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Shim L, Wensley C, Casement J, Parke R. What determinants impact deceased organ donation consent in the adult intensive care unit? An integrative review exploring the perspectives of staff and families. Aust Crit Care 2024; 37:638-650. [PMID: 38216416 DOI: 10.1016/j.aucc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Deceased organ donation saves lives. Donation processes in New Zealand operate under an opt-in system, which requires consent from families of patients diagnosed with brain death or circulatory death while in the intensivecare unit. The donation demand and supply mismatch is a global phenomenon. OBJECTIVES The objective of this study was to understand the determinants of deceased organ donation decisions in the adult intensive care setting from the perspectives of staff and families. METHODS An integrative review based on Whittemore and Knafl's approach searched literature through databases CINAHL Plus, SCOPUS, Proquest Medline Ovid, and manual ancestry searches. Inclusion/exclusion criteria screened for pertinent literature, which were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Selected studies were appraised using a generic scoring tool, and data were systematically extracted and coded onto spreadsheets using inductive, thematic analysis. RESULTS A total of 21 studies (12 qualitative, seven quantitative, two mixed methods) were included. Publication dates ranged from 1993 to 2021 from multiple countries (18 opt-in, three opt-out systems). Four overarching themes pertaining to families and staff were generated. Important knowledge related to families' knowledge deficits around brain death, the purpose of ventilation, donation procedures, patients' wishes, and staffs' lack of training. Challenging communication highlighted miscommunications due to language choices and interrupted continuity of care during staff-family interactions. Internal determinants explored the cultural, spiritual, and emotional perspectives of families, while staff faced a sense of burden and conflicting values in delivering care between donors and recipients. External determinants related to the clinical environment impacting on grieving families, while for the staff, it explained concerns around resources and organisational processes. CONCLUSIONS Factors underpinning deceased organ donation are multifaceted and complex. Staff actions and families' decisions are inextricably intertwined. Modifiable factors include a lack of formal training and communicational skills and environmental limitations of an intensive care setting.
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Affiliation(s)
- Lydia Shim
- Auckland City Hospital Department of Critical Care Medicine, Te Toka Tumai, Grafton, New Zealand; School of Nursing, The University of Auckland, Faculty of Medical and Health Sciences, Grafton, New Zealand.
| | - Cynthia Wensley
- School of Nursing, The University of Auckland, Faculty of Medical and Health Sciences, Grafton, New Zealand.
| | - Jonathan Casement
- Organ Donation New Zealand, New Zealand Blood Service, 71 Great South Rd, Epsom PO Box 99 431, Newmarket, Auckland 1149, New Zealand; Intensive Care Unit, North Shore Hospital, Waitemata, Te Whatu Ora, Auckland, New Zealand.
| | - Rachael Parke
- School of Nursing, The University of Auckland, Faculty of Medical and Health Sciences, Grafton, New Zealand; Cardiothoracic and Vascular Intensive Care Unit, Te Toka Tumai Auckland, Grafton, New Zealand.
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Nejatollahi SMR, Abdolmohammadi Y, Ahmadi S, Hasanzade A, Hosseini F, Mohseni A, Shafaghi S, Dezfuli MM, Ghorbani F. Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:241-249. [PMID: 37997212 PMCID: PMC10772271 DOI: 10.4285/kjt.23.0049] [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: 09/04/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 11/25/2023] Open
Abstract
Background Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. Methods In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. Results A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. Conclusions This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.
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Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yazdan Abdolmohammadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Hasanzade
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshia Mohseni
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mokhber Dezfuli
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Holthe E, Husby VS. Barriers to Organ Donation: A Qualitative Study of Intensive Care Nurses' Experiences. Dimens Crit Care Nurs 2023; 42:277-285. [PMID: 37523727 DOI: 10.1097/dcc.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND An increasing number of patients affected by organ failure can be treated with organ transplantation. The need for organs available for transplantation is critical and patients die while on the transplant list. Intensive care unit (ICU) nurses are essential in facilitating organ donation through their ceaseless bedside care for potential organ donors and their families. AIMS AND OBJECTIVES The aim of this study was to describe the challenges faced by ICU nurses in the organ donation process. DESIGN A descriptive qualitative study design was used. METHOD Semistructured individual interviews of 9 ICU nurses from 1 university hospital were performed. Data were analyzed using Malterud's systematic text condensation. RESULTS Three themes describe the core of the results: (1) practical tasks, (2) challenging care for the next of kin, and (3) ethical and emotional challenges. CONCLUSIONS Practical tasks represent challenges in the organ donation process that are not previously revealed. Actions to address these challenges should be prioritized to promote organ donation. Simulation-based training may optimize practical aspects of the organ donation process and implementation of simulation-based training should be assessed by future research.
