Family insights on organ donation: Reasons for accept or refuse of organ donation request
Marzieh Latifi1,2, Elahe Pourhosein3, Mohammad Tagi Talebian4, Habib Rahban5, Sanaz Dehghani3,6.
1Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Medical ethics and law research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; 4Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; 5Department of Cardiovascular Disease, Creighton University School of Medicine, St. Joseph Hospital and Medical Center, Phoenix, AZ, United States; 6Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
Background: Regarding the important role that families play in organ donation, the purpose of this study was to determine the factors influencing the relatives’ decisions to refuse consent for organ donation in brain-dead donors.
Methods: This case-control study was performed during the years 2021- 2023 in Tehran, Iran. Of 201 brain-dead potential donors, 139 families accepted (group A), while 62 families refused the donation requests (group B). The data was collected by using a reliable and valid questionnaire. The data was analyzed by using SPSS 18 software.
Results: The study evaluated 201 brain-dead cases with an average age of 35.73 years, predominantly male (63.7%). A significant statistical difference was found between the two groups regarding age (p=0.004), while factors such as family education level, prior discussions about organ donation, and economic status were also significantly different (P<0.001). The comparison of Characteristics of the brain-dead cases is displayed in Table 1.
| Variables | Group A (n=139) | Group B (n=62) | P value | |
| Age | 38.06 ± 17.86 | 30.48 ± 15.76 | 0.004 | |
| Gender | Male | 86(61.9%) | 42(67.7%) | 0.109 |
| Female | 53(38.1%) | 20(32.3%) | ||
| Level of education (BD cases) | Lower than a diploma | 69(49.6%) | 28(45.2%) | 0.109 |
| Diploma | 39(28.1%) | 16(25.8%) | ||
| Academic | 16(11.5%) | 2(3.2%) | ||
| Student | 15(10.8%) | 16(25.8%) | ||
| Marital status | Married | 56(40.3%) | 33(53.2%) | 0.061 |
| Single | 83(59.7) | 29(46.8%) | ||
| Have a child | Yes | 61(43.9%) | 21(33.9%) | 0.119 |
| No | 78 (56.1%) | 41(66.1%) | ||
| Job | Unemployed | 47(33.8%) | 25(40.3%) | 0.327 |
| Employed | 12(8.6%) | 2(3.2%) | ||
| Worker | 12(8.6%) | 5(8.1%) | ||
| Self-employed | 25(18%) | 12(19.4%) | ||
| House maker | 31(22.3%) | 11(17.7%) | ||
| Others | 12(8.6%) | 7(11.3%) | ||
| Family educational level | Under diploma | 45(32.3%) | 41(66.1%) | <0.001 |
| Diploma | 75(54%) | 20 (32.3%) | ||
| Academic | 19(13.7%) | 1(1.6%) | ||
| Economic status | Low | 30(21.6%) | 27(43.5%) | <0.001 |
| Medium | 39(28.1%) | 30(48.4%) | ||
| Good | 70(50.4%) | 5(8.1%) | ||
| Bread winner | Yes | 53(38.1%) | 20(32.3%) | 0.262 |
| No | 86(61.9%) | 42(67.7%) | ||
| Previous donation discussion or having a donor card | Yes | 51(36.7%) | 3(4.8%) | <0.001 |
| No | 88(63.3%) | 59(95.2%) |
After adjusting for risk factors, only prior knowledge of the patient's donation wishes, age, job, nationality, and family educational level were significantly associated with consent(P<0.001). The primary reason for refusal among families was the hope for recovery.
Discussion: The primary barrier to consent was the family's persistent hope for the patient’s recovery, highlighting the emotional complexities surrounding organ donation decisions. This underscores the need for effective communication and education on organ donation wishes and the importance of addressing family concerns to enhance donation rates. Therefore, appropriate training techniques in approaching potential donor families are essential for the healthcare staff.
[1] organ donation
[2] Organ transplantation
[3] Brain death
[4] Family refusal
[5] Family consent