1
|
Ott M, Murphy N, Lingard L, Slessarev M, Blackstock L, Basmaji J, Brahmania M, Healey A, Shemie S, Skaro A, Weijer C. Sowing "seeds of trust": How trust in normothermic regional perfusion is built in a continuum of care. Am J Transplant 2024:S1600-6135(24)00345-9. [PMID: 38825154 DOI: 10.1016/j.ajt.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024]
Abstract
Normothermic regional perfusion (NRP) is a promising technology to improve organ transplantation outcomes by reversing ischemic injury caused by controlled donation after circulatory determination of death. However, it has not yet been implemented in Canada due to ethical questions. These issues must be resolved to preserve public trust in organ donation and transplantation. This qualitative, constructivist grounded theory study sought to understand how those most impacted by NRP perceived the ethical implications. We interviewed 29 participants across stakeholder groups of donor families, organ recipients, donation and transplantation system leaders, and care providers. The interview protocol included a short presentation about the purpose of NRP and procedures in abdomen versus chest and abdomen NRP, followed by questions probing potential violations of the dead donor rule and concerns regarding brain reperfusion. The results present a grounded theory placing NRP within a trust-building continuum of care for the donor, their family, and organ recipients. Stakeholders consistently described both forms of NRP as an ethical intervention, but their rationales were predicated on assumptions that neurologic criteria for death had been met following circulatory death determination. Empirical validation of these assumptions will help ground the implementation of NRP in a trust-preserving way.
Collapse
Affiliation(s)
- Mary Ott
- Faculty of Education, York University, Toronto, Ontario, Canada; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Nicholas Murphy
- Departments of Philsophy and Medicine, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation and Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; Trillium Gift of Life Network, Toronto, Ontario, Canada
| | - Laurie Blackstock
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - John Basmaji
- Departments of Medicine and Epidemiology & Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Mayur Brahmania
- Division of Gastroenterology, Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Andrew Healey
- Trillium Gift of Life Network, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sam Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Canadian Blood Services, Ottawa, Ontario, Canada
| | - Anton Skaro
- Department of Surgery, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Charles Weijer
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Ontario, Canada
| |
Collapse
|
2
|
Lee LA, Martin DA, Mahoney M, James L, Avitzur Y, Carroll A, Piggott B, Tomlinson C, Urschel S, Hamiwka L. Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022. Pediatr Crit Care Med 2024; 25:416-424. [PMID: 37966310 PMCID: PMC11060061 DOI: 10.1097/pcc.0000000000003404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers. DESIGN A cross-sectional survey carried out 2021-2022. SETTING Canadian PICUs affiliated with a donor physician network. SUBJECTS Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution. MEASUREMENTS AND MAIN RESULTS A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units. CONCLUSIONS Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.
Collapse
Affiliation(s)
- Laurie A Lee
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Dori-Ann Martin
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meagan Mahoney
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
| | - Allison Carroll
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Christopher Tomlinson
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Simon Urschel
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Lorraine Hamiwka
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
3
|
Ben-Shlomo S, Oreg A, Cohen N. Families of organ donors between Jews and Arabs in Israel during a military operation: Constructing meaning through participation in an epistemic Community - Media analysis of two cases. DEATH STUDIES 2024:1-10. [PMID: 38635693 DOI: 10.1080/07481187.2024.2341881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
This study explores how bereaved families of organ donors become participants in an 'imagined epistemic community' of organ donor families, amidst a national conflict between Jews and Arabs in Israel. Utilizing a media case study approach, we identified factors contributing to the creation of this bi-national community and examined what the families received in return for their part. Additionally, we explored the reasons behind the community splitting into two separate entities. Based on the media reports, we suggest that entry into the community is conditional on donating organs during wartime, granting these families a special moral status in return, resonating messages of altruism, solidarity and coexistence. Further to this, we propose that when the Arab family felt they did not receive the expected recognition, they withdrew from the common community in favor of a separate national community.
