When the living and the deceased cannot agree on organ donation: a survey of US organ procurement organizations (OPOs)

Am J Transplant. 2014 Jan;14(1):172-7. doi: 10.1111/ajt.12519.


The legal concept of first person authorization (FPA) is based on the principle that a decision by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web-based survey of all 58 Organ Procurement Organization (OPO)executive directors in the United States to assess OPOs' procurement policies and practices in the context of family objections. All 58 respondents(100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs(89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was <10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.

MeSH terms

  • Data Collection
  • Family*
  • Humans
  • Tissue Donors / legislation & jurisprudence*
  • Tissue and Organ Procurement / legislation & jurisprudence*
  • United States