When the Living and the Deceased Cannot Agree on Organ Donation: Survey of OPOs

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.12519/abstract

When the Living and the Deceased Cannot Agree on Organ Donation: A Survey of US Organ Procurement Organizations (OPOs)
W. J. Chon1,*, M. A. Josephson1, E. J. Gordon2, Y. T. Becker3, P. Witkowski3, D. J. Arwindekar1, A. Naik1, J. R. Thistlethwaite Jr.3, C. Liao4, L. F. Ross3,5
DOI: 10.1111/ajt.12519
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

Abstract
The legal concept of first person authorization (FPA) is based on the principle that a decision by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web-based survey of all 58 Organ Procurement Organization (OPO) executive directors in the United States to assess OPOs' procurement policies and practices in the context of family objections. All 58 respondents (100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs (89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was <10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.