Organ Donation Decision in Families With Brain-Dead Patients: An Evolutionary Concept Analysis

Bereaved family members' perspectives of their organ donation decision at 3 months post death of the donor-eligible patient in critical care: A dual-method study

BACKGROUND

Offering organ donation is part of routine end-of-life care in critical care. Families describe feeling emotionally overwhelmed, which reduces their ability to understand complex medical information necessary to make informed decisions about organ donation. Late decisional regret is more common among families who decline donation. Thus, it is vital to investigate whether the organ donation decision choices that families make in hospital endure unchanged and what factors affect their perspectives.

OBJECTIVES

The objective of this study was to explore family members' perspectives of their final organ donation decision in hospital, either to consent or to decline donation, at around 90 d later.

METHODS

This dual-method study comprised semistructured interviews of family members of donor-eligible patients who experienced care in seven metropolitan teaching hospitals, a tertiary paediatric hospital, and a major regional hospital in New South Wales, Australia. Interviews were audio recorded and transcribed verbatim. Descriptive quantitative analysis and thematic analysis were used.

FINDINGS

Participants overwhelmingly agreed that their organ donation decision remained unchanged at 3 months after the death of their relative (n = 127, 97%). The remainder (n = 3, 2%) were unsure or stated "possibly not" (n = 1, 1%); in these cases, the eligible donor was certified dead via circulatory criteria. Five themes were synthesised in relation to the organ donation decision: Knowledge of the donor-eligible patient's prior wishes, Family members' prior decision to donate their own organs, Solace in the decision, Altruism, and Reality of the process.

CONCLUSIONS

The organ donation decision choice remained unchanged for the large majority. Further research is required to ascertain how people can be assisted to understand the organ donation process, particularly in the setting of certification of death by circulatory criteria, and how best to positively influence consent rates.

CLINICAL TRIAL REGISTRY NUMBER

Australian and New Zealand Clinical Trial Registration ACTRN12613000815763.

Psychosocial Profile of the Attitude Toward Family Organ Donation in People Older Than 65 Years

BACKGROUND

The population over 65 years of age is key in the decision to donate organs in its different aspects. We sought to analyze the attitude toward organ donation from a relative among people over 65 years of age and to determine the psychosocial variables that may influence their attitude.

METHODS

The study population consisted of citizens over 65 years of age. A representative sample was obtained in southeastern Spain (N = 420). A questionnaire about attitudes toward organ donation and transplantation (ODT) was used. Several psycho-social variables were also taken into account. Statistical analysis included the χ2 test and multivariate analysis.

RESULTS

The completion rate was 84% (n = 351). The favorable attitude toward organ donation from a relative was 53% (n = 184). The univariate analysis showed the influence of information variables, conversations on the subject with family and friends, meeting a donor, acceptance of cremation and autopsy, not being afraid of scars after donation, and carrying out prosocial activities (P < .05). In the multivariate analysis, the desire to carry out activities related to the ODT (odds ratio [OR] 2.06) and the favorable opinion of the partner (OR 3.72) persisted.

CONCLUSIONS

The attitude of older people toward organ donation from a relative is unfavorable. This attitude is influenced by various factors, including dialogue with family and friends and the fact that the partner has a favorable opinion regarding this issue. It is important to carry out training activities on ODT in this group in order not to have a negative impact on organ donation rates in the coming years.

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.