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Alshammari A, Brown M. Attitudes That Might Impact upon Donation after Brain Death in Intensive Care Unit Settings: A Systematic Review. Healthcare (Basel) 2023; 11:1857. [PMID: 37444690 DOI: 10.3390/healthcare11131857] [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: 05/29/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Organ donation and transplantation can save or improve the quality of life of people worldwide. However, there are many challenges associated with organ donation, as the demand for organs greatly outstrips supply. Additionally, there are brain-dead patients who could be potential organ donors. It is thus important to determine the attitudes affecting organ donation and transplantation in intensive care unit settings. AIM this study aimed to identify attitudes that might affect organ donation and transplantation in intensive care unit settings. METHODOLOGY Five electronic databases (CINAHL, Medline, PsycINFO, Scopus, and EMBASE) were searched systematically. A systematic search strategy was formulated. The quality of each study was assessed using the MMAT quality appraisal tool. RESULTS A total of seven studies were included. The findings of this systematic review demonstrate that education, policy, and continuing professional development could help to address barriers to donation. CONCLUSIONS therefore, to influence organ donation and transplantation positively, the main themes evaluated in this systematic review provide an opportunity to influence organ donation and transplantation attitudes in intensive care unit settings.
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Affiliation(s)
- Areej Alshammari
- Northern Area Armed Forces Hospital, Hafar Albatin, King Khaild Military City 39748, Saudi Arabia
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
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Gibson JE, Campbell T, Gibson K, Kottemann K, Krause MA, Pack L. Collaborative Approach to Organ Donation in a Level II Trauma Center. AACN Adv Crit Care 2023; 34:88-94. [PMID: 37289629 DOI: 10.4037/aacnacc2023552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although a shortage of organ donors is a continuing global problem in health care, obtaining authorization for donation after an individual experiences a traumatic nonsurvivable event can be difficult. OBJECTIVE To improve organ donation practices at a level II trauma center. METHODS After reviewing trauma mortality cases and performance improvement metrics with their organ procurement organization's hospital liaison, leaders at the trauma center implemented a multidisciplinary performance improvement initiative to engage the facility's donation advisory committee, provide education for staff members, and increase program visibility to create a more donation-friendly culture for the facility. RESULTS The initiative led to an improved donation conversion rate and a greater number of organs procured. Continued education increased staff and provider awareness of organ donation, contributing to the positive outcomes. CONCLUSION A multidisciplinary initiative that includes continuing staff education can improve organ donation practices and program visibility, ultimately benefiting patients in need of organ transplantation.
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Affiliation(s)
- Jesse E Gibson
- Jesse E. Gibson is Trauma Program Director, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Teisha Campbell
- Teisha Campbell is Hospital Development Liaison II, LifeLink of Georgia, Norcross, Georgia
| | - Kyle Gibson
- Kyle Gibson is Nurse Practitioner, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Kim Kottemann
- Kim Kottemann is Director of Professional Programs and Transplant Center Relations, LifeLink of Georgia, Norcross, Georgia
| | - Morgan A Krause
- Morgan A. Krause is Trauma Research Coordinator, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Leigh Pack
- Leigh Pack is Trauma Research Coordinator, Northeast Georgia Medical Center, 743 Spring St NE, Gainesville, GA 30501
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Timar J, Bleil M, Daly T, Koomar S, Hasz R, Nathan H. Successful strategies to increase organ donation: the Gift of Life Donor Program Philadelphia model. Indian J Thorac Cardiovasc Surg 2021; 37:380-394. [PMID: 34629767 PMCID: PMC8464643 DOI: 10.1007/s12055-021-01219-9] [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: 03/16/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022] Open
Abstract
Organ donation connects the ending of one life with the renewal of another. Acute care hospitals care for the organ donor and transplant organizations complete life-saving surgeries. Between them is a vital component: a less-known medical team dedicated to ensuring that organ donation and transplantation are possible. Organ procurement organizations (OPOs) support grieving families during a painful time of loss, providing a rare and precious opportunity in donation. The OPO is simultaneously poised to ensure that organs successfully begin their journey to renewing life and restoring hope for recipients and their loved ones. Every OPO faces a myriad of challenges in meeting its responsibilities. A recognized leader in the field, Gift of Life Donor Program (GLDP) in Philadelphia, Pennsylvania has been committed to meeting these challenges for nearly fifty years. The successes of this OPO reflect the legacies of organ donors, recipients, and their cherished loved ones.
