions about how medical personnel may approach the treatment of potential donors. (b) Participants expressed their concerns by describing hypothetical scenarios of medical treatment. These scenarios were designed to play up the plausibility of receiving less-than-optimal care and situated the speaker as the victim in the scenario. (c) Participants' uncertainty about the quality of medical treatment was sufficient grounds for not donating. (d) Participants expressed their concerns about medical treatment in terms of the perceived corruptibility of sociocultural institutions, including medical institutions. This analysis also revealed the lines of reasoning through which participants overcame a concern about receiving less-than-optimal-care. In our view, the most promising line of reasoning expressed by participants was to trust the legal and procedural protections built into the recovery process.

Facts versus `Feelings'

Researchers are already aware that decision making about health issues is not necessarily driven by rational or cognitive-based decision-making processes. This appears to be especially true for the decision to donate organs. Although hints about what is actually driving the decision-making process are scattered throughout the literature, noncognitive factors have not been tested systematically. Structural equation modeling of data gathered from 4426 participants at six different geographic locations in the United States demonstrates that cognitive-based factors (such as knowledge about donation) are less influential on the decision to donate than noncognitive variables such as the desire to maintain bodily integrity, worries that signing a donor card might `jinx' a person, and medical mistrust.

Understanding the relationship between knowledge and African Americans' donation decision-making

OBJECTIVE

To explore the association between different types of knowledge related to donation and transplantation and the expression of donation intentions via one's driver's license, a donor card, or sharing one's wishes with family.

METHODS

Cross-sectional data were gathered via self-administered questionnaire from 425 Black adults, age 18 years and older who were recruited from nine churches in a large metropolitan area in the southeast United States.

RESULTS

Results indicate that knowledge of the allocation system and experiential knowledge of a transplant recipient are associated with donation intentions after controlling for age, gender, and highest level of education. However, the following types of knowledge were unrelated to donation intentions: donation-related statistics (including an understanding of African Americans' overrepresentation among those in need), the donation process, the process for determining medical suitability, and religious institutions' support for donation.

CONCLUSIONS

Findings suggest that the relationship between donation-related knowledge and donation intentions is complex and may depend on the specific type of knowledge being measured.

PRACTICE IMPLICATIONS

Knowledge of the allocation system and experiential knowledge of a recipient may be critical aspects of the donation decision-making process. Research findings suggest the need for an educational approach that seeks to improve the specific types of knowledge that are most strongly associated with donation intentions.

Factors influencing organ donation decisions by African Americans: a review of the literature

The purpose of this article is to review the literature from 1980 to 2005 regarding organ donation decision making by African Americans for themselves and their loved ones and recommend improvements in subsequent studies. Using the behavioral model of health services utilization as an organizing framework, the review procedure consists of a (1) search of health and medical literature using several key words and eight indexes, (2) selection of articles based on specific criteria, and (3) review of each article with regard to the population and sample used, study design, dependent variables addressed, and its findings. The review indicates that predisposing, enabling, and need factors each influence African Americans' organ donation decision making. Retrospective chart reviews provide a good design for future multivariate analyses of the many factors influencing African American decision making. Interventions to influence decision making should emphasize both community education and the process of organ procurement.

More than nation and knowledge: cultural micro-diversity and organ donation in Switzerland

OBJECTIVE

While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation.

METHODS

We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings.

RESULTS

The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs--differences that persist even in the context of strong national identity, relatively homogeneous cultural background, and the public good nature of organ donation.

CONCLUSION

The results demonstrate a need to consider and address cultural factors and barriers when designing organ donation campaigns.

PRACTICE IMPLICATIONS

Centrally designed organ donation campaigns are not likely to be effective and efficient. Message strategies should rather be tailored to different (micro-) cultural groups.

