Factors Affecting the Decision to Grant Consent for Organ Donation: A Survey of Adults in England.

Abstract

Solid organ transplantation reduces both morbidity and mortality. Donation rates have increased by more than 60% in the last 6 years in the United Kingdom, largely through improved identification and management of potential donors. However, the next of kin (NoK) decline to consent in 43% of cases-the second highest rate in Europe. We aimed to define factors that influence decisions to consent for organ donation. This is an online survey of 1549 adult residents of England with results weighted to national demographics. Eighty percent would consider donating some or all of their organs. Religion, age, and ethnicity influenced this support. Concerns over body integrity, religion, and effects on the quality of care received reduce support. Only 48% recognized that NoK consent would be sought before any donation. Previous discussion and Organ Donor Register (ODR) enrollment both correlate with NoK consent: 87% would consent after discussion and ODR enrollment, 79% would consent after discussion alone, 55% would consent with ODR registration alone, and 29% would consent without either. Reported misconceptions inhibiting consent included a perceived inability to deregister from the ODR and that individuals were too old to donate. Those who did not wish to donate their own organs were more likely to overrule others' expressed wishes to donate. To ensure that organ donation occurs wherever appropriate, attention should focus primarily on determining an individual's wishes before death, ensuring that any misconceptions are corrected before a decision is made, promotion of ODR enrollment, and challenging those NoK who wish to overrule others' wishes.