The death of a potential organ donor most commonly occurs in the intensive care unit (ICU). In most Western countries, family members must provide consent for deceased organ donation. Inability to obtain family consent is a significant barrier to organ donation, with international consent rates ranging from 13% to 73%. Data suggest that on receiving news of their loved one’s impending death, family members with denial-related emotional responses are more likely to refuse decedent organ donation. Few published studies have examined families’ emotional response during organ donation decision-making, and those studies have been qualitative and involve only participants who had provided consent to organ donation. These studies often are focused on the direct relationships between family member emotions and their decision to donate rather than examining situational factors that influence family members’ emotional responses. Understanding factors that influence their emotional reactions may inform ways to support family members as they begin grieving, making it more likely that they will provide consent for organ donation.Therefore, the investigators conducted an observational, cross-sectional study with quantitative analytic methods to describe the relationship between concurring situational factors and the emotional responses of families presented with an organ donation decision upon learning of the patient’s imminent death. The investigators recruited 421 family systems from 16 Spanish hospitals within 7 autonomous regions of Spain during a 36-month period. Using a previously validated instrument, the hospital transplant coordinators characterized family members’ emotional responses. The investigators used multiple correspondence analysis to examine how these emotional responses coincided with the patient’s age, circumstances of the patient’s death, family system characteristics and beliefs, and clinician-related factors.The investigators found that families who perceived the death as unexpected, lacked supportive resources (eg, mourning time, low sociocultural level), and reported additional stressors (eg, poor family relations, negative perspectives of clinicians) were more likely to experience denial-related emotional responses. This finding is consistent with prior conceptual work. Such circumstances may cause overload, limiting a family’s ability to accept the reality of the patient’s death. Notably, the study was limited because only characteristics that were directly observable by clinicians were measured; nonobservable factors (eg, unexpressed cognitive and emotional states) were not addressed. To conclude, the investigators recommend ICU clinicians remain mindful of specific situational factors (eg, unexpected death, poor family relations, and negative care perceptions) that may indicate the need for additional support. Such support may allow families to healthily grieve the loss of the patient and thus increase the likelihood of their consenting to organ donation.Jorge López, PhD, MD, corresponding author of this evidence-based review (EBR) article, says that this study is the final phase of a “very extensive research program” focused on family consent to organ donation. The preliminary phases involved qualitative work with hospital transplant coordinators and families of potential donors who had either consented to or declined organ donation, and quantitative examination of converging variables during the patient’s death and the family’s organ donation decision-making.Through these experiences, Dr López has identified 5 “fundamental working principles” that may enhance the scientific quality of research for all investigators: (1) Use interdisciplinary perspectives—Given the complexity of human-based research, “it is essential to integrate professionals from different fields.” (2) Be flexible and capitalize on synergy—“research activities benefit from cooperative dynamics…” by including those “who can make relevant contributions.” (3) Be transparent and practice reciprocity— “share the information and benefits of research” and make “the results available without restriction.” (4) Identify the social utility of the research—“the objectives of research are defined taking into account the social needs and proposals” of relevant stakeholders. (5) Maintain humility—regardless of your expertise, “always listen and learn from professionals” of various backgrounds, “especially those who are involved in daily health care activities.”Dr López contends that these principles are especially relevant for his area of research, as it is an “ever-evolving field.” Given that organ donation is “limited by the gap between organ availability and the number of patients who would potentially benefit from receiving a transplant,” transplant professionals are on “a continuous search for new organ generation alternatives.” These alternatives, such as non-heart-beating donation and nontherapeutic intensive care organ donation procedures are promising, yet introduce additional complexities to organ donation coordination. Dr López acknowledges that “donation researchers must face the challenge” of understanding family experiences in these situations to enhance family support and obtain donation consent. To do so, Dr López believes that “families should be provided with the necessary support to cope with the loss of their loved one and also need to be provided with the adequate conditions” to make an informed decision about the organ donation. He asserts that providing these adequate conditions “is a right” for patients and their families.Dr López contends that this work “helps to systematize and show, from a quantitative point of view, the factors that help predict the emotional reactions of families when coping with the death of their loved one,” and “why certain [emotional] reactions … arise.” He acknowledges that some of these factors are “not modifiable, but knowledge about them helps health care professionals anticipate the occurrence of certain reactions.” He summarizes: “on the basis of our empirical results, our work proposes 3 dimensions that help anticipate the emotional reactions of families: the extent to which the death of the loved one breaks the vital expectations of family members, the extent to which the family has resources to deal with the loss (time, personal resources, support), and the extent to which additional stressors (family conflicts, perception of inadequate personal treatment by health care staff, perception of inadequate health care) converge in the process of illness/death. The combination of a larger number of stressors would encourage more intense reactions, including anger and denial of death.”This feature briefly describes the personal journey and background story of the EBR article’s investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.Jorge López, PhD, MD, is an associate professor at the Public University of Navarre and a member of the IdiSNA, Navarre Institute for Health Research. For years, his research team has coordinated their efforts with the Spanish National Transplant Organization, helping it “make more informed and effective decisions in the field of donation-promoting policies.” His professional experiences throughout his career have inspired him to “devote [him]self more to researching the psychosocial dimensions of health and not toward health care practice.” He is currently teaching social psychology at the university level and conducting research in the field of applied social psychology.As a medical student, he “became highly interested in the psychological and social dimensions of health.” After earning his MD degree, he completed a PhD in social psychology; his dissertation examined family decisional processes during organ donation, which gave rise to his research program. His training as a physician and social psychologist “has helped [him] properly understand and investigate the complexity of different factors that condition success in obtaining donations,” which “comprise medical, sociological, organizational, cultural, and psychosocial processes, among others.”