Factors influencing consent rates of deceased organ donation in Western Cape Province, South Africa

• Published in: South African medical journal 2020-03, Vol.110 (3), p.204-209
• Main Authors: Steenkamp, L., McCurdie, F., Thomson, D., Bookholane, H., Prins, L., Gili, B., Michaelides, A., Human, L.
• Format: Article
• Language: English
• Subjects: Family; Informed consent; Organ transplantation; Reason; Tissue donation
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2020.v110i3.14227

Background. South Africa (SA) has very low and unchanging organ donation rates. A key point in the pathway of organ donation is obtaining informed consent from the family, which is necessary before organ donation can proceed. There is no published SA research on the consent rate and factors that influence this. Objectives. To describe the number of requests for consent and factors influencing this process in the SA context. Methods. A prospective descriptive study was performed of all requests to families for organ donation in Western Cape Province, SA, by Groote Schuur Hospital (state sector), Red Cross War Memorial Children’s Hospital (state sector) and Netcare (private sector) transplant co-ordinators from 1 May 2017 to 1 May 2018 to describe factors influencing consent rates. Results. The 6 co-ordinators (3 state sector and 3 private sector) recorded data of 83 consecutive families approached in 16 hospitals over the 1-year period. Consent to organ donation was granted for 23 family requests (n=18 (state sector); n=5 (private sector)). The number of families approached was greater in the state sector (n=74) than in the private sector (n=9). The overall consent rate was 27.7% (24.3% (state sector); 55.5% (private sector)). The majority of referrals came from trauma and emergency units (n=55; 66.3%) and very few from intensive care units (n=25; 30.1%). Immediate fluid resuscitation was required in 56 (67.5%) potential donors. The majority of families (n=74; 89.2%) were receptive to the organ donation request, independent of their ultimate decision regarding donation. The main reason given for refusing to consent was that it was against their religion (n=21) or culture (n=18). Conclusions. This study showed that the number of families approached for consent to organ donation were low in the Western Cape (lower in the private sector), with a low consent rate (lower in the state sector). Donor management by clinical teams needs to be ongoing and active during the consent process. Consent discussions (and public awareness initiatives) need to be sensitive to and deal with religious and cultural reservations about organ donation.