Update on Causes of Family Refusal for Organ Donation and the Related Factors: Reporting the Changes Over 6 Years

Abstract

IntroductionAfter significant improvement of the family consent rate to organ donation (OD) in recent years, owing to an increase in cultural activities and social awareness, a plateau has been reached. This study was performed to detect the causes for this plateau. MethodsWe reviewed exact causes of family refusal after providing a list of failed potential donors from July 2015 to December 2016. The expert coordinators responsible for handling the failed cases chose the cause of refusal from the previously prepared list. The list was rechecked by contacting the nondonating families by phone. The results were compared with those obtained from a similar group of families in 2009. ResultsIn an 18-month period of OD practice, 353 potential brain dead organ donors were referred to our organ procurement unit. The mean age of the cases was 42.6, and 62% were male. The main causes of brain death were cerebrovascular accident and trauma (41.2% and 32.6%, respectively). The family consent rate was 84.4%, and 55 families rejected the request for OD. The leading cause for family refusal was religious beliefs, mainly from Sunni families (43.6% vs 8.6% in 2009). Brain death denial reduced significantly from 44.4% in 2009 to 12.7% in 2015 and 2016 (P < .001 for both causes). Opposite donor wishes, unstable family mood, the belief in body integrity, and expectation of a miracle were the other causes of no reportable changes. ConclusionsAfter massive social activities in the media designed to enhance social awareness regarding brain death and OD, people currently do not doubt the irreversibility of death, as in the past. However, the noticeable increase in the consent rate has made the religious cause of family refusal prominent. Therefore, this cause seems to be the next barrier to fight against, requiring a careful approach to religious leaders and societies.