Previous research has identified specific fears and concerns among the general public about organ and tissue donation. However, little to none of that research has dealt with fears and concerns at the time of the donation discussion. In this study, 180 experienced coordinators ranked the fears and concerns most commonly heard during the donation discussion. They further classified the fears and concerns according to the ease with which they can be addressed. Subsequently, the fears and concerns were classified in 4 groups: often heard and easy to deal with, often heard and hard to deal with, seldom heard and easy to deal with, seldom heard and hard to deal with. The results can be used to stimulate further research on family fears and concerns, to train and retrain coordinators to address those concerns in the donation discussion, and to improve existing strategies for increasing organ and tissue donation.

This study builds on previous research that identified fears and concerns heard by procurement coordinators during the donation discussion and that classified those concerns according to the ease with which they can be addressed. In this study, 53 coordinators working for 4 procurement agencies provided data on 323 donation discussions, including fears and concerns expressed by families. The fears and concerns were analyzed by outcome (consent or refusal), race and ethnicity of the family, frequency of reports, and difficulty in addressing. This research confirms many of the findings of the earlier study. The results also indicate that the types of concerns expressed by donor and non-donor families vary somewhat by the family's race and ethnicity. The results can be used to provide training targeted at raising consent rates and to train minority requestors.

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The organ procurement community has always considered public education a primary challenge. According to conventional wisdom, greater awareness generated by public education will lead to more donated organs. This notion may be based on faulty assumptions about public education and about the relationship between awareness and behavior. Public education, as the primary focus for the organ procurement community, should be abandoned. Increased efforts in professional education and basic research are more appropriate endeavors for organ procurement organizations.

Procurement professionals disagree on the necessity for matching donation requestors with donor families by race or ethnicity in order to increase donation rates. However, reports from minority requestors indicate that displays of cultural sensitivity during donation discussions may affect both the discussions and family decisions. In donation discussions with African Americans, Asians, American Indians, and Hispanic people from traditional cultures, requestors should consider factors such as which family representatives to include, cultural familiarity with specific diseases necessitating transplants, forms of address, concepts of time, methods of decision making and communicating refusal, and families' previous experience with the hospital and the American society as a whole.