Approaching the Families of Potential Deceased Organ Donors: An Overview of Regulations and Practices in Council of Europe Member States

Abstract

The primary aim of this study was to describe regulations and practices concerning the family approach to discuss donation, specifically after the neurological determination of death, one of the most challenging steps in the donation pathway. A secondary objective was to assess the impact of legislation on consent rates for organ donation. The Council of Europe surveyed 39 member states about national regulations, practices, and consent rates; 34 replied. Opt-out legislation is present in 19, opt-in in 9 and a mixed system in six countries. An opt-out register is kept by 24 countries and an opt-in register by 18 countries, some keeping both. The mean consent rate was 81.2% of all family approaches. Most countries regulate how death using neurological criteria is confirmed (85.3%), while regulation of other aspects of the deceased donation pathway varies: the timing of informing the family about brain death (47.1%) and organ donation (58.8%), the profile of professional who discusses both topics with the family (52.9% and 64.7%, respectively) and the withdrawal of treatment after brain death (47.1%). We also noted a mismatch between what regulations state and what is done in practice in most countries. We suggest possible reasons for this disparity.

The Impact of the Donor Card Holder Prioritization Program on Kidney Allocation in Israel

“…Across Europe, all family approaches had an overall average consent rate of 81.2%. 1 Unlike in some European countries where the "opting out" principle is associated with a very high donation rate of 30 to 40 donors per million population per year, 2 consent rate in Israel is significantly lower (about 60%) and reached only 102 donors in 2022, a donation rate of 11.46 donors per million population. 3 The main barriers to donation often stem from religious and cultural beliefs, with a higher willingness to organ donation in Israel observed in the secular sector compared with all 3 religious sectors (Jews, Muslims, and Christians).…”