COVID-19 pandemic and the confusion of the world at the beginning of the epidemic affected many aspects of the life and health care. In this regard, organ donation as a vital approach for life saving in patients on the waiting list was influenced too. This essential treatment requires the provision of vital organs from the brain death cases, which is a sensitive, accurate and lengthy process. This process begins with the identification of Glasgow Coma Scale (GCS) cases less than five and is followed by organ harvesting and assignment to waiting list patients. Organ donation and factors related to its process have been fluctuated during three specific time periods, including the first and second year of the epidemic with the year before the epidemic. This decrease in the number of donations has been felt worldwide and it has been reported that this number has decreased significantly even in the amount of blood donation. Numerous barriers to the treatment system during the epidemic, limitations of surgeries except in emergencies, asymptomatic patients, and many unknown aspects of the disease have shown that the policies and approaches of procurement centers need to be changed to continue efforts in this situation. New protocols (according to the needs of these days) should be developed and implemented according to the conditions ahead.

Background: In our organ procurement unit, we use three different strategies to identify all potential brain death donors. So we aimed to evaluate the incentives and deterrents in the process of donor identification based on hospital characteristics. Methods: In the electronic, cross-sectional study, a 16-item questionnaire that includes information regarding hospital characteristics (having a transplant and neurosurgery ward), being related to an organization versus general or private hospital, and also medical staff experience about the donation process and their attitude about donor identification. Items related to the donor identification were nine questions about the potential facilitators as well as seven items corresponding to the potential barriers. Results: Two-hundred-thirty nurses and medical staff with a mean age of 38.5±28 years participated in the study, of which 62.3% (n=143) were female. In the type I hospitals, 12.4% of respondents believed that hospital policies were weak in identifying potential identifiers, and in type II hospitals, 21.7% agreed that these policies were weak. While 35.9% and 42.2% of them in type I and II hospitals, respectively, believed that the hospital's policies are strong and acceptable, P=0.04. The main facilitator was active detection via regular phone calls which were mentioned by 65.2%. Donor detection by in-hospital coordinators was in second place (42.7%). Also, the availability of the donor coordinators and visiting by the inspectors were other important motivations for donor detection. Regarding barriers, staff viewpoints toward donor selection affect the donor referral to the OPU (54.7%) and staff opinions that this process would be distressing to the donor family avoids donor identification (47.1%). Moreover, concerns about patient care were another notable obstacle (43.1%). Conclusions: It is important to use phone calls for better coverage of donation and also train medical staff to improve their ability in donor selection.

Background: Brain death is the most important source of organ procurement for patients with end stage organ failure. The causes of donor loss is divided into two main categories including: the potential donor may not be clinically suitable and family refusal. Although many studies have reported the causes of family refusal, literature is poor regarding the causes of willing to donation. Respecting family refusal, lake of knowledge and believing in miracles are major reasons for family refusal. Identifying the factors that influence a family's decision could improve the quality of family interview. Methods: This qualitative study has been conducted at in organ procurement unit of Shahid Beheshti University of Medical Sciences, Iran. We randomly selected 100 families of brain-dead donors from 2018 to 2021 and assess the reasons of consent to donation via an interview by a semi-structured questionnaire. Results: Sympathy by patients on waiting list was the most frequent reason (74%). This idea that the donor would be alive after organ transplantation was the second trigger factor (15%) and hope to be forgiven was another facilitating factor (6%) and some other reasons such as donation card of the brain dead person, being famous, getting some points in 5%. There was a significant association between mentioned factors and different causes of brain death. In donors who were children under the age of 14 years, the most common reason was willing to meet the recipients and for middle-aged donors, the most motivating factor for relatives' was sympathy. Families of young aged donors agreed to donation with the intention of their loved one to be forgiven. Conclusions: This study demonstrated that the transplant coordinators should pay attention not only to the religious, cultural and social aspects, but also they should consider the causes of brain death and the donor's age to obtain consent for organ donation.