Death and organ procurement: public beliefs and attitudes

While brain death and the dead donor rule (patients must not be killed by organ retrieval) have been clinically and legally accepted in the US as a prerequisite to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents >or=18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: brain dead, in a coma, or in a persistent vegetative state (PVS). Respondents' provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. Over 98% of respondents had heard of the term brain death, but only one-third (33.7%) believed that someone who was brain dead was legally dead. The majority of respondents (86.2%) identified the brain dead patient in the first scenario as dead, 57.2% identified the patient in a coma as dead (Scenario 2), and 34.1% identified the patient in a PVS as dead (Scenario 3). Nearly, a third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed or held beliefs that were not congruent with current definitions of brain death. This study highlights the need for more public dialogue and education about brain death and organ donation.

Achieving equity in referrals for renal transplant evaluations with African-American patients: the role of nephrology social workers

Research over the last 12 years has repeatedly shown that African-American ESRD patients are less likely than white patients to be referred for a transplant evaluation. This article takes an exploratory look at issues surrounding this racial disparity. Among the issues focused on are: (a) the multiple ramifications from this racial disparity; (b) neglected factors which may be militating against the equitable referral of African-American patients; and (c) the vulnerabilities of this patient population. The final focus is on intervention strategies for nephrology social workers and how they might help to facilitate a greater equity in this area of health care with African-American patients.

A cross-validation study of nurses' attitudes and commitment to organ donation in Hong Kong

This study examined the attitudes and commitment to posthumous organ donation among a group of nurses (N=314) in a teaching hospital in Hong Kong. Attitude was operationally defined by a self-report measure of favorable or unfavorable feelings and beliefs about organ donation, whereas commitment was defined by having signed a donor card. Consistent with findings reported in the West, nurses who exhibited favorable attitudes towards organ donation were of greater proportion than those who had signed a donor card. Younger and unmarried nurses were more likely to commit to posthumous organ donation. More than half (55%) of the nurses were undecided about commitment to organ donation, but most of them were likely to sign a donor card. Principal component analysis confirmed the conceptual structure of the Organ Donation Attitude Scale developed by Parisi and Katz (Health Psychol. 5 (1986) 565-580). Reliability of the factor scores (Humanitarian and moral conviction, Fears of bodily mutilation, and Fears of medical neglect) was satisfactory (Cronbach alpha ranged from 0.80 to 0.86). Fears of bodily mutilation were most significantly related to unwillingness to commit to organ donation. Implications of the findings for nursing education are discussed and suggestions for future research made.

Promoting organ donation among high school students: an educational intervention

OBJECTIVE

To evaluate the impact of a high school education program to promote organ donation awareness. The primary outcomes were intention to discuss organ donation with family or friends and actual discussion behavior.

DESIGN

Longitudinal, observational study.

METHODS

665 high school students filled out evaluations at the beginning and at the end of a 1-hour education program. One month later, the students were asked to report whether they had discussed donation.

RESULTS

After the program, knowledge and attitude scores and the proportion of students who intended to discuss donation increased (P < .05). At 1-month follow-up, 48% of students reported actual discussion. Intention has a strong, positive relationship with discussion behavior (odds ratio, 8.27; 95% CI, 3.18-21.51). Ethnicity, sex, and attitude of the students were also predictors of donation discussion behavior.

CONCLUSIONS

This program appears to be effective in prompting discussion of organ donation among high school students.

Knowledge and opinions about organ donation among urban high school students: pilot test of a health education program

BACKGROUND

Increasing the diversity of the organ donor pool might improve the opportunities for people of color on organ transplant waiting lists to receive donated organs. We report on the results of a pilot classroom health education program to improve knowledge about organ donation and transplantation among a diverse student body at an urban high school.

METHODS

The effectiveness of the educational program was evaluated with baseline and follow-up questionnaires which examined: 1) whether the program increased knowledge about organ donation; 2) whether the students' opinions about organ donation changed; and 3) whether the program was related to any changes in opinion.

RESULTS

On the follow-up questionnaire, correct answers on 15 factual questions increased by 18% for the treatment group, compared to 5% for the control group (p = 0.00). Regarding opinions, at baseline 92% of white students had positive opinions about donation, compared to 48% of the students of color (p = 0.00). In the follow-up survey, the increase in positive opinions among the students of color was significantly greater than among white students (p = 0.04). In this pilot study, however, changes in opinions occurred with equal frequency among students in the treatment and control groups. In regression analysis, both knowledge of the subject and discussing donation with one's family were significantly associated with positive opinions about donation.

