[Interviews with families of organ donors: analysis of motivation for acceptance or refusal of donation]

Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU

Little is known about the memories of relatives after they have been confronted with the brain death of a loved one and the request for organ donation. We conducted this study, guided by Grounded Theory, to explore relatives' experiences, their interactions with health care providers and what influenced their memories. We interviewed 40 relatives (31 consenting to and 9 refusing organ donation) of 33 brain-dead individuals. Relatives described their experiences as a difficult process composed of several stages spanning from the initial encounter to the final decision about donation. Long-term memories of bereaved relatives were influenced by the characteristics of their decision-making style (clear vs. ambivalent) and the perceived quality of the interaction with professionals on the intensive care unit. Organ-focused behavior of professionals and an ambivalent decision-making style of relatives appear to be risk factors for traumatic memories.

Pénurie d'organes et de tissus en France

INTRODUCTION

Despite an increase in the number of brain deaths over the past 10 years, France faces a shortage of organs for transplantation. A high percentage of families oppose organ donation. Over the past decade, the mean age of organ donors has risen by 10 years.

METHODS

Specific provisions of the public health code have regulated transplantation activity since 1994. Implementation of the Transplant Plan in 2000 led to the investment of substantial financial and human resources in this area. The data reported here come from the 2004 report of the French Transplantation Agency, now the Biomedicine Agency, and from its database.

RESULTS

Data for 2004 show more than 2500 listed donors, with at least one organ taken from 1291 and more than 4000 organ transplants. The donors' mean age was 47 years. Cerebrovascular diseases accounted for most of the deaths; traffic accidents, which have decreased substantially in recent years, caused only 16%. The number of people with brain death reported in France is difficult to measure but we estimate the figure to be 3500. Refusal rates remain high and are an obstacle to increasing transplants.

DISCUSSION

We need to appeal to live donors. We are also setting up pilot programs to use organs from non-heart-beating donors. With these new initiatives we hope to reach rates equal to those in Spain, the European leader in organ transplants.

[Factors associated with refusal of organ donation in France from 1996 to 1999]

OBJECTIVE

The demand for organ transplantation exceeds organ donation in France and refusal to organ donation remains close to 30%. This study analysed risk factors associated with refusal of organ donation.

STUDY DESIGN

Retrospective study.

PATIENTS

All potential organ donors registered by the French transplantation agency between 1996 and 1999 were included, excepted those with a contraindication to organ procurement or a logistic problem: 5,911 donors were included.

METHODS

Data analysed were those collected routinely on the French database. A logistic model was used to identify statistically significant factors and a stepwise procedure was performed to identify independent factors linked with refusal.

RESULTS

In univariate analysis, age > 60 years and age < 13 years, stroke, lack of suicide, localisation in an university hospital and in others regions than the Centre-East of France were associated with a higher refusal rate. Year of harvesting, low level of organ procurement activity were not associated with refusal. In multivariate analysis, factors independently associated with refusal were age > 60 years [Odds-Ratio (OR) = 1.2)] or age < 13 years (OR = 1.5), stroke (OR = 1.2), meningitis and cranial tumour (OR = 1.4), suicide (OR = 0.5) and others French regions than Centre-East.

CONCLUSION

The risk factors described should be taking into account when family's members are approached for donation. They represent the interactions between the history of the donors, harvesting organisation, and sociocultural factors.

Organ donation and family decision-making within the Spanish donation system

This study analyses the variables associated with the decisions made by families of potential organ donors to give or deny consent for the extraction of organs. Different indicators were recorded in 68 cases of family interview for petition of consent carried out in 13 Spanish hospitals. Those variables showing the strongest relation with family decision (donation/refusal of consent) are knowledge shown by the family about the deceased's wishes with regard to donation (p<0.001), family relationship climate (p<0.01), expression of family's satisfaction level with medical attention received (p<0.01) and number of relatives present at the consent request interview (p<0.01). Logistic regression on family decision with considered variables correctly predicted relatives' final choice in 98.4% of cases. In turn, multivariate exploratory analysis highlights a potential association between the expression of the deceased's wishes and several concurrent variables in the process (satisfaction with personal treatment and medical attention received, emotional reactions in the interviews of notification of death and consent request). It also shows that patterns of reaction and family participation in this process may vary according to the sex of the deceased relative. Results suggest that both educational efforts devoted to promoting a positive attitude toward donation in the general population and the training of health professionals involved in the generation of organs may be key factors in reducing organ shortage.