Deterrents to Organ Donation: A Multivariate Analysis of 766 Survey Respondents.

BACKGROUND: Although successful on many fronts, solid organ transplantation fails patients who die on waitlists. Too few organ donors beget this failure. Dispelling misperceptions associated with donation and transplantation would expectedly increase donation and decrease waitlist mortality; recipients would also receive transplants earlier in their disease process, leading to better post-transplantation outcomes.

STUDY DESIGN: Survey responses to 7 questions pertaining to organ donation and transplantation were analyzed to determine their association with willingness to donate. Subgroup analyses according to race, residence status (rural vs nonrural), and education level were performed.

RESULTS: There were 766 respondents; 84.6% were willing to be a donor, 76.2% were female, 79.7% were Caucasian, and 16.5% were African-American. Having concerns about getting inadequate medical care if registered as a donor was the strongest independent predictor of willingness to donate overall (odds ratio 0.21; 95% CI 0.13 to 0.36) and in each subgroup; African Americans were more likely than Caucasians to have this concern (20.2% vs 9.5%; p < 0.001). Race (odds ratio 0.41; 95% CI 0.22 to 0.75 for African Americans) and age were also predictive overall, but less so. Willingness to donate a family member's organs depended on whether a discussion about donation had hypothetically occurred: 61.0% would donate if there had been no discussion; 95.2% would donate if the family member had said "yes" to donation; and 11.0% would donate if the family member had said "no" (p < 0.001). If there was no prior discussion, having concerns about getting less-aggressive medical care predicted willingness to donate a family member's organs (odds ratio 0.40; 95% CI 0.25 to 0.65).

CONCLUSIONS: The strongest deterrent of willingness to donate one's own or a family member's organs is a misperception that should be correctable. Race and age are less predictive. Efforts to dispel misperceptions and increase donation remain desperately needed to improve waitlist mortality and post-transplantation outcomes.