Rate of Family Refusal of Organ Donation in Dead-Brain Donors: the Iranian Tissue Bank Experience

Background: The growing gap between organ supply and demand remains a worldwide serious problem. Losing dead-brain donor organs can be attributed to several reasons including un-recognition of potential donor by ICU staff, death before official declaration of brain death and high refusal rate of deceased donors' families. Objective: To study the trend of dead-brain patients' relatives refusal of organ donation from 2007 to 2011. Methods: This study was a retrospective review of all patients who had been introduced as brain death to the organ procurement unit (OPU) of Iranian Tissue Bank between April 2007 and April 2012 according to preliminary neurological exam performed in the hospital of origin. The refusal rate of dead-brain patients' families and its reasons was evaluated. Results: A total of 874 ICU admitted patients with severe brain injury (Glasgow coma score <7) was introduced to our center and were visited by the coordinator team during April 2007 to April 2012. 412 (47%) patients were excluded from the study mainly due to unsuitability for donation according to the approved medical protocols (n=205) and not fulfilling the brain death criteria (n=66). The families of the remaining cases (n=462) had been interviewed 343 (74.2%) of whom permitted donation. The mean±SD age of donors was 29.8±13.2 years; the male/female ratio was almost 2. The most common reason of brain death was traffic collision (n=120; 56.3%) and cerebrovascular accidents (n=40; 18.8%). The refusal rate from 2007 to 2011 has decreased respectively, from 30.4% to 20% in Tehran, and from 57.1% to 51.6% in other cities. The overall refusal rate was 25.8%. Conclusion: Our study confirmed that more level of expertise of the coordinator team and continuous public education, would result in higher rate of consent to organ donation.