Barriers to Registration in the National Donor Registry in Nations Using the Opt-In System: A Review of the Literature

Abstract Background To increase the number of postmortem organ and tissue donors, donor registries (DRs) have been introduced. The aim of this review was to understand why people in nations with an Opt-in system, who are for or against donation after death, do not register in the DR. Knowing these barriers will help in developing policies to increase the registration rate in the DR. Methods For this review, 2 authors independently assessed the eligibility of the identified studies from 2000 to 2015 in the Pubmed- Medline database. Included were observational and interventional studies concerned with reported barriers to residents joining the national DR in Denmark, The Netherlands, and the United Kingdom. Results We included 15 relevant articles for the review. The main barriers to signing the DR in nations using the Opt-in system were: religion; medical mistrust, anxiety, and affective emotions; lack of information; concern about insufficient time to mourn, and that the funeral may be delayed and the deceased not look presentable; physical integrity; ignorance about how to register in the DR; own benefit; and social status. Conclusions The outcome suggests that the main barriers to enrolling in the DR are based on people's doubts about their own ability to perform the registration and cope with the consequences, knowledge, outcome expectations, and concerns about what others will think of them for agreeing to donation. However, not all barriers are easily modifiable, owing to their association with affect or emotions.