Collapse
Affiliation(s)
- Shirley Ben-Shlomo
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel
| | - Ayelet Oreg
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel
| | - Noaz Cohen
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel
| |
Collapse
|
4
|
Gettis MA, Basu R, Welling S, Wall E, Dutreuil V, Calamaro CJ. Pediatric Death and Family Organ Donation: Bereavement Support Services in One Pediatric Health System. J Patient Exp 2024; 11:23743735241226987. [PMID: 38361833 PMCID: PMC10868482 DOI: 10.1177/23743735241226987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Health care providers need to support families and provide resources when facing their child's death and potential organ donation. Aims of this retrospective chart review in a tertiary health care system were: (1) describe characteristics of pediatric organ donors compared to those who were not; (2) determine differences between services utilized by families who selected organ donation versus those who did not. From 2017 to 2023 of 288 pediatric deaths, 76 were organ donors and 212 did not donate. Organ donors' mean age at admission was 6.3 ± 5.8 years. Thirty-four (44.7%) participated in Honor Walks. Significant differences existed between organ donors and non-organ donors in patients who were diagnosed with SIDS (3.9% vs 13.2%; P = .025). This study provides additional data to help further our understanding of bereavement support services for families making difficult decisions regarding organ donation.
Collapse
Affiliation(s)
| | - Rajit Basu
- Division Critical Care Medicine, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Eryn Wall
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Valerie Dutreuil
- Emory University Pediatric Biostatistics Core, Emory School of Medicine, Atlanta, GA, USA
| | - Christina J Calamaro
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| |
Collapse
|
5
|
Dicks SG, Northam HL, van Haren FM, Boer DP. The bereavement experiences of families of potential organ donors: a qualitative longitudinal case study illuminating opportunities for family care. Int J Qual Stud Health Well-being 2023; 18:2149100. [PMID: 36469685 PMCID: PMC9731585 DOI: 10.1080/17482631.2022.2149100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To illuminate opportunities for care in the context of deceased organ donation by exploring pre-existing family and healthcare professional characteristics, in-hospital experiences, and ongoing adjustment through the lenses of grief theory, systems theory, meaning-making, narrative, and organ donation literature. METHOD Qualitative longitudinal case studies explored individual and family change in five Australian families who had consented to Donation after Circulatory Determination of Death at a single centre. Participants attended semi-structured interviews at four, eight, and twelve months after the death. FINDINGS Family values, pre-existing relationships, and in-hospital experiences influenced first responses to their changed lives, understanding of the patient's death, and ongoing family adjustment. Novel behaviour that was conguent with family values was required at the hospital, especially if the patient had previously played a key role in family decision-making. This behaviour and emerging interactional patterns were drawn into family life over the first year of their bereavement. RECOMMENDATIONS Training that includes lenses introduced in this study will enable healthcare professionals to confidently respond to individual and family psychosocial needs. CONCLUSION The lenses of grief theory and systems thinking highlight opportunities for care tailored to the unique in-hospital context and needs that emerge in the months that follow.
Collapse
Affiliation(s)
- Sean G. Dicks
- Department of Psychology, University of Canberra, Canberra, Australia
| | - Holly L. Northam
- Department of Nursing and Midwifery, University of Canberra, Canberra, Australia
| | | | - Douglas P. Boer
- Department of Psychology, University of Canberra, Canberra, Australia
| |
Collapse
|
6
|
Avilés L, Kean S, Tocher J. Ambiguous loss in organ donor families: A constructivist grounded theory. J Clin Nurs 2023; 32:6504-6518. [PMID: 36345135 DOI: 10.1111/jocn.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
AIMS AND OBJECTIVES Explore families' experiences when being approached for organ donation authorisation after brainstem death. BACKGROUND The complexities of potential organ donor families' experiences include challenges related to emotional distress, coping with the loss and the organ donation decision-making process, and support needed. A lack of conceptual clarity was found concerning families' experiences when being approached for organ donation authorisation, which guided the study. DESIGN Constructivist grounded theory. METHODS Seventy-one participants, including healthcare professionals and families, were recruited from two large hospitals in Chile between 2017 and 2019. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) were collected and analysed following Charmaz's constructivist grounded theory principles and practices until theoretical saturation was reached. The study is reported using the COREQ checklist. RESULTS A third type of ambiguous loss of bereaved families' experience was developed as a fourfold process: (1) impending loss, (2) confirming loss, (3) ambiguous loss and organ donation decision-making and (4) organ donation as a third type of ambiguous loss. This grounded theory expands the concepts of ambiguous loss by Boss, dying by Glaser and Strauss and grief by Brinkmann, enabling explanation of families' experiences. CONCLUSION Families of potential organ donors develop a highly complex grieving process, which may play a significant role in the organ donation decision-making process. Ambiguity is embedded in how donor families reframe the existence of the donor through the act of giving life. RELEVANCE TO CLINICAL PRACTICE The findings shed light on families' experiences on the organ donation process after brainstem death. The study can be used in nursing practice, education and to inform policy nationally and globally, mainly due to the current focus on quantitative measures and legislative changes fostering individual decision-making. PATIENT OR PUBLIC CONTRIBUTION Families contributed through their first-hand experiences of the organ donation process.
