title: Causes of organ donation failure in Brazil.
abstract: BACKGROUND
  There has been a great improvement in transplantation medicine in Brazil in the last 2 decades. However, there remain several barriers regarding notification of brain and cardiac death as well as completion of the donation process.
  
  
  METHODS
  This retrospective study was performed between January 2008 and December 2010. We reviewed all deaths in a University Hospital, observing the causes of non-notification to the State Transplantation Authority and non-donations.
  
  
  RESULTS
  There were 41 notifications of brain death resulting in donation in only 19.5% of those cases. Cardiac death was diagnosed in 21 patients, resulting in 52.4% donations. The main cause for non-donation were family refusal (37.2%), infectious diseases (30.2%), and clinical contraindications (32.6%). Most of the missed possible donors occurred during the night (54.8%) and in the emergency room (80.9%).
  
  
  CONCLUSIONS
  There is an urgent need for better education of the Brazilian population about organ donation and brain death definitions. Other identified problems include lack of uniformity in brain death determinations among hospitals, rigid contraindications to donation in the State of Parana, physician unawareness or disbelief about brain death diagnostic criteria, and lack of structure of our Hospital.
authors.affiliation: Maringa State University, Maringa, Parana, Brazil. cmdagnolo@uem.br
authors.forename: C M
authors.initials: CM
authors.lastname: Dell Agnolo
authors.forename: R A
authors.initials: RA
authors.lastname: de Freitas
authors.forename: V J O
authors.initials: VJ
authors.lastname: Toffolo
authors.forename: M L F
authors.initials: ML
authors.lastname: de Oliveira
authors.forename: D F
authors.initials: DF
authors.lastname: de Almeida
authors.forename: M D B
authors.initials: MD
authors.lastname: Carvalho
authors.forename: S M
authors.initials: SM
authors.lastname: Pelloso
mesh_terms: D000533:Altruism; D001291:Attitude of Health Personnel; D001364:Awareness; D001926:Brain Death / Q000175:diagnosis*; D001938:Brazil; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality; D046148:Donor Selection; D004636:Emergency Service, Hospital; D005190:Family / Q000523:psychology*; D037921:Gift Giving; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D009042:Motivation; D010819:Physician's Role; D012189:Retrospective Studies; D020458:Third-Party Consent; D013997:Time Factors; D009927:Tissue and Organ Procurement