Satisfaction With the Organ Donation Process of Brain Dead Donors' Families In Korea

A mixed-methods study of emotional support for families of organ donors in Hunan Province, China

Background

Family consent is a prerequisite for the organ donation of the deceased in China. However, a large number of donors are individuals who died due to accidental injuries or unanticipated diseases, which means that most of the families of such donors have just experienced the sudden death of their loved one and have to make a donation decision in a short time. This decision may cause psychological stress and some psychological damage to the minds of relatives of the donors. In addition, cultural sensitivity also has largely caused the relatives of donors inner conflicts and contradictions. And sometimes organ donation may still be stigmatized. However, have they received any emotional support and what is their emotional support needs are some questions that need to be answered. Therefore, this study aims to investigate the emotional support, influencing factors, and needs of the family members of organ donors in Hunan Province, China.

Materials and methods

This is mixed-methods research that combines quantitative and qualitative research methods. A cross-sectional survey was conducted among 102 donor families using a questionnaire to investigate their emotional support status. To further understand their emotional support needs, 12 donor families participated in the semi-structured interview.

Results

The results confirmed that: (1) A total of 67.7% of the 102 respondents received emotional support or psychological comfort. Thus, only a small number of respondents (31.4%) felt respected by the public. (2) Emotional support came mainly from immediate family members (73.91%), and official organizations such as the Red Cross (43.48%). (3) Marital status, health status, occupation, and coping style can affect the emotional support of the donor families (p < 0.05). (4) Interview showed that the families of donors need emotional support and psychological aid from psychological professionals mostly. And they also wish to receive the understanding and respect of the public.

Conclusion

Most families of organ donors received emotional support from family, Red Cross, and friends, but only a minority of families of donors reported receiving respect from the public after the donation. And families of donor showed a strong need for emotional support and professional psychological aid from institutions.

A Systematic Review on Improving the Family Experience After Consent for Deceased Organ Donation

Introduction

The demand for transplanted organs outweighs the supply and intensifies the need to improve care for donor families. Studies have shown inadequate care by hospital staff can increase posttraumatic stress disorder and complicated grief in these families but putting solutions into practice remains slow.

Objective

This systematic review identified factors that relieve or contribute to distress for deceased organ donor families in the time since the decision to donate. Additionally, it provides insights into potential improvements at public health, educational, and health system levels to address these deficiencies.

Methods

Search terms included organ don*, famil* or relati*, family-centered, grief, and experience*. The search covered original research articles, published in English, from 2014 to July 2021.

Results

Four key themes emerged among the studies. (a) Understanding factors that affect the emotional aftermath can help staff prevent posttraumatic stress disorder and complicated grief. (b) Improving communication by hospital staff includes: avoiding medical jargon, providing adequate audio and visual explanations, and understanding that the next of kin is struggling to comprehend the tragedy and the information they are being told. (c) End-of-life care such as memory making, bringing in palliative care resources, and parting ceremonies can assist with familial coping as well as staff interactions. (d) Families want more support in the months and years after the donation decision.

Discussion

Changes at multiple levels can improve the quality of care for families whose relative gave the gift of life, but more research and translation into practice are needed.

When Life Ceases-Relatives' Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor-A Literature Review

Introduction

Most healthcare professionals rarely experience situations of a request for organ donation being made to the patient's family and need to have knowledge and understanding of the relatives' experiences.

Objective

To describe relatives' experiences when a family member is confirmed brain dead and becomes a potential organ donor.

Methods

A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019.

Results

The overarching theme When life ceases emerged as a description of relatives' experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss.

Conclusion

Caring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives' processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.

Relationship Between Bereavement Reaction With Posttraumatic Stress Disorder and Depression in Organ Donor Families in Iran

BACKGROUND

This study aimed to determine the relationship among bereavement, depression, and posttraumatic stress disorder (PTSD) in organ donor families in Iran.

METHODS

This is a correlational study of 96 family members of brain-dead patients whose organs were donated. Using census sampling method, we approached the families through the Kerman University's Organ Donation Center. Data were collected using the Core Bereavement Items, Beck Depression Inventory, and Impact of Event Scale-Revised.

RESULTS

The mean (SD) total score of bereavement, depression, and PTSD were 38.44 (9.25), 18.01 (12.92), and 41.90 (12.69), respectively. Among bereavement subscales, the highest mean (SD) score belonged to the "Images and Thoughts" (15.96 [4.16]) and the lowest belonged to "Grief" (10.57 [3.16]). Among different aspects of PTSD, the Intrusion subscale had the highest mean (SD) score (19.25 [6.22]), and the Hyperarousal subscale had the lowest (11.23 [5.34]). The Pearson correlation coefficient showed that bereavement was positively correlated with both depression (r = 0.72, P < .001) and PTSD (r = 0.59, P < .001).