Collapse
Affiliation(s)
- Lissette Avilés
- Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Susanne Kean
- Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Jennifer Tocher
- Old Medical School, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Sarti AJ, Sutherland S, Meade M, Hornby L, Wilson LC, Landriault A, Vanderspank-Wright B, Valiani S, Keenan S, Weiss MJ, Werestiuk K, Beed S, Kramer AH, Kawchuk J, Cardinal P, Dhanani S, Lotherington K, Pagliarello G, Chassé M, Gatien M, Parsons K, Chandler JA, Nickerson P, Shemie SD. Death determination by neurologic criteria-what do families understand? Can J Anaesth 2023; 70:637-650. [PMID: 37131029 PMCID: PMC10203015 DOI: 10.1007/s12630-023-02416-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE Currently, there is little empirical data on family understanding about brain death and death determination. The purpose of this study was to describe family members' (FMs') understanding of brain death and the process of determining death in the context of organ donation in Canadian intensive care units (ICUs). METHODS We conducted a qualitative study using semistructured, in-depth interviews with FMs who were asked to make an organ donation decision on behalf of adult or pediatric patients with death determination by neurologic criteria (DNC) in Canadian ICUs. RESULTS From interviews with 179 FMs, six main themes emerged: 1) state of mind, 2) communication, 3) DNC may be counterintuitive, 4) preparation for the DNC clinical assessment, 5) DNC clinical assessment, and 6) time of death. Recommendations on how clinicians can help FMs to understand and accept DNC through communication at key moments were described including preparing FMs for death determination, allowing FMs to be present, and explaining the legal time of death, combined with multimodal strategies. For many FMs, understanding of DNC unfolded over time, facilitated with repeated encounters and explanation, rather than during a single meeting. CONCLUSION Family members' understanding of brain death and death determination represented a journey that they reported in sequential meeting with health care providers, most notably physicians. Modifiable factors to improve communication and bereavement outcomes during DNC include attention to the state of mind of the family, pacing and repeating discussions according to families' expressed understanding, and preparing and inviting families to be present for the clinical determination including apnea testing. We have provided family-generated recommendations that are pragmatic and can be easily implemented.
Collapse
Affiliation(s)
- Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Stephanie Sutherland
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Maureen Meade
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angele Landriault
- Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sabira Valiani
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Sean Keenan
- BC Transplant, Vancouver, BC, Canada
- Division of Critical Care, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Stephen Beed
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andreas H Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary and Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Joann Kawchuk
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Pierre Cardinal
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Sonny Dhanani
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Giuseppe Pagliarello
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Michaël Chassé
- Department of Medicine, Centre hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Mary Gatien
- Horizon Health Network, Miramichi, NB, Canada
| | - Kim Parsons
- Organ Procurement and Exchange of Newfoundland and Labrador, St. John's, NL, Canada
| | - Jennifer A Chandler
- Common Law Section, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Peter Nickerson
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| |
Collapse
|
8
|
Ferrada P, Cannon JW, Kozar RA, Bulger EM, Sugrue M, Napolitano LM, Tisherman SA, Coopersmith CM, Efron PA, Dries DJ, Dunn TB, Kaplan LJ. Surgical Science and the Evolution of Critical Care Medicine. Crit Care Med 2023; 51:182-211. [PMID: 36661448 DOI: 10.1097/ccm.0000000000005708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.
Collapse
Affiliation(s)
- Paula Ferrada
- Division of Trauma and Acute Care Surgery, Department of Surgery, Inova Fairfax Hospital, Falls Church, VA
| | - Jeremy W Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemary A Kozar
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eileen M Bulger
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington at Seattle, Harborview, Seattle, WA
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, County of Donegal, Ireland
| | - Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Craig M Coopersmith
- Division of General Surgery, Department of Surgery, Emory University, Emory Critical Care Center, Atlanta, GA
| | - Phil A Efron
- Department of Surgery, Division of Critical Care, University of Florida, Gainesville, FL
| | - David J Dries
- Department of Surgery, University of Minnesota, Regions Healthcare, St. Paul, MN
| | - Ty B Dunn
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Section of Surgical Critical Care, Surgical Services, Philadelphia, PA
| |
Collapse
|
9
|
Martinez-Lopez MV, Coll E, Cruz-Quintana F, Dominguez-Gil B, Hannikainen IR, Lara Rosales R, Pérez-Blanco A, Perez-Marfil MN, Pérez-Villares JM, Uruñuela D, Rodríguez-Arias D. Family bereavement and organ donation in Spain: a mixed method, prospective cohort study protocol. BMJ Open 2023; 13:e066286. [PMID: 36609324 PMCID: PMC9827244 DOI: 10.1136/bmjopen-2022-066286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors' relatives. METHODS AND ANALYSIS A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient's death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives' grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software. ETHICS AND DISSEMINATION This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.
