Survey of Public Attitudes Towards Imminent Death Donation in the United States

Laura Washburn; Nhu Thao Nguyen Galván; Priyanka Moolchandani; Matthew B. Price; Smruti Rath; Ruth Ackah; Kevin A. Myers; R. P. Wood; Sandra Parsons; Ryan P. Brown; Elitza Ranova; Matthew Goss; Abbas Rana; John A. Goss

Disclosures

American Journal of Transplantation. 2021;21(1):114-122. 

In This Article

Abstract and Introduction

Abstract

Imminent death donation (IDD) is described as living organ donation prior to a planned withdrawal of life-sustaining care in an imminently dying patient. Although IDD was ethically justified by United Network for Organ Sharing, the concept remains controversial due to presumed lack of public support. The aim of this study was to evaluate the public's attitudes towards IDD. A cross-sectional survey was conducted of US adults age >18 years (n = 2644). The survey included a case scenario of a patient with a devastating brain injury. Responses were assessed on a 5-point Likert scale. Results showed that 68% - 74% of participants agreed or strongly agreed with IDD when posed as a general question and in relation to the case scenario. Participants were concerned about "recovery after a devastating brain injury" (34%), and that "doctors would not try as hard to save a patient's life" (33%). Only 9% of participants would be less likely to trust the organ donation process. In conclusion, our study demonstrates strong public support for IDD in the case of a patient with a devastating brain injury. Notably, participants were not largely concerned with losing trust in the organ donation process. These results justify policy change towards imminent death donation.

Introduction

Organ transplantation is a life-saving treatment for patients with end-organ failure. In 2018, there were ≈17 000 living and deceased donors leading to >36 000 transplants performed in the United States.[1] However, the waiting list continues to exceed 100 000 patients, and expansion of the donor pool remains an active issue in the transplant community. Imminent death donation (IDD) has been proposed as an additional option for organ donation that may increase the quantity and quality of organs available for transplant.[2] IDD is described as recovery of a living donor organ immediately prior to an impending and planned withdrawal of ventilator support expected to result in the patient's death.[3]

Preliminary studies suggest that IDD would likely increase the available number and quality of organs available for transplantation. One study from a Wisconsin hospital extrapolated a potential of 6000–31 000 kidneys that could be donated annually in the US via IDD based on calculations using number of annual deaths with normal renal function and percentage of those willing to donate within their system.[4] Our group reviewed all donation after cardiac death (DCD) donors who would have also qualified as IDD donors in 2015. We identified just over 100 eligible left lateral lobe liver donors who could have theoretically covered the pediatric liver waitlist patients who do not get transplanted every year.[5] While these data are theoretical and cannot be proven until practiced, they suggest substantial prospects for our transplant candidates. Although IDD has the potential to substantially ameliorate the allograft shortage for transplant waiting lists,[4–6] the policy remains largely controversial.[7–10] The Organ Procurement and Transplantation Network/United Network for Organ Sharing (UNOS) Ethics Committee determined that IDD may be ethical and justified, but lack of community support and the potential to violate the public trust were considered major challenges to implementation.[3] Perceived lack of public support often serves as the crux of the argument against IDD; however, limited data exist regarding public attitudes towards organ donation in the imminently dying.[11] A focus group study of families who had experienced unsuccessful DCD found that participants were largely accepting of single kidney IDD, and had experienced the second loss of the inability to donate.[12] This challenges the notion that the general public would oppose organ donation in the imminently dying.

The purpose of this study was to evaluate public attitudes towards IDD, described as organ donation prior to a planned withdrawal of life-sustaining care in an incapacitated patient who had a devastating brain injury.

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