Communication strategies to enhance organ donation requests across cultures: a review of the literature.

Background: Requesting consent for deceased organ donation is a uniquely challenging communication that has profound consequences at the individual and population level. Communication between requesters and family decision-makers who come from different cultures must be better understood. This review aims to identify communication variables that influence consent for organ donation in cross-cultural requests, with a goal of enhancing end-of - life experiences for families and increasing access to life-saving transplants.

Methods: We conducted a MEDLINE search of English language studies from 1996-September 2022. Inclusion criteria required that studies examine in-person requests for deceased organ donation and include both cross-cultural and interpersonal factors in the study analysis. 427 titles and abstracts were assessed by author-pairs, followed by 46 full text reviews.

Results: Nine studies met inclusion criteria. Study locations included the United States (5), Israel (2), and Australia (2). Communication variables were grouped into three domains: pre-request, family approach, and request. The main outcome was likelihood of family authorization. Foreign birth and language and high religiosity were associated with lower likelihood of family approach and consent. Interpreter use was negatively associated with authorization, as was lower family satisfaction of interactions with medical staff. Perceptions of family willingness to donate and communication practices of requesters differed by family race. Family ratings of requester communication skills were less favorable in racially discordant requests.

Conclusions: A small number of international quantitative studies assess the effect of cross-cultural communication on organ donation requests. Findings indicate a significant impact on the experience of family decision-makers and suggest an overall negative association with consent. Strategies to alleviate barriers to communication in cross-cultural requests are suggested along with areas for future research.