J Korean Med Sci.  2020 Apr;35(13):e94. 10.3346/jkms.2020.35.e94.

Recent Decrease in Organ Donation from Brain-Dead Potential Organ Donors in Korea and Possible Causes

• Park J
• Kim CJ

• KMID: 2509601
• DOI: http://doi.org/10.3346/jkms.2020.35.e94

Abstract

Background
In 1999, the Organ Transplantation Act legalized organ donation from brain-dead patients. As a result of the government's continued efforts, the number of brain-dead donors steadily increased from 2002 through 2016. However, the number has declined since 2017. This paper examined the possible reasons behind the decline in brain-dead organ donation.
Methods
This investigation was an analysis of published data from the Korea Organ Donation Agency annual reports from 2013 to 2018.
Results
The number of brain-dead organ donors in Korea rose steadily until 2016, declined in 2017 for the first time since 2002, and then dropped sharply in 2018. Although the number of brain-dead potential organ donors increased between 2017 and 2018, the number of eligible donors decreased, suggesting that patient families rejected the brain-death determination process and brain-dead organ donation. Statistics gathered during identification of brain-dead potential donors and actual donations confirm that rejection or withdrawal of consent by the family has increased. During the same period when donation from brain- dead patients decreased, five events occurred: 1) compensation for donor families was abolished; 2) an incident of mistreatment of a brain-dead donor's remains occurred; 3) the Life-Sustaining Treatment Act was enacted, providing a legal procedure whereby families of brain-dead patients could forgo life-sustaining treatment; 4) residents' work week was limited to 80 hours; and 5) the Labor Standards Law was amended.
Conclusion
Fewer eligible donors in spite of an increase in brain-dead potential organ donors suggests that reduction in these donations resulted mainly from factors associated with family consent. Among such factors, implementation of the Life-sustaining Treatment Act appears to be most important. Abolition of family compensation and the incident in which a brain-dead donor's remains were mistreated may also have influenced family consent.

Keyword

Brain Death; Ethics; Family; Organ Donor; Organ Transplantation

Figure

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  Fig. 1 Relationship among monthly change of PBDs, TDs, and the ratio between them depending on events associated with the family consent factor and donor management process factor.PBD = brain-dead potential organ donor, TD = transplanted donor.

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  Fig. 2 Change of causes of failure to proceed to EDs from brain-dead potential organ donors from 2013 to 2018.ED = eligible donor.

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