title: 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.
abstract: BACKGROUND
  Recently, we reported a donation consent rate of only 80% for patients designated as donors with the Department of Motor Vehicles (DMV), which equaled missed opportunities for 17 potential transplant recipients during 3 months. We undertook the current study to increase our donation consent rate in patients with prior DMV donor designations.
  
  
  METHODS
  In October 2006, we modified our approach for donor consent by asking to honor the patient's wishes rather than asking for permission. The consent rates from January through September 2006 (preinitiative) were compared with rates from October through April 2007 (postinitiative).
  
  
  RESULTS
  During the preinitiative period, 66 approaches were made; 24 patients were registered as donors with the DMV (36%). In total, consent for donation was obtained from 43 families (65%). Only 20 of 24 (83%) families of patients with prior DMV designation donated, and 23 of 42 families of patients with no DMV designation donated (55%). One hundred forty-one organs were successfully transplanted (average 3.3 organs per procurement). Of 71 postinitiative approaches, 42 families donated (59%) and 125 organs were transplanted (average 3.0 organs per procurement). Consent for donation was obtained in 23 of 52 non-DMV-designated donors (44%). The families of all 19 DMV-designated donors consented for donation (100%).
  
  
  CONCLUSIONS
  Modifying our approach to consent for organ donation to honor the patient's wishes based on DMV donor designation rather than ask for permission increased organ procurement in this population to 100%. However, further efforts are needed at the state and national levels regarding the recognition of first-person consent for organ donation.
authors.affiliation: Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA. ashley.christmas@carolinashealthcare.org
authors.forename: Ashley Britton
authors.initials: AB
authors.lastname: Christmas
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Mallico
authors.forename: Gary W
authors.initials: GW
authors.lastname: Burris
authors.forename: Tyson A
authors.initials: TA
authors.lastname: Bogart
authors.forename: Harry James
authors.initials: HJ
authors.lastname: Norton
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent / Q000706:statistics & numerical data*; D009657:North Carolina; D013022:South Carolina; D020458:Third-Party Consent / Q000706:statistics & numerical data*; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*