Introduction: The number of deceased donors that have increased annually until 2016 has started to decline in the last three years. This study therefore intends to analyze the trend of potential brain death reported to KODA and use the analysis results as a basic data for the activation of organ donation.
Methods: A retrospective survey was conducted on the records of 12,674 potential brain death cases reported to the KODA  from 2014 through 2019, and family interview data during these period at the same time. a comparative analysis was performed for the first period (P1: 2014 to 2016) where the number of donations continued to increase and the second period (P2: 2017 to 2019) that showed decline in donations compared to 2016.
Results: The cases of potential brain death reported to KODA was 5,548 in P1 and 7,126 in P2, a 28.4% increase from the previous period. Among these, the cases of medically suitable for organ donation increased by 36.5%, from 4,053 in P1 to 5,534 in P2. The number of finally agreed cases for donation from the medically fit group was 1,721 in  P1 and 1,617 in P2, a 6.4% down from the previous period, with decreasing the consent rate from 52.9% in P1 to 37.2% in P2. The number of cases where the reasons for refusal to donation by patients’ families were identified 869 in P1 and 1,408 in P2. Specific reasons for refusal were as follows: desire for active treatment and non-acceptance of the brain death diagnosis were found in 339 cases (39%) in P1 and 453 cases (32%) in P2; disagreement between family members in 219 cases (25.2%) in P1 and 317 cases (22.5%) in P2; and indifference that prevented families from considering donation sharply increased, from 128 cases (14.7%) in P1 to 287 cases (20.4%). In addition, the discontinuation of donation process even after family consent increased by 17.6% (from 74 cases in P1 to 87 cases in P2), mostly due to legal issues and death before the judgment of brain death.
Conclusion: The decrease in families’ consent for organ donation turned out to be the biggest cause of declining donation. The major reasons for refusal to donation such as “desire to prolong treatment until the patient is healed,” “disagreement among families regarding donation,” and “indifference toward donation” can be attributed to the lack of understanding of the medical state of brain death, a negative image of sharing and donation that is pervasive in Korean society, and the distrust between community members. Therefore, there is a need for education and promotion at a national level to enhance the awareness of the value of life and to encourage the public to practice the value of sharing.