A discrepancy exists between the demand for and the availability of solid organs for transplant. Barriers to organ donation can be encountered at 2 key points: (1) when trying to increase the number of people willing to become organ donors and registering their intent and (2) at the time of organ procurement. Several predictors of individual willingness to register as an organ donor are discussed, along with issues surrounding families' refusal of consent or failures in the hospital system to identify potential donors. Several countries have adopted presumed-consent policies and have seen a subsequent increase in donation rates. Research is needed to explore the effectiveness of approaches to overcome the barriers to individual registration and family consent, particularly in countries where presumed consent has not been and is not likely to be adopted.
MocanNTekinE.The determinants of the willingness to donate an organ among young adults: Evidence from the United States and the European Union. Soc Sci Med.2007;65(12):2527–2538.
7.
ReubsaetAVan den BorneBBrugJPruynJVan HooffH.Determinants of the intention of Dutch adolescents to register as organ donors. Soc Sci Med.2001;53(3):383–392.
8.
MorganSEHarrisonTRAfifiWALongSDStephensonMT. In their own words: The reasons why people will (not) sign an organ donor card. Health Commun.2008;23(1):23–33.
9.
BresnahanMLeeSYSmithSW. A theory of planned behavior study of college students' intention to register as organ donors in Japan, Korea, and the United States. Health Commun.2007;21(3):201–211.
10.
RumseySHurfordDPColeAK. Influence of knowledge and religiousness on attitudes toward organ donation. Transplant Proc.2003;35(8):2845–2850.
11.
CallenderCOMilesPV. Obstacles to organ donation in ethnic minorities. Pediatr Transplant.2001;5(6):383–385.
12.
HydeMKWhiteKM. Young Australian adults' knowledge and beliefs about organ donation. Prog Transplant.2007;17(3): 220–227.
13.
SimpkinALRobertsonLCBarberVSYoungJD. Modifiable factors influencing relatives' decision to offer organ donation: Systematic review. BMJ.2009;338:b991.
14.
DeJongWFranzHGWolfeSM. Requesting organ donation: An interview study of donor and nondonor families. Am J Crit Care.1998;7(1):13–23.
15.
BeaulieuD.Organ donation: The family's right to make an informed choice. J Neurosci Nurs.1999;31(1):37–42.
16.
GortmakerSLBeasleyCLSheehyE. Improving the request process to increase family consent for organ donation. J Transpl Coord.1998;8(4):210–217.
17.
HaddowG.Donor and nondonor families' accounts of communication and relations with healthcare professionals. Prog Transplant.2004;14(1):41–48.
18.
GarrisonRNBentleyFRRaqueGH. There is an answer to the shortage of organ donors. Surg Gynecol Obstet.1991;173(5):391–396.
19.
NilesPAMatticeBJ. The timing factor in the consent process. J Transpl Coord.1996;6(2):84–87.
20.
BlokGAMortonJMorleyMKerckhoffsCCKootstraGVan der VleutenCP. Requesting organ donation: The case of self-efficacy—effects of the European Donor Hospital Education Programme (EDHEP). Adv Health Sci Educ Theory Pract.2004;9(4):261–282.
21.
MortonJBlokGAReidCVan DalenJMorleyM.The European Donor Hospital Education Programme (EDHEP): Enhancing communication skills with bereaved relatives. Anaesth Intensive Care.2000;28(2):184–190.
22.
ChristmasABMallicoEJBurrisGWBogartTANortonHJSingRF. A paradigm shift in the approach to families for organ donation: Honoring patients' wishes versus request for permission in patients with Department of Motor Vehicles donor designations. J Trauma.2008;65(6):1507–1509; discussion 1509–1510.
23.
ACRE Trial Collaborators. Effect of “collaborative requesting” on consent rate for organ donation: Randomised controlled trial (ACRE trial). BMJ.2009;339.
24.
EssebagVCantarovichMCrelinstenG.Routine advance directive and organ donation questioning on admission to hospital. Ann RColl Physicians Surg Can.2002;35(4):225–231.
25.
BiresMH. Comparison of consent rates between hospital-based designated requestors and organ procurement coordinators. J Transpl Coord.1999;9(3):177–180.
26.
Al-SebayelMIAl-EnaziAMAl-SofayanMS. Improving organ donation in Central Saudi Arabia. Saudi Med J.2004;25(10):1366–1368.
27.
SingerP.Cadaveric organ donation in Israel: The facts and the perspectives. Ann Transplant.1999;4(1):5–10.
28.
MathewTHChapmanJR. Organ donation: A chance for Australia to do better. Med J Aust.2006;185(5):245–246.
29.
MarksWHWagnerDPearsonTC. Organ donation and utilization, 1995–2004: Entering the collaborative era. Am J Transplant.2006;6(5 pt 2):1101–1110.
30.
HortonRLHortonPJ. A model of willingness to become a potential organ donor. Soc Sci Med.1991;33(9):1037–1051.
31.
ManninenDLEvansRW. Public attitudes and behavior regarding organ donation. JAMA.1985;253(21):3111–3115.
32.
ProttasJM. Encouraging altruism: Public attitudes and the marketing of organ donation. Milbank Mem Fund Q Health Soc.1983;61(2):278–306.
33.
Callender CO. Organ donation in the black population: Where do we go from here?Transplant Proc.1987;19(2suppl 2):36–40.
34.
SiminoffLAGordonNHewlettJArnoldRM. Factors influencing families' consent for donation of solid organs for transplantation. JAMA.2001;286(1):71–77.
35.
MossialosECosta-FontJRudisillC.Does organ donation legislation affect individuals' willingness to donate their own or their relative's organs? Evidence from European Union survey data. BMC Health Serv Res.2008;8:48.
36.
RadeckiCMJaccardJ.Psychological aspects of organ donation: A critical review and synthesis of individual and next-of-kin donation decisions. Health Psychol.1997;16(2):183–195.
37.
VerheijdeJLRadyMYMcGregorJLFriederich-MurrayC.Enforcement of presumed-consent policy and willingness to donate organs as identified in the European Union Survey: The role of legislation in reinforcing ideology in pluralistic societies. Health Policy.2009;90(1):26–31.
38.
RithaliaAMcDaidCSuekarranSMyersLSowdenA.Impact of presumed consent for organ donation on donation rates: A systematic review. BMJ.2009;338:a3162.
39.
MirandaBCanonJCuendeN.The Spanish organizational structure for organ donation: Update. Transplant Rev.2001; 15(1):33–45.
40.
RadaGarcia A.Spanish transplant model would save 20,000 lives a year in EU. BMJ.2010;340:c1758.
