Organ donation rates held back by families refusing consent, study finds

Family members refusing to consent to the
organs of their loved ones being donated
after they die are keeping organ donation
rates in Australia low, new research has
found.
While doctors were good at identifying
which patients may be suitable for organ
donation, low next-of-kin consent rates
meant the donor rate was substantially
less than the best performing countries,
the study, published in the Medical
Journal of Australia on Monday, found.
Researchers from the Royal Prince Alfred
hospital in NSW conducted an audit of all
427 deaths at the hospital during a six-
month period in 2012. Of those, 10 patients
were found to be eligible for organ
donation, but family members refused in
half of those cases.
Of the remaining five patients, only three
became organ donors because brain death
in the other two occurred more than 90
minutes after life support was removed,
making them ineligible because the organs
would be too starved of oxygen by that
time to be useable.
An author of the study, Associate Professor
Michael O’Leary, who is co-medical
director of the NSW Organ and Tissue
Donation Service, said it highlighted just
how few patient deaths led to suitable
donors being found, with under 1% of
those who died becoming donors.
It also meant family consent for suitable
donor patients was critical, he said.
“Even if a dead patient is found to have
previously consented on the organ
donation register, family members of that
person are always consulted and given the
chance to override that,” O’Leary said.
“Nobody could imagine a system where
family members who were completely
opposed to organ donation were made to
sit and watch as their loved one was
wheeled out of an intensive care unit for
organ donation.
There were a number of reasons people
refused consent, he said.
“But for many, it’s a highly traumatic time
for them and sometimes it’s just not
something they can think about,” he said.
Australia has an opt-in organ donation
register, but O’Leary said several reviews
had found an opt-out system made little
difference to donation rates, because
family were still given the final say.
It meant ensuring clinicians are well-
trained in discussing organ donation with
bereaved family members and
highlighting its benefits, and ensuring
people signed up to the organ donation
register, were essential to driving up
donation numbers, he said.
“If you are an unfortunate person whose
loved one who has become brain-dead in
an intensive care unit, if you say no to
donation, it’s not like there will be another
donor the next day. It’s such a rare event.”
The study marked the first time a
comprehensive audit of all deaths in an
Australian hospital had been carried out to
identify the organ donation potential of
those patients.
It follows the release earlier this month of
the Organ and Tissue Authority
performance report by the federal health
minister, Fiona Nash.
There were 378 organ donors last year, that
report found, a decrease of 3% from the
previous year. Those donors helped 1,117
patients, with one organ or tissue donor
helping up to 10 people.
Research shows that more than 60% of
Australian families give consent for organ
and tissue donation to proceed, jumping to
80% when families know and have
discussed the donation decision of their
family member.
“In 2015 we will focus on continued change
in clinical practice such as increasing the
number of identified potential donors,
improving the donation process for loved
ones and enhancing IT systems to support
organ and tissue donation and
transplantation,” Nash said.