Barriers to Registration in the National Donor Registry in Nations Using the Opt-In System: A Review of the Literature.

BACKGROUND: To increase the number of postmortem organ and tissue donors, donor registries (DRs) have been introduced. The aim of this review was to understand why people in nations with an Opt-in system, who are for or against donation after death, do not register in the DR. Knowing these barriers will help in developing policies to increase the registration rate in the DR. METHODS: For this review, 2 authors independently assessed the eligibility of the identified studies from 2000 to 2015 in the Pubmed- Medline database. Included were observational and interventional studies concerned with reported barriers to residents joining the national DR in Denmark, The Netherlands, and the United Kingdom. RESULTS: We included 15 relevant articles for the review. The main barriers to signing the DR in nations using the Opt-in system were: religion; medical mistrust, anxiety, and affective emotions; lack of information; concern about insufficient time to mourn, and that the funeral may be delayed and the deceased not look presentable; physical integrity; ignorance about how to register in the DR; own benefit; and social status. CONCLUSIONS: The outcome suggests that the main barriers to enrolling in the DR are based on people's doubts about their own ability to perform the registration and cope with the consequences, knowledge, outcome expectations, and concerns about what others will think of them for agreeing to donation. However, not all barriers are easily modifiable, owing to their association with affect or emotions.

Video-Based E-Learning in Communication Skills for Physicians Provides Higher Agreement to Tissue Donation.

BACKGROUND: In hospitals, physicians are rarely confronted with tissue donation. Besides correctly identifying an eligible tissue donor, the physician also must deal with the bereaved family. When the immediate family members were asked to consent for tissue donation, objection by the next of kin appears to be the main reason for the loss of potential tissue donors, if no registration is found in the donor register. Therefore, physicians' guidance of next of kin through the consent process for tissue donation is an essential part of the recruitment process and requires adequate communication about donation skills and techniques. We analyzed if physicians educated with a video-based E-learning program on "communication about donation skills" successfully contributes to a higher consent rate for tissue donation. METHODS: This retrospective study was conducted in 2014 in a Dutch teaching hospital. Two groups of physicians were compared; physicians receiving a lecture on "tissue donation" and physicians receiving additional E-learning on "communication about donation." The results were analyzed on the outcome "obtained consent" for tissue donation from next of kin. RESULTS: Analyses show that physicians receiving a lecture about organ and tissue donation extended with video-based E-learning on communication about donation obtain a significantly (P ≤ .011) higher consent rate (55.6%) for tissue donation compared with physicians who only receive a lecture (15.5%). CONCLUSIONS: A mandatory offer for physicians to follow E-learning on communication about donation must be considered. This could help the availability of tissue donors.