Laws requiring hospitals to develop and implement policies to ensure that health care professionals (HCPs) talk with deceased patients' families about organ donation have not resulted in the expected increase in procurement. The proposed study is a continuation of our current study which examines HCPs' compliance with required request legislation in a stratified sample of 23 hospitals in two states. Preliminary results from this study suggest that HCPs do a far better job of identifying donors and approaching donor eligible families than was anticipated. Rates of consent to donation, however, were much lower than anticipated with only 47.3% of all organ eligible families approached consent to donation. The major failure of required request laws are, unexpectedly, not that HCPs do not ask families to donate, but that families refuse to donate over half the time. To examine the factors affecting decisions regarding the donation of organs, we will review 12,600 charts and recruit 400 eligible patient cases from 7 acute care general hospitals in two Greater Metropolitan Areas: Pittsburgh, PA and Baltimore, MD. Data collected will include interviews of 800 family members and 1,260 HCP respondents. This four- year study will collect analogous data from two sources: 1) donor eligible patients' families and 2) the HCPs and relevant Organ Procurement Organization (OPO) staff directly involved in requesting donation. The family interview will be an in-depth, audiotaped interview designed to document potential donor families' experiences and the factors affecting their decisions about donation. The HCP interview will be a much briefer, structured interview designed to provide information regarding the HCPs' discussions with the family. The study will: 1) characterize determinants of families' willingness to donate, 2) assess the effectiveness of approaches to asking for donation, and 3) recommend ways in which the procurement process can be improved. Our proposed systematic analysis of the determinants of consent to organ donation in a representative sample of hospitals in two large metropolitan areas in conjunction with data from our on-going study, will provide information to help guide future policy changes to he procurement system.
