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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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Morrison LJ, Sandroni C, Grunau B, Parr M, Macneil F, Perkins GD, Aibiki M, Censullo E, Lin S, Neumar RW, Brooks SC. Organ Donation After Out-of-Hospital Cardiac Arrest: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2023; 148:e120-e146. [PMID: 37551611 DOI: 10.1161/cir.0000000000001125] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
AIM OF THE REVIEW Improving rates of organ donation among patients with out-of-hospital cardiac arrest who do not survive is an opportunity to save countless lives. The objectives of this scientific statement were to do the following: define the opportunity for organ donation among patients with out-of-hospital cardiac arrest; identify challenges and opportunities associated with organ donation by patients with cardiac arrest; identify strategies, including a generic protocol for organ donation after cardiac arrest, to increase the rate and consistency of organ donation from this population; and provide rationale for including organ donation as a key clinical outcome for all future cardiac arrest clinical trials and registries. METHODS The scope of this International Liaison Committee on Resuscitation scientific statement was approved by the International Liaison Committee on Resuscitation board and the American Heart Association, posted on ILCOR.org for public comment, and then assigned by section to primary and secondary authors. A unique literature search was completed and updated for each section. RESULTS There are a number of defining pathways for patients with out-of-hospital cardiac arrest to become organ donors; however, modifications in the Maastricht classification system need to be made to correctly identify these donors and to report outcomes with consistency. Suggested modifications to the minimum data set for reporting cardiac arrests will increase reporting of organ donation as an important resuscitation outcome. There are a number of challenges with implementing uncontrolled donation after cardiac death protocols, and the greatest impediment is the lack of legislation in most countries to mandate organ donation as the default option. Extracorporeal cardiopulmonary resuscitation has the potential to increase organ donation rates, but more research is needed to derive neuroprognostication rules to guide clinical decision-making about when to stop extracorporeal cardiopulmonary resuscitation and to evaluate cost-effectiveness. CONCLUSIONS All health systems should develop, implement, and evaluate protocols designed to optimize organ donation opportunities for patients who have an out-of-hospital cardiac arrest and failed attempts at resuscitation.
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Morrison LJ, Sandroni C, Grunau B, Parr M, Macneil F, Perkins GD, Aibiki M, Censullo E, Lin S, Neumar RW, Brooks SC. Organ Donation After Out-of-Hospital Cardiac Arrest: A Scientific Statement From the International Liaison Committee on Resuscitation. Resuscitation 2023; 190:109864. [PMID: 37548950 DOI: 10.1016/j.resuscitation.2023.109864] [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] [Indexed: 08/08/2023]
Abstract
AIM OF THE REVIEW Improving rates of organ donation among patients with out-of-hospital cardiac arrest who do not survive is an opportunity to save countless lives. The objectives of this scientific statement were to do the following: define the opportunity for organ donation among patients with out-of-hospital cardiac arrest; identify challenges and opportunities associated with organ donation by patients with cardiac arrest; identify strategies, including a generic protocol for organ donation after cardiac arrest, to increase the rate and consistency of organ donation from this population; and provide rationale for including organ donation as a key clinical outcome for all future cardiac arrest clinical trials and registries. METHODS The scope of this International Liaison Committee on Resuscitation scientific statement was approved by the International Liaison Committee on Resuscitation board and the American Heart Association, posted on ILCOR.org for public comment, and then assigned by section to primary and secondary authors. A unique literature search was completed and updated for each section. RESULTS There are a number of defining pathways for patients with out-of-hospital cardiac arrest to become organ donors; however, modifications in the Maastricht classification system need to be made to correctly identify these donors and to report outcomes with consistency. Suggested modifications to the minimum data set for reporting cardiac arrests will increase reporting of organ donation as an important resuscitation outcome. There are a number of challenges with implementing uncontrolled donation after cardiac death protocols, and the greatest impediment is the lack of legislation in most countries to mandate organ donation as the default option. Extracorporeal cardiopulmonary resuscitation has the potential to increase organ donation rates, but more research is needed to derive neuroprognostication rules to guide clinical decision-making about when to stop extracorporeal cardiopulmonary resuscitation and to evaluate cost-effectiveness. CONCLUSIONS All health systems should develop, implement, and evaluate protocols designed to optimise organ donation opportunities for patients who have an out-of-hospital cardiac arrest and failed attempts at resuscitation.
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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.
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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
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Baumann A, Thilly N, Joseph L, Claudot F. Ethical reflection support for potential organ donors' relatives: A narrative review. Nurs Ethics 2022; 29:660-674. [PMID: 35172649 DOI: 10.1177/09697330211015274] [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: 11/16/2022]
Abstract
BACKGROUND Even in countries with an opt-out or presumed consent system, relatives have a considerable influence on the post-mortem organ harvesting decision. However, their reflection capacity may be compromised by grief, and they are, therefore, often prone to choose refusal as default option. Quite often, it results in late remorse and dissatisfaction. So, a high-quality reflection support seems critical to enable them to gain a stable position and a long-term peace of mind, and also avoid undue loss of potential grafts. In practice, recent studies have shown that the ethical aspects of reflection are rarely and often poorly discussed with relatives and that no or incomplete guidance is offered. No review of the literature is available to date, although it could be of value to improve the quality of the daily practice. OBJECTIVES The objective was to review and synthesize the main concepts and approaches, theories and practices of ethical reflection support of the relatives or surrogates of potential post-mortem organ donors. RESEARCH DESIGN A narrative review was performed in the medical, psychological and ethical fields using PubMed, PsycArticles and Web of Science databases (1980-2020). RESULTS Out of 150 papers, 25 were finally retained. Four themes were drawn: the moral status of the potential post-mortem organ donor, the principlistic approach with its limits and critics, the narrative approach and the transcendental approach. DISCUSSION This review suggests an extension of psychological support towards ethical reflection support. The process of helping relatives in their ethical exploration of post-mortem organ donation is psychologically and morally characterized. The need for specialized