Collapse
Affiliation(s)
| | | | - Francisco Cruz-Quintana
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
| | | | - Ivar R Hannikainen
- Department of Philosophy I, Faculty of Philosophy, University of Granada, Granada, Spain
| | | | | | - Maria Nieves Perez-Marfil
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
| | | | | | - David Rodríguez-Arias
- Department of Philosophy I, Faculty of Philosophy, University of Granada, Granada, Spain
| |
Collapse
|
10
|
Experiência de famílias de doadores falecidos durante o processo de doação de órgãos: um estudo qualitativo. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao004334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
11
|
Bjelland S, Jones K. A Systematic Review on Improving the Family Experience After Consent for Deceased Organ Donation. Prog Transplant 2022; 32:152-166. [DOI: 10.1177/15269248221087429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sonja Bjelland
- University of Illinois at Chicago College of Nursing, Urbana, IL, USA
| | - Krista Jones
- Department of Population Health Nursing Science, University of Illinois at Chicago College of Nursing, Urbana, IL, USA
| |
Collapse
|
12
|
Luo A, He H, Xu Z, Ouyang W, Chen Y, Li K, Xie W. A Qualitative Study in Family Units on Organ Donation: Attitude, Influencing Factors and Communication Patterns. Transpl Int 2022; 35:10411. [PMID: 35401037 PMCID: PMC8983816 DOI: 10.3389/ti.2022.10411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
This study aimed to analyze the attitude, influencing factors and communication patterns of organ donation in Chinses families. We conducted in-depth interviews with 97 participants from 26 families in China from August 2018 to October 2020. Interviews were audio-recorded, transcribed by the researchers. Thematic analysis was used to analyze the data and Nvivo 12 was used to catalog coded data. Thirty-eight participants indicated that they would like to be a donor while the majority were unlikely to donate. Among those who were willing to donate, some disagreed with family members to donate organs. Themes found included attitude, the timing of thinking, taboo and fear, traditional beliefs, ethics and family communication patterns. Lack of knowledge, fear, taboo, some traditional beliefs and mistrust may discourage donation. Altruism and policy which is good for the family seem to encourage donation. We also constructed three family communication patterns to provide a deeper understanding of the family in China. This is the first qualitative study that analyzed attitude, influencing factors and communication patterns based on family units in China mainland. Our findings showed that family comes first in Chinese. We suggest that family-based consent and incentives are more suitable for the Chinese social context.
Collapse
Affiliation(s)
- Aijing Luo
- The Third Xiangya Hospital of Central South University, Changsha, China.,Second Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
| | - Haiyan He
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Zehua Xu
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,Public Health College of Central South University, Changsha, China
| | - Wei Ouyang
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Yang Chen
- School of Life Sciences, Central South University, Changsha, China
| | - Ke Li
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Wenzhao Xie
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| |
Collapse
|
13
|
Padoan CS, Garcia LF, Crespo KC, Longaray VK, Martini M, Contessa JC, Kapczinski F, de Oliveira FH, Goldim JR, Vs Magalhães P. A qualitative study exploring the process of postmortem brain tissue donation after suicide. Sci Rep 2022; 12:4710. [PMID: 35304551 PMCID: PMC8933424 DOI: 10.1038/s41598-022-08729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Access to postmortem brain tissue can be valuable in refining knowledge on the pathophysiology and genetics of neuropsychiatric disorders. Obtaining postmortem consent for the donation after death by suicide can be difficult, as families may be overwhelmed by a violent and unexpected death. Examining the process of brain donation can inform on how the request can best be conducted. This is a qualitative study with in-depth interviews with forty-one people that were asked to consider brain donation-32 who had consented to donation and 9 who refused it. Data collection and analyses were carried out according to grounded theory. Five key themes emerged from data analysis: the context of the families, the invitation to talk to the research team, the experience with the request protocol, the participants' assessment of the experience, and their participation in the study as an opportunity to heal. The participants indicated that a brain donation request that is respectful and tactful can be made without adding to the family distress brought on by suicide and pondering brain donation was seen as an opportunity to transform the meaning of the death and invest it with a modicum of solace for being able to contribute to research.
