Demography of brain stem death and factors leading to successful consent for organ donation

There is a widening gap between the patients requiring transplants in proportion to the availability of organs donated. After brain stem death (BSD), counselling for consent is mandatory and if successful, and viable organs are recovered. A low consent rate for donation results in failed donation in a number of potential donors. Many potential donors fail to make a donation due to various social and familial reasons resulting in a poor consent rate. The aim of this study was to identify the variables that lead to donation denials.

This retrospective study, carried out from Jan 2009 to Dec 2021 at a tertiary centre with an active transplant and donation programme, analysed BSDs and their counselling outcomes.

A total of 10998 patients were admitted to the intensive care unit, with 2401 (21.8%) deaths. BSD was diagnosed in 8.5% of all deaths, with donor suitability seen in 77.1% (n = 158) cases. After counselling, 55.7% families consented for organ donation. Amongst the families declining consent, most had multiple reasons. The commonest reasons were a difference of opinion among the family members (70%) and unclarity of BSD concept (44.3%). Other reasons included fear of mutilation, religious beliefs, and hope of a miracle.

As most reasons of denial are social and related to public awareness, a meticulous transplant program with enthusiastic coordinators coupled with augmentation of public awareness, responsible media reporting, and improved doctor-patient-relative communication would result in enhanced rates of consent.