[Family approach--retrospective analysis of 6,617 donation requests]

According to surveys the majority of the German population has a positive attitude towards organ donation. However, declarations of will concerning this matter are often missing in case of death. Thus, in nearly all cases consent must be obtained from the family of the deceased. Compared with refusal rates of other countries the refusal rate in Germany (approximately 40%) is rather high. The modification of the German Transplantation Legislation in November 2012 supports the voluntary documentation of everyone's decision with regard to organ donation.

Based on 6,617 documented donation requests collected between 2009 and 2011, factors were identified, which--besides personal attitude of morality--could influence the decision about donation.

The decedent's will is often unknown (67.4%) and the family's decision is based on the suspected will of the patient. This resulted in 4097 (61.9%) consents and 2520 (38.1%) refusals. 4669 (70.6%) of these donation-requests were carried out by the physician in charge and 1948 (29.4%) with the assistance of a coordinator from the German foundation for organ transplantation (DSO). Predictive (p<0.001) for consent were the presence of a specially trained coordinator and the timing of the request for organ donation.

There is a big discrepancy between the attitude displayed in surveys and the actual consent rate to organ donation. The major challenge is an improved caregiving for the donor family. Donation requests should be made preferably by trained physicians as well as coordinators. Waiting for the finalized certification of brain death may not be appropriate in all cases.