Collapse
Affiliation(s)
- Carolina Stopinski Padoan
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Lucas França Garcia
- Graduate Program in Health Promotion, Cesumar University, Maringá, Paraná, Brazil
| | - Kleber Cardoso Crespo
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Vanessa Kenne Longaray
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Murilo Martini
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Júlia Camargo Contessa
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Flávio Kapczinski
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
- St. Joseph's Healthcare Hamilton McMaster University, Hamilton, ON, Canada
| | - Francine Hehn de Oliveira
- Serviço de Patologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Roberto Goldim
- Bioethics Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Vs Magalhães
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil.
| |
Collapse
|
14
|
Rafii F, Rahimi S. Organ Donation Decision in Families With Brain-Dead Patients: An Evolutionary Concept Analysis. Prof Case Manag 2022; 27:67-84. [PMID: 35099421 DOI: 10.1097/ncm.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Organ donation decision is a complicated process for bereaved families; however, its attributes and associated factors are not clear. Accordingly, the purpose of this study was to analyze the concept of organ donation decision in families with brain-dead patients. METHODS Concept analysis was performed using Rodgers' evolutionary method. For this purpose, PubMed, OVID, Scopus, and ProQuest databases were searched in English from 1985 to 2019. In total, 54 articles were analyzed using the thematic analysis to identify the attributes, antecedents, and consequences of the concept. The validity of the data was provided by examining the analysis process by 2 independent researchers. FINDINGS/CONCLUSIONS Organ donation decision in these families is a complicated and conflicting process of vicarious decision-making that begins with an organ donation request: a difficult, painful, and critical experience that requires extensive interpersonal interactions and is ultimately influenced by various factors, leading to the acceptance or refusal. The antecedents include deceased-related factors, family-related factors, the quality of organ donation request, and the quality of health care professionals' interactions. The consequences include the positive outcomes (grief solace, gift of life, and promoting human values) and negative outcomes (ambiguity, doubt and regret, and psychological inconsistency). The results of this concept analysis led to a better understanding of the complexity of an organ donation decision in these families. In this way, in addition to knowledge development, it assists the health care staff to support families in making the organ donation decision. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Although case managers rarely participate in organ donation, they definitely need to understand the concepts related to organ donation decision while advocating for the patients or families. The results of this concept analysis can broaden the case managers' and other health care professionals' knowledge about families' organ donation decision and help them take more effective interventions for management of this process. Case managers and the health care team can use the information of this article for informing families about brain death, negotiating with families for organ donation, preparing information, and caring and facilitating the families in making the clear and unconflicted decision.
Collapse
Affiliation(s)
- Forough Rafii
- Forough Rafii, PhD, MSN , is a Professor, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Sara Rahimi, MSN , is a PhD student, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Rahimi
- Forough Rafii, PhD, MSN , is a Professor, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Sara Rahimi, MSN , is a PhD student, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
15
|
Yeo NYK, Reddi B, Kocher M, Wilson S, Jastrzebski N, Duncan K, Moodie S. Collaboration between the intensive care unit and organ donation agency to achieve routine consideration of organ donation and comprehensive bereavement follow-up: an improvement project in a quaternary Australian hospital. AUST HEALTH REV 2021; 45:124-131. [PMID: 33317686 DOI: 10.1071/ah20005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/20/2020] [Indexed: 11/23/2022]
Abstract
Objective Routine family follow-up after bereavement in the intensive care unit (ICU) and routine consideration of organ and tissue donation at end of life are both integral to good health care delivery, yet neither is widely achieved. This study evaluated an initiative to efficiently deliver these outcomes in an Australian setting through a novel collaboration between DonateLife South Australia (DLSA) and the ICU of the Royal Adelaide Hospital. Methods A Plan-Do-Study-Act method of quality improvement was used in the Royal Adelaide Hospital ICU between February 2018 and February 2019. The ICU clinical team identified adult patients and family members at medical consensus of end of life to donation specialist nursing coordinators, who assessed potential for donation and enrolled patients