CONCLUSIONS

Overall, this pilot study provided encouraging evidence that the classroom health education program affected knowledge about organ donation, and that opinions about organ donation are responsive to increases in knowledge.

Current considerations in the issue of brain death

Brain death is an anatomically and physiologically complex process. The societal and psychological implications of brain death and organ donation are equally complex, and they have profound ramifications. Because the vast majority of organ donors die as a consequence of catastrophic intracranial processes, neurosurgeons are in a unique position to positively influence the supply of transplantable organs. Enhanced knowledge of the physiology of evolving brain death will improve the care of potential organ donors and increase the probability of successful transplantation. Likewise, better information about patient and family directives, beliefs, grieving, concurrent exposure to other health care workers, and experiences in the hospital environment will assist the neurosurgeon in providing the family with the opportunity for donation. Neurosurgeons can also play a leading role in the multidisciplinary approach required to support the families of potential organ donors during the transition from neurointerventional therapy to somatic support. New federal regulations on organ donation and a review of the literature about the "art of asking" are presented.

Correlates of support for organ donation among three ethnic groups

Telephone interviews about organ donation were conducted with 4880 white respondents, 634 African-American respondents and 566 Hispanic respondents. Forty-three percent (42.9%) of whites, 31.2% of Hispanics and 22.6% of African-Americans reported that they were willing to donate their organs after their death (p < 0.001). Logistic regression analysis revealed three significant correlates of willingness to donate across all ethnic groups: having had a family discussion about end-of-life issues; the belief that a doctor does all he or she can to save a life before pursuing donation; and concerns about surgical 'disfigurement' of a relative's body after donation. Concerns in relation to body disfigurement were more prevalent among African-American and Hispanic respondents (p < 0.001) than among white respondents. Public education should: a) stress the need for family communication about end-of-life issues including organ donation; b) underline the fact that donation is considered only after all efforts to save the life of the patient are exhausted; and c) reassure minorities that the body of the donor is treated respectfully and not disfigured.

Organ donor potential and performance: size and nature of the organ donor shortfall

OBJECTIVES

To estimate the potential for solid organ donation; to identify modifiable reasons for nondonation.

DESIGN

Retrospective medical records review.

SETTING

Sixty-nine acute care hospitals in four geographic areas of the United States in 1990, and a stratified random sample of 89 hospitals in three of the same areas and 33 of the same hospitals in 1993.

PATIENTS

PATIENTS < or = 70 yrs of age who were brain dead and medically suitable for donation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Standard forms were used to record patient demographic and hospital information. Reasons for nondonation were coded as "not identified," "family not asked," "consent denied," or "other." The main outcome measures were rate of donation and rates of nonidentification, not asking, and nonconsent. Organ donation occurred among 33% (299/916) of medically suitable cases identified in 1990 (95% confidence interval 30% to 36%). Ninety-four potential donors were not identified, 156 were not asked, 326 families denied consent, and 41 potential donors were categorized as "other," including patients who had suffered a cardiac arrest, and medical examiner prohibition of donation. In the 1993 study, organ donation occurred in an estimated 33% of suitable cases. In 1990, rates of donation were highest among patients <50 yrs of age, patients who died of traumatic causes, and non-Hispanic white patients. Logistic regression showed lower odds of donation for African American patients (odds ratio 0.38, 95% confidence interval 0.23 to 0.63) independent of potentially confounding hospital and patient variables (p=.0001). Donation rates did not vary by hospital size or type.

CONCLUSIONS

Despite legal and policy initiatives, only one third of potential donors became donors in 1990, with similar results in 1993. Extrapolating the 1990 findings to the United States suggests a pool of 13,700 medically suitable donors per year. Prospective identification and requesting donation in all suitable potential donor cases could lead to 1,800 additional donors per year.

Organ donation. Psychiatric, social, and ethical considerations

The authors examine the issues of solid cadaveric and living organ donation, taking into account the psychological, legal, and ethical issues of donating an organ. Future recommendations for increasing organ donations are made.