A Comparison of the Content and Quality of Organ Donation Discussions with African American Families Who Authorize and Refuse Donation



This study compares the experiences of African American (AA) families who authorized organ donation with those who refused.


Large administrative datasets were obtained from 9 partnering Organ Procurement Organizations (OPO). Initial analyses used these data to assess authorization among African American families (n = 1651). Subsequent analyses were performed using a subsample of interview data of AA family decision makers (n = 276). Initial bivariate analyses tested differences in study variables by authorization status (donor/nondonor). Two separate multilevel logistic regressions examined associations between independent variables and family authorization.


Analyses of the administrative datasets found that refusal was more likely when the patient was older, female, a DCD case, and not referred in a timely manner; refusal was less likely when families initiated donation conversations. Interview data revealed that families who refused donation were less likely to respond favorably to initial donation requests and reported less satisfaction with the overall approach, amount of time with OPO staff, and how questions were handled. Refusing families were also more likely to feel pressured, had less comprehensive donation discussions, and rated the OPO requesters’ communication skills lower. No significant differences in organ donation attitudes were found between families who authorized donation and those refusing to donate.


The study suggests that AA families making decisions about organ donation would benefit from culturally appropriate discussions.

Trial Registration

Clinical Trial Notation: NCT02138227.

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Fig. 1

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.



African American


Donation after cardiac death


Family decision maker


Healthcare provider


Minority Organ Tissue Transplant Education Program


Organ Procurement Organization


Relational communication scale


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This research was funded by grants #R01DK081118 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and #R39OT10581 from the Division of Transplantation, Health Resources & Services Administration, US Department of Health and Human Services (HRSA).

Author information




LAS participated in the research design, writing of the paper, performance of the research, and data analysis. GPA participated in the writing of the paper and performance of the research. HMG participated in the research design, writing of the paper, performance of the research, and data analysis. RDH participated in the writing of the paper. PAM participated in the writing of the paper. MWG participated in the writing of the paper and the analysis of the paper.

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Correspondence to Laura A. Siminoff.

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Siminoff, L.A., Alolod, G.P., Gardiner, H.M. et al. A Comparison of the Content and Quality of Organ Donation Discussions with African American Families Who Authorize and Refuse Donation. J. Racial and Ethnic Health Disparities 8, 485–493 (2021). https://doi.org/10.1007/s40615-020-00806-7

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  • Organ donation
  • Decision making
  • African American
  • Communication
  • Disparities