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

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.

Keywords: Brain Death; Ethics; Family; Organ Donor; Organ Transplantation.

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.

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

ED = eligible donor.