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

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 ofan 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.