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Affiliation(s)
- Jennifer Timar
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Maria Bleil
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Theresa Daly
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Susan Koomar
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Richard Hasz
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Howard Nathan
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
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Facilitators and Barriers in the Organ Donation Process: A Qualitative Study among Nurse Transplant Coordinators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217996. [PMID: 33143168 PMCID: PMC7662326 DOI: 10.3390/ijerph17217996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023]
Abstract
Background: Spain is the world leader in organ donation, with a rate of 49.0 donations per million population. Nurse transplant coordinators fulfill key roles for the success of the complex donation process. Our aims were: (a) to describe the experience of nurse transplant coordinators and (b) to identify barriers and facilitators during the process of organ donation. Methods: A qualitative phenomenological study was conducted within the National Transplant Organization. A purposive sampling method was used, and data collection methods included semistructured interviews, researcher field notes, and participants’ personal letters. A systematic text condensation analysis was performed. The study was approved by the Clinical Research Ethics Committee. Results: A total of 16 participants were recruited and four themes were identified: (a) a different job for nurses, (b) facilitators and barriers of the coordinator’s job, (c) not a job for a novice nurse, and (d) coordinators facing a paradigm shift. Coordinators described their job as being characterized with uncertainty and having to face emotional and institutional barriers. The facilitators identified were high educational level and training, and feelings of pride for being part of the National Transplant Organization. Conclusions: The organ donation process requires specialized training to avoid organizational barriers.
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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.
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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
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Pek JH, Ho VK, Ng WS, Kabir T, Tiah L, Koh Y. Missed opportunities for organ donation in patients with intracranial haemorrhage at the emergency department: A single-centre study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819868487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The demand for transplantable organs has increased in Singapore. However, organ donation has been consistently lower than international standards. Donation after brain death (DBD) most commonly follows intracranial haemorrhage (ICH). Objective: Our aim was to identify missed opportunities for organ donation among those who presented to the Emergency Department (ED) and died following ICH. Methods: A retrospective study was carried out for all cases of ICH presenting to the ED from 1 January 2013 to 31 December 2017. The patients’ medical records were reviewed for identification of potential donors and actualisation of organ donation. Results: There were 615 cases of ICH, with a mortality rate of 6.0%. Among those who died, 28 (75.7%) died in the Intensive Care Unit (ICU) and nine (24.3%) patients had withdrawal of care in the ED. Thirty patients (81.1%) were potential donors but organ donation was actualised in only three (8.1%) patients. Thirteen organs, as well as heart valves and iliac vessels were retrieved from the organ donors for transplantation. Conclusion: There were missed opportunities for organ donation. EDs have an important role to play in the national organ donation programme by identifying potential donors for organ donation and considering admitting these patients to ICU to facilitate organ donation.
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Affiliation(s)
- Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, Singapore
| | - Wei Sheng Ng
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Yexin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
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A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation. Can J Anaesth 2019; 66:686-695. [PMID: 30809778 DOI: 10.1007/s12630-019-01332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/23/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Rates of organ donation vary between otherwise comparable intensive care units (ICUs) suggesting that the process of donation must vary between ICUs. The purpose of this study was to describe the process of organ donation from the perspective of ICU staff, identify important drivers of successful donation, and develop strategies to improve the process of donation. METHODS We conducted qualitative interviews with 32 ICU staff, including physicians, nurses, and respiratory therapists, using an interview guide developed from previous studies on organ donation. Using a qualitative descriptive approach, we coded interviews using qualitative content analysis. We integrated findings from the interviews in a mixed-methods analysis with previously published data from a document analysis and cross-sectional survey to identify practices that may enhance organ donation in the ICU. RESULTS Five major themes important to the organ donation process emerged from the interviews: i) staff relationship with organ donation coordinators; ii) standardized processes; iii) ICU staff beliefs; iv) integration of donation and high quality end-of-life care; v) feedback and staff support. In the mixed-methods analysis, we identified 22 actionable practices to enhance the process of organ donation in the ICU. CONCLUSION Incorporating the perspectives of ICU staff, we were able to identify 22 practice changes that may have a significant cumulative impact on donation outcomes. Future research is required to evaluate whether these findings account for the variability of donation rates between otherwise comparable ICUs.
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