Collaborative requesting - a
request for organ donation made jointly by the patient's clinician and a donor
transplant coordinator - does not increase consent rates compared with routine
requesting by the patient's clinician, finds research published on bmj.com.
The technique is advocated by the
UK's Organ Donation Task Force, but its effectiveness has never been rigorously
One of the biggest barriers to
increased donor rates is the refusal of consent by relatives. A recent audit of
341 deaths in intensive care units in the UK revealed that 41% of relatives of
potential donors denied consent. In an interview study a third of relatives who
had refused donation said that they would not refuse again, whereas only a few
of people who had given consent regretted their decision.
There may therefore be factors in
the way the request for donation is made that could affect the decision.
So a research team, led by Dr
Duncan Young from John Radcliffe Hospital in Oxford, carried out the first
randomised controlled trial to compare collaborative requesting with routing
The study involved 201 relatives
of patients meeting brain stem death criteria in 79 UK intensive care units.
Relatives were randomly assigned to either collaborative requesting by the
patient's clinician and a donor transplant coordinator or routine requesting by
the patient's clinician alone.
Sixty one per cent of relatives
in the routine requesting group consented to organ donation and 57% consented
in the collaborative requesting group.
The conversion rate (donors with consent
from whom any organs were retrieved) was 91.9% in the routine requesting group
and 78.9% in the collaborative requesting group.
This study provides clear
evidence that there is no increase in the relatives' consent rates for organ
donation when collaborative requesting is used in place of routine requesting
by the patient's clinician, say the authors.
These findings also have
implications for UK policy, as the UK Department of Health Organ Donation Task
Force report recommends the use of collaborative requesting by donor transplant
coordinators in all hospitals in the UK, they write.
In light of these results, they suggest it may be more
effective to focus on other strategies to increase consent rates, such as the
"long contact" technique where donor transplant coordinator is involved with
the family before an approach is made.