Honoring patients' organ donation decisions when family conflict is present: Experience from a single organ procurement organization

Paul A Stahler, Susan E Weese, Rachel M Nygaard, Mark J Hill, Chad J Richardson, Susan Mau Larson, Susan Gunderson, Robert R Quickel
Journal of Trauma and Acute Care Surgery 2014, 77 (4): 555-8

BACKGROUND: Donor designation refers to the laws and processes for documentation of an individual's wishes regarding organ donation should that person become eligible for donation at death. All 50 states have laws supporting donor designation. Donor-family conflict arises when a designated donor's family attempts to rescind the donor's authorization to donate. Little guidance exists in the current literature to address these situations.

METHODS: Hospital public relations offices and organ procurement organization (OPO) records were queried to assess the incidence of legal action and adverse media coverage. Public legal records were searched for civil actions involving the hospitals at which these conflicts occurred.

RESULTS: Fourteen cases of donor-family conflict were identified. Organ procurement proceeded in 9 (64%) of 14. A total of 38 organs were transplanted from these 9 donors. For those nine cases, median follow-up time was 57 months (interquartile range, 52-77 months; range, 38-114 months). The identified reasons for conflict include a belief by the family that they were given a choice in the decision about whether to proceed with donation; misunderstanding and lack of acceptance of the brain death diagnosis; disagreement among family members; concerns about timing/length of the donation process and desire to withdraw ventilator support; next-of-kin anger over cause of death when cause of death was suicide; and challenges to the validity of donor document and stated donor intent. No adverse news items were reported, and no lawsuits were filed in cases of donor-family conflict where organ donation proceeded. In addition, we found no mention of lawsuits brought against hospitals for failure to proceed with organ donation when donor was designated and eligible.

CONCLUSION: The 2006 Anatomical Gift Act compels hospitals and OPOs to pursue donation regardless of family wishes in cases of brain death in designated donors. When a donor's family attempts to rescind the donor's authorization, the donor's wishes, not the families, should be honored. Fears of legal action and adverse media coverage are unfounded. Clinicians, OPO staff, and hospital administrators should strive to understand state donor designation law and create a plan for managing this conflict should it arise.

LEVEL OF EVIDENCE: Therapeutic/care management study, level V.

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