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Issues in Organ Donation

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Most of us are aware that the number of organ donors cannot meet the growing number of candidates waiting for life-saving organs.1-3 Over the past decade, the number of organ donors increased 2% to 3% per year but the number of candidates on the waiting list grew 8%.1 As a result of the national shortage of organ donors, many candidates die or become too sick to receive a transplant.2  

Background
Organ procurement organizations (OPOs) are authorized to procure organs for transplantation in each state. OPOs are responsible for all aspects of the procurement process, from evaluating potential donors to obtaining consent to hosting the procurement process. Despite a generally favorable attitude toward donation by Americans and a decade of outreach and awareness programs, the rate of donation has increased only slightly.3 Even national efforts have not produced noticeable change in donation rates.4 The increases in donation that have occurred could be due in part to expansions of the donor pool (e.g., accepting older donors).5

Although 80% of U.S. residents state they are willing to receive an organ if needed, many are uncertain or negative about being organ donors themselves.6 The 2005 National Public Opinion Survey on Organ Donation found that 95% of Americans support the idea of organ donation, but only 52.7% have granted permission on a driver's license or organ donor card.7 The percentage of Americans who have given permission on a driver's license or organ donor card remain close to the percentage of those who have actually consented (50th percentile). The donation rate is often lower in certain ethnic minorities.8 Campaigns for organ donation have also had limited success, as evidenced by the lack of change in consent rates.9

Patient and graft survival rates illustrate the benefit of organ transplantation. "Graft," "transplant" and "transplanted organ" are interchangeable terms. Graft survival rates for a liver at 1 year, 3 years and 5 years are 84%, 74% and 68%, respectively.10 Patient survival rates after liver transplant at 1, 3 and 5 years are 86%, 78% and 73%, respectively. The worst solid organ transplant survival rates at 5 years are among lung transplant patients (49%).10

Literature
One way to increase the supply of organs is to identify barriers to donation. The Theory of Reasoned Action (TRA) is a theoretical framework that focuses on predicting consumer intentions and behaviors, as well as identifying where and how to target consumer behavior change.11 The main premise of the TRA is that a person's attitude leads to an intention to perform, or not perform, a particular behavior. We reviewed the literature for attitudes and beliefs (potential barriers) about organ donation.

The two main barriers that emerged are lack of family discussions about organ donation and lack of accurate knowledge about numerous areas that affect the decision to donate.3,8,9,12-15

Barriers Identified
Research has identified many barriers to organ donation. Most of these barriers are the result of a knowledge deficit in at least one of the following areas:

  • diagnosis
  • brain death
  • sale of organs
  • equity in organ distribution
  • loved one's viable appearance on life support
  • loved one's sensation of pain
  • provider willingness to save designated organ donors
  • religious acceptance of donation
  • perceived acceptable age or health status for donation
  • cost to donor family
  • organ removal procedure
  • inaccurate portrayals of organ donation
  • assumption that permission given on a driver's license or donor card means wishes will be carried out by medical personnel.

Barrier 1: Diagnosis Unclear
To agree to organ donation, most families need to understand that the patient is not going to recover.15 Typically, a potential organ donor has suffered a severe head injury, aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage or another condition that cause swelling, ischemia or brain herniation.16


Issues in Organ Donation

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