What factors influence a family's decision to agree to organ donation? A critical literature review.

Background: There is a shortage of organs for transplantation in the UK. However, whilst 82% of the population consider donating their organs, only 35% of people have joined the NHS Organ Donor Register. Although the Human Tissue Acts (2004, 2006) and Human Transplantation (Wales) Act (2013) state that the wishes of the deceased cannot be vetoed, it is unlikely that healthcare teams will continue with the retrieval process without the family's agreement to proceed. Aim: To understand what influences the decision of families to donate in order to guide clinical practice, education, training and increase donation rates to 80% in line with the NHS Blood and Transplant - Taking Organ Donation to 2020 strategy. Method: A literature review of published research. Results: Seven papers met the inclusion criteria. Several significant factors were identified that influence family decisions, including prior knowledge of the deceased's wishes (e.g. carrying a donor card), presence at the time of the donor's injury, understanding of brain stem death testing, 'personal realisation' of death and hospital related factors (e.g. information, communication and care). These were organised to form the acronym DONATE that serves as a useful mnemonic to guide the requester prior to discussing organ donation. Conclusions: Rates of donation of organ donation may increase through understanding family decision-making.