A paradigm shift in the approach to families for organ donation: honoring patients' wishes versus request for permission in patients with Department of Motor Vehicles donor designations.

BACKGROUND: Recently, we reported a donation consent rate of only 80% for patients designated as donors with the Department of Motor Vehicles (DMV), which equaled missed opportunities for 17 potential transplant recipients during 3 months. We undertook the current study to increase our donation consent rate in patients with prior DMV donor designations. METHODS: In October 2006, we modified our approach for donor consent by asking to honor the patient's wishes rather than asking for permission. The consent rates from January through September 2006 (preinitiative) were compared with rates from October through April 2007 (postinitiative). RESULTS: During the preinitiative period, 66 approaches were made; 24 patients were registered as donors with the DMV (36%). In total, consent for donation was obtained from 43 families (65%). Only 20 of 24 (83%) families of patients with prior DMV designation donated, and 23 of 42 families of patients with no DMV designation donated (55%). One hundred forty-one organs were successfully transplanted (average 3.3 organs per procurement). Of 71 postinitiative approaches, 42 families donated (59%) and 125 organs were transplanted (average 3.0 organs per procurement). Consent for donation was obtained in 23 of 52 non-DMV-designated donors (44%). The families of all 19 DMV-designated donors consented for donation (100%). CONCLUSION: Modifying our approach to consent for organ donation to honor the patient's wishes based on DMV donor designation rather than ask for permission increased organ procurement in this population to 100%. However, further efforts are needed at the state and national levels regarding the recognition of first-person consent for organ donation.

Organ donation: family members NOT honoring patient wishes.

BACKGROUND: Each year, many organ donation opportunities are missed because of the lack of familial consent. Occasionally, patients' consents for organ donation through the Department of Motor Vehicles (DMV) are posthumously overruled by their families. We assessed the number of potential opportunities for organ donation that are missed because of lack of familial consent despite previously expressed wishes for donation as registered with the state DMV. METHODS: The medical records of potential donors were reviewed to ascertain appropriateness for donation, familial consent or denial for donation, and number of organs transplanted from each eligible donor. These data were then compared with DMV data regarding prior patient designations either for or against organ donation. RESULTS: One hundred four approaches for donation were made to families during a 3-month period. The DMV donor status was available for 84 patients; 25 were designated as organ donors. Five families refused consent for organ donation despite the patient's documented wishes to donate (80% organ recovery). Twenty-two consents were obtained from the remaining 59 patients not listed as donors by the DMV (37% organ recovery). An average of 3.4 organs were transplanted from eligible donors. CONCLUSION: DMV designation for organ donation increases the yield of consent for organ donation. However, despite prior DMV designations for donation, 20% of families ultimately denied consent for donation. This translated into 17 missed opportunities for potential transplant recipients during the 3-month study period.