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 tested.
AdvertisementOne 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 testing.
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.
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