Does family disagreement affect donation decisions by next of kin?

CONTEXT: Information about the relationship between family disagreement and donation decisions may facilitate development of strategies to help families resolve conflict and possibly increase donation consent rates.

OBJECTIVE: To assess how family interactions influence next-of-kin decisions about organ donation.

DESIGN: Semistructured survey.

SETTING AND PARTICIPANTS: Next of kin of potential donors (147 donors, 138 non-donors) from 1 organ procurement organization participated in a semistructured telephone interview, answering questions about the presence and influence of others during decision making related to organ donation.

RESULTS: When others were actively involved in the donation decision (68%), disagreement about the donation decision occurred in 32% of cases. Compared with families initially in agreement, families not in agreement were less likely to donate (P < .001), took longer to make a decision (P < .001), and were less likely to make the same decision now (P < .001). Family disagreement was significantly associated with having more family members involved in the discussion, characteristics of the deceased (younger age, not married, nonwhite race, fewer days in the hospital, trauma-related death), next-of-kin characteristics (less education, less favorable organ donation beliefs), not knowing the deceased's donation intentions, less satisfaction with the health care team, and perceptions of a less compassionate donation requester.

CONCLUSIONS: Family disagreement occurred in one-third of donation approaches when other family members were present. Such disagreement is most likely to contribute to donation refusal when the deceased's donation intentions are unknown. Recognizing and assessing the nature of family disagreement may increase donation consent.