title: Difficult Consent Scale: An Assessment Scale for Anticipated Difficulty in Obtaining Consent for Organ Donation.
abstract: OBJECTIVE
  Seeking consent for organ procurement from a brain-dead patient 's family is challenging, especially in developing countries. In the Middle East, legislation necessitates an opt-in system that engages all first-degree relatives. To improve our success rate in the Masih Daneshvari Organ Procurement Unit in Tehran, Iran, we invented a scale for the consent process to predict the degree of difficulty of each family interview before venturing into it.
  
  
  METHODS
  We reviewed the records of brain-dead patients treated in our unit over the previous 10 years. Focusing on cases where families refused to donate organs, we searched for determinants that played a role in the final results. We extracted minor and major determinants, then ascribed a 3-level scale to each determinant (from 1, easiest, to 3, most difficult). We thereby obtained a clear assessment of each consent-taking session based on determinants from real encounters.
  
  
  RESULTS
  We analyzed 150 brain-dead patients and extracted 17 determinants: 2 major and 15 minor. We grouped these into 3 distinct categories: A, patient-related; B, family-related; C, hospital-related. Inspired by the Glasgow Coma Scale, we named our scale the "Difficulty Consent Scale, " in which a score of 15, using the minor determinants, indicates the easiest scenario for obtaining consent and 45 indicates the most difficult scenario. The 2 major factors function as coefficients to either double or halve the degree of difficulty.
  
  
  CONCLUSIONS
  This speculative model may help the managers of organ procurement units choose the best-suited person for any family interview, and it may help clinicians attempting to obtain consent to compare their results over time. Our model must be tested in a real context to discover its predictive power.
authors.affiliation: Lung Transplantation Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Mazaheri
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Sadegh Beigee
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001926:Brain Death; D003142:Communication; D003466:Cultural Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007492:Iran; D008297:Male; D008875:Middle Aged; D011368:Professional-Family Relations / Q000941:ethics*; D012307:Risk Factors; D020458:Third-Party Consent / Q000941:ethics*; D014019:Tissue Donors / Q000941:ethics*; D009927:Tissue and Organ Procurement / Q000941:ethics*; D055815:Young Adult