and family members into a bereavement follow-up program. After death, family members received bereavement information and details of a structured telephone follow-up conversation that took place 6-8 weeks later. Results Of 241 deaths, 216 were enrolled in the project. Follow-up telephone calls were completed with 124 of 201 (62%) family members, with 77 (38%) family members not contactable. Follow-up telephone interviews yielded practical suggestions to improve end-of-life care. Donation was considered in all patients enrolled in the project, and referral through DLSA increased from 24% to 90% of all ICU deaths. Associated with the collaborative initiative, consent to organ donation recorded a 63% increase on the 10-year average (from 19 to 31 donors). Corneal donation referral increased by 625%. The initiative required an additional 0.4 full-time equivalent registered nurse. Family members valued the opportunity to debrief their experience. Conclusions Collaboration between DLSA and the Royal Adelaide Hospital ICU achieved universal consideration of organ donation and high rates of structured bereavement follow-up. Follow-up calls were valued with areas for improvement identified. What is known about this topic? Death in the ICU is associated with significant psychopathology among bereaved family members, and bereavement follow-up is widely recommended. Opportunities to consider organ and tissue donation are commonly missed due to lack of consideration at end of life. What does this paper add? Collaboratively exploring donation and performing bereavement follow-up is feasible with a minimal added resource. Such comprehensive approach to good end-of-life care helps identify aspects of care that could be improved and is associated with an increase in organ and tissue donation rates. What are the implications for practitioners? Collaboration between the ICU and DonateLife achieved mutually beneficial outcomes of understanding the end-of-life experience for family members and timely consideration of organ and tissue donation. This timely consideration potentially identified some missed organ donors and then allowed family members to give feedback on their experience.
Collapse
Affiliation(s)
- Nikki Yeok Kee Yeo
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia. ; ; ; ; and Present address: Intensive Care Unit, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA 5011, Australia; and Corresponding author.
| | - Benjamin Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia. ; ; ;
| | - Mandy Kocher
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia. ; ; ;
| | - Serena Wilson
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia. ; ; ;
| | - Natalia Jastrzebski
- DonateLife South Australia, Ground Floor Allianz Centre, 55 Currie Street, Adelaide, SA 5000, Australia. ;
| | - Kerry Duncan
- DonateLife South Australia, Ground Floor Allianz Centre, 55 Currie Street, Adelaide, SA 5000, Australia. ;
| | - Stewart Moodie
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia. ; ; ; ; and DonateLife South Australia, Ground Floor Allianz Centre, 55 Currie Street, Adelaide, SA 5000, Australia. ;
| |
Collapse
|
16
|
Anthony SJ, Lin J, Pol SJ, Wright L, Dhanani S. Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario. Can J Anaesth 2021; 68:611-621. [PMID: 33575991 PMCID: PMC7878166 DOI: 10.1007/s12630-021-01928-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/24/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In Ontario, an individual's registered wish for organ donation is legally valid consent following death. Family veto occurs when the deceased donor's substitute decision-maker (SDM) overrides this consent to donate, evoking a legal and ethical conflict. The objective of this study was to examine the experiences of Organ and Tissue Donation Coordinators (OTDCs) working with SDMs who vetoed a deceased donor's consent for organ donation. METHODS Qualitative focus groups were conducted with ten OTDCs in Ontario, Canada who reported experience with family veto. An interpretative phenomenological approach informed data analysis. Themes emerged through team consensus and were further refined through collaborative and reflexive engagement. RESULTS Four themes emerged regarding family veto: 1) the significance of the OTDC role, 2) emotional distress and the "understandable" family veto, 3) barriers contributing to family veto, and 4) strategies towards a culture of organ donation. Findings highlighted the importance of patient advocacy in the OTDC role, while revealing the emotional distress of experiencing family veto. OTDCs identified timing and healthcare providers' perceived ambivalence toward organ donation as critical barriers to family authorization. Value-positive language, role reframing, and increased education were offered as strategies to address these barriers and reduce family veto. CONCLUSION This study highlights important considerations about organ donation authorization processes in Ontario. Findings support practice changes towards reducing family veto and further research nationally. Collaborations with key stakeholders are warranted to align healthcare practices, donation policies, and education initiatives towards a shared goal of increasing organ donation.
