Timing is crucial for family consent in brain dead organ donors

The researchers believe that discussing the issue of donation with relatives of victims of catastrophic brain injury earlier on in the process may have a negative effect on the consent rate.

The Dutch team set out to examine the ways in which organ donation from brain dead donors has changed over time, using data collected retrospectively from 228 patients declared brain dead between 1987 and 2009 in the Erasmus MC University Medical Center, Netherlands.

Yorick de Groot and co-workers found that several trends emerged over the 22-year time period in the Dutch hospital, including, significantly, that the introduction of the Donor Register in the Netherlands in 1998 increased patient-consent rates more than seven-fold, from 5.7% to 41%. The Donor Register, designed as an opt-in system, allows people to register their preferences regarding organ donation. Those who aren't registered can donate only with consent from their next of kin.

In addition, the investigators observed that, over the past 15 years, there was a decline in donation after brain death from 89% to 58%, whilst donation after circulatory death increased from 11% to 42% in the same period.

Most significantly, the time at which organ donation is first discussed with relatives has changed over the 22-year time period. Initially, between 1987 and 1998, organ donation was mentioned for the first time after the completion of all tests, conforming to the National Brain Death protocol. However, after 1998, organ donation was discussed in most cases after determination of loss of consciousness and the absence of brainstem reflexes but before completion of the confirmatory tests.

The researchers speculated that the introduction of the Donor Register may have allowed the physician to consider the possibility of organ donation at an earlier time than was required before its introduction in 1998.

Dr Erwin Kompanje, the lead investigator, said, "It is unclear whether the observed shift contributed to the high refusal rate in the Netherlands and the increase in family refusal in our hospital after 1998 … it is possible that this may have a counterproductive effect."