Introduction: Progress in paediatric transplantation and posttransplant survival have created a promising vision in this field. However, due to the lack of age-matched organs on one side and the more challenging process of getting consent for organ donation, the mortality rate in this group is high. In this study, we aimed to assess the challenges of family consent in the pediatric-aged group.
Methods: This questionnaire-based study was conducted in the Organ Procurement Unit of Shahid Beheshti University of Medical Sciences. From August 2018 to 2023, all families of potential donors less than 15 years old were evaluated and classified the refusal etiologies.
Results: The family consent rate was 74% in pediatric potential donors. The time consumed for family interviews was 15.7 (3.9) hours which was significantly higher than that of adults with 9.8 (5.2) hours. Of cases that refuse to donate, most of them (89% believed in miracle), 80 % were afraid of loss of body integrity, 74 % of refusal corresponded to lack of trust in the health system, 48 % of families were not aware of donation and brain death, 42 % were in shock, 8% didn’t know the will of dead (in case of more than 10 y/o), 5% of families were against donation, 5 % of refusal was related to the religious beliefs. Also, another important reason for refusal was the feeling of guilt (89%) and discomfort that the child will be in a suffering situation (73%).
Conclusion: We found out that willingness to miracle and a sense of guilt are the most important items threatening family consent in this group. We recommend having a teamwork approach including an expert donor coordinator, a psychologist, and a social worker for family interviews in the paediatric age group. 

Keywords: Paediatric age group, Family Refusal, Brain Deth