CONCLUSION

Donor families experienced bereavement, PTSD, and depression after organ donation. Healthcare professionals should approach and assess these families for potential emotional-psychological consequences, provide emotional and practical support to alleviate their depression and PTSD, and assist them through the bereavement process.

Grief Reactions of Potential Organ Donors' Bereaved Relatives: An Observational Study

BACKGROUND

Most family members of potential organ donors experience the death of their relative in an intensive care unit. While under an emotional burden, bereaved relatives must make a decision that will affect the life of other patients. A better understanding of grief within the context of organ donation will help intensive care unit staff better support families during this process.

OBJECTIVES

To empirically describe the emotional reactions of potential organ donors' family members facing a loved one's death and analyze the relationship of these reactions to factors that occur in the process of illness and death.

METHODS

A prospective observational study was conducted in 16 Spanish hospitals for 36 months. Data of 421 relatives of potential organ donors, collected through a previously validated instrument, included relatives' emotional responses, deceased's and relatives' characteristics, circumstances of death, and behavior of health care staff.

RESULTS

Unexpected deaths were linked to more intense emotional reactions and less acceptance of death than were anticipated deaths. Additional stressors, such as perception of poor treatment by hospital staff, perception of deficient medical care, and poor relationships among family members, were associated with stronger reactions.

CONCLUSIONS

Observation and analysis of the factors studied may help hospital staff members anticipate bereaved relatives' emotional reactions and provide better support during the grieving process, increasing family members' well-being and facilitating a better-informed organ donation decision.

Remapping the organ donation ethical climate: a care ethics consideration

Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.

Grief, Stress, Trauma, and Support During the Organ Donation Process

The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.

Stressors experienced by the family members of brain-dead people during the process of organ donation: A qualitative study

More is known about organ donor recipients than donor families. We explored the stressors experienced by family members of brain-dead people during the process of organ donation. Seventeen family members and five organ procurers were interviewed and the data analyzed through conventional qualitative content analysis. Stressors experienced by family members fell into six themes-perceived threat of loss, decision making under conflict, painful corrosive farewell, feeling of insecurity, complexity of grief, and seeking relief. Findings highlight the necessity of developing and using standard protocols for supporting brain-dead people's family members throughout the process of organ donation and following bereavement.

The development of a narrative describing the bereavement of families of potential organ donors: A systematic review

Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.

Experiencing organ donation: feelings of relatives after consent

Objective:

to identify experiences and feelings on the organ donation process, from the perspective of a relative of an organ donor in a transplant unit.

Method:

this was exploratory research using a qualitative approach, performed with seven family members of different organ donors, selected by a lottery. Sociodemographic data and the experiences regarding the donation process were collected through semi-structured interviews. The language material was transcribed and submitted to content analysis.

Results:

poor sensitivity of the medical staff communicating the relative's brain death - the potential donor - and the lack of socio-emotional support prior to the situation experienced by the family was highlighted by participants.

Conclusions:

the study identified the need to provide social-emotional support for families facing the experience of the organ donation process. From these findings, other care and management practices in health must be discussed to impact the strengthening of the family ties, post-donation, as well as the organ procurement indexes.

Outcomes of organ donation in brain-dead patient's families: Ethical perspective

Background:

The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial.

Objective:

The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients.

Methods:

This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs.

Findings:

The main category of the data was “Decision to organ donation: a challenge from conflict to transcendence.” This main category consisted of 10 subcategories and 3 general categories. The general categories were “challenging outcomes,” “reassuring outcomes,” and “transcending outcomes.”

Ethical considerations:

The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used.

Conclusion:

Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.

Knowledge and Opinions of Deceased Organ Donation Among Middle and High School Students in Korea

BACKGROUND

Adolescents are an important target group for organ donation education. As yet, little is known about the attitude of Korean adolescents toward deceased organ donation, or the factors related to their decision. In this study, we explored the knowledge and opinions of deceased organ donation among middle and high school students in Korea.

METHODS

A self-reported survey was conducted among middle and high school students in Seoul, Korea. The questionnaire assessed knowledge, personal experience, and opinions of organ donation. Logistic regression analysis was performed to determine significant factors associated with willingness to become an organ donor.

RESULTS

Of the 323 students, 161 (49.8%) were willing to be a deceased donor, and the other 162 (50.2%) were unwilling or unsure. Neither level of knowledge nor experience of recent public information on organ donation affected students' decisions. Instead, a cohesive family environment and family discussion were strong predictors of the willingness of Korean middle and high school students to be an organ donor.

CONCLUSIONS

A donation education program that promotes family communication and discussion about organ donation could increase willingness to be an organ donor among Korean adolescents.