Collapse
Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
| | - Jia Lin
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah J Pol
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda Wright
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| |
Collapse
|
17
|
Ma J, Zeng L, Li T, Tian X, Wang L. Experiences of Families Following Organ Donation Consent: A Qualitative Systematic Review. Transplant Proc 2021; 53:501-512. [PMID: 33483168 DOI: 10.1016/j.transproceed.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This systematic review synthesizes qualitative evidence on the experiences of donor families after consent to organ donation. METHODS This robust, qualitative systematic review included an exhaustive search of electronic databases, including PubMed, Scopus, EBSCO PsycINFO, and CINAHL Complete. Manual searches of reference lists and gray literature were conducted to achieve a comprehensive identification of all relevant research. A qualitative study design served to capture the experiences of donor families after organ donation consent. RESULTS A total of 6 articles that met the eligibility criteria were identified and included in this review. Three key themes emerged from the primary research: 1. family members were ambivalent about consent due to the ambiguity of brain death; 2. conversations about donation requirements proved uncomfortable; and 3. support is needed after donation. CONCLUSIONS Family members demonstrated ongoing ambivalence and distress that lasted for weeks after organ donation due to the ambiguity of brain death. Some family members were unhappy with having been approached for a conversation about organ donation. Donor families were not always able to deal with the difficulties they faced after their decision about organ donation. Health care professionals should provide ongoing care and updated information to family members. This review helped to identify family members' needs for both psychological and financial assistance.
Collapse
Affiliation(s)
- Juanjuan Ma
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Li Zeng
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China.
| | - Tingjun Li
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Xiaofei Tian
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Wang
- Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| |
Collapse
|
18
|
Kerstis B, Widarsson M. When Life Ceases-Relatives' Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor-A Literature Review. SAGE Open Nurs 2021; 6:2377960820922031. [PMID: 33415278 PMCID: PMC7774436 DOI: 10.1177/2377960820922031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/26/2020] [Accepted: 04/04/2020] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Margareta Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| |
Collapse
|
19
|
The Implementation of a Multidisciplinary Approach for Potential Organ Donors in the Emergency Department. Transplantation 2020; 103:2359-2365. [PMID: 30893291 DOI: 10.1097/tp.0000000000002701] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the implementation process of a multidisciplinary approach for potential organ donors in the emergency department (ED) in order to incorporate organ donation into their end-of-life care plans. METHODS A new multidisciplinary approach was implemented in 6 hospitals in The Netherlands between January 2016 and January 2018. The approach was introduced during staff meetings in the ED, intensive care unit (ICU), and neurology department. When patients with a devastating brain injury had a futile prognosis in the ED, without contraindications for organ donation, an ICU admission was considered. Every ICU admission to incorporate organ donation into end-of-life care was systematically evaluated with the involved physicians using a standardized questionnaire. RESULTS In total, 55 potential organ donors were admitted to the ICU to incorporate organ donation into end-of-life care. Twenty-seven families consented to donation and 20 successful organ donations were performed. Twenty-nine percent of the total pool of organ donors in these hospitals were admitted to the ICU for organ donation. CONCLUSIONS Patients with a devastating brain injury and futile medical prognosis in the ED are an important proportion of the total number of donors. The implementation of a multidisciplinary approach is feasible and could lead to better identification of potential donors in the ED.
Collapse
|
20
|
Takaoka A, Honarmand K, Vanstone M, Tam B, Smith OM, Baker A, LeBlanc A, Swinton M, Neville TH, Clarke FJ, Hancock J, McMullen S, Meade MO, Rose T, Arora S, Cook DJ. Organ Donation at the End of Life: Experiences From the 3 Wishes Project. J Intensive Care Med 2020; 36:404-412. [PMID: 31960743 DOI: 10.1177/0885066619900125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ donation as experienced by families, clinicians, and organ donation coordinators. METHODS In a multicenter evaluation of the 3WP in 4 Canadian ICUs, we conducted a thematic analysis of transcripts from interviews and focus groups with clinicians, organ donation coordinators, and families of dying or died patients for whom donation was considered. RESULTS We analyzed transcripts from 26 interviews and 2 focus groups with 18 family members, 17 clinicians, and 6 organ donation coordinators. The central theme describes the mutual goals of the 3WP and organ donation-emphasizing personhood and agency across the temporal continuum of care. During family decision-making, conversations encouraged by the 3WP can facilitate preliminary discussions about donation. During preparation for donation, memory-making activities supported by the 3WP redirect focus toward personhood. During postmortem family care, the 3WP supports families, including when donation is unsuccessful, and highlights aspirational pursuits of donation while encouraging reflections on other fulfilled wishes. CONCLUSIONS Organ donation and the 3WP provide complementary opportunities to engage in value-based conversations during the dying process. The shared values of these programs may help to incorporate organ donation and death into a person's life narrative and incorporate new life into a person's death narrative.
Collapse
Affiliation(s)
- Alyson Takaoka
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada.,Co-primary authors
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western Ontario, London, Canada.,Co-primary authors
| | - Meredith Vanstone
- McMaster program for Education Research Innovation & Theory, Department of Family Medicine, 3710McMaster University, Hamilton, Canada
| | - Benjamin Tam
- Division of Critical Care, Department of Medicine, 37195Niagara Health, St. Catharines, Canada
| | - Orla M Smith
- Critical Care Department, Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Toronto, Canada
| | - Andrew Baker
- Department of Anesthesia, 10071St Michael's Hospital, Toronto, Canada.,Department of Critical Care, 10071St Michael's Hospital, Toronto, Canada
| | - Allana LeBlanc
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Marilyn Swinton
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada
| | - Thanh H Neville
- Division of Pulmonary & Critical Care, Department of Medicine, 8783University of California, Los Angeles, CA, USA
| | - France J Clarke
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Jennifer Hancock
- Department of Critical Care, 3688University of Dalhousie, Halifax, Canada
| | - Sarah McMullen
- Department of Critical Care, 3688University of Dalhousie, Halifax, Canada
| | - Maureen O Meade
- Faculty of Health Sciences, Department of Medicine, Faculty, 3710McMaster University, Hamilton, Canada
| | - Trudy Rose
- Department of Spiritual Care, Grand River Hospital, Kitchener, Canada
| | - Samantha Arora
- Department of Medicine, 3710McMaster University, Hamilton, Canada
| | - Deborah J Cook
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada.,Faculty of Health Sciences, Department of Medicine, Faculty, 3710McMaster University, Hamilton, Canada
| |
Collapse
|
21
|
Walker W, Sque M. Family bereavement: A case study of controlled organ donation after circulatory death. Nurs Crit Care 2019; 24:229-234. [PMID: 31144416 DOI: 10.1111/nicc.12436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 01/03/2023]
Abstract
Deceased organ donation represents a major source of organs for human transplantation practice. In the United Kingdom, as well as other parts of the world, donation after circulatory death accounts for a proportion of all deceased organ donors. Organ and tissue donation emotively takes place in the context of dying, death and bereavement, yet little is known about the family experience of donation after circulatory death. This paper presents a case study of the phenomenon of controlled donation after circulatory death in intensive care. We present a critical analysis of care processes through the lens of a British donor family who participated in a national study of organ and tissue donation. Anonymized family quotes are applied to illustrate specific case issues, and with reference to relevant national guidance and international research. The case portrayed intimate details of the moment in time when the family experienced the potential for controlled donation after circulatory death, factors that appeared to influence family consent and the perceived expectations and outcomes arising from the donation decision. Case analysis demonstrated local compliance with best practice guidance and compassionate end-of-life care while supporting organ retrieval. Caring for the grieving family of potential organ donors requires sensitivity and skill. Of importance is a sound professional knowledge and understanding of the clinical care pathway, together with effective teamwork, optimal communication, family and staff support. Further research is required to determine the impact of controlled donation after circulatory death on family grief and bereavement.
Collapse
Affiliation(s)
- Wendy Walker
- Acute and Critical Care Nursing, University of Wolverhampton, Faculty of Education, Health and Wellbeing, Institute of Health, Wolverhampton, UK
| | - Magi Sque
- University of Wolverhampton, Wolverhampton, UK
| |
Collapse
|
22
|
Life From Death-The Brain Dead Organ Donor Process As an Intersection of Family Bereavement and Needs and Clinician Awareness and Empathy. Crit Care Med 2019; 47:606-607. [PMID: 30882431 DOI: 10.1097/ccm.0000000000003674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Kentish-Barnes N, Siminoff LA, Walker W, Urbanski M, Charpentier J, Thuong M, Sarti A, Shemie SD, Azoulay E. A narrative review of family members’ experience of organ donation request after brain death in the critical care setting. Intensive Care Med 2019; 45:331-342. [DOI: 10.1007/s00134-019-05575-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/19/2019] [Indexed: 11/27/2022]
|
24
|
Critical synopsis and key questions in brain death determination. Intensive Care Med 2019; 45:306-309. [PMID: 30725142 DOI: 10.1007/s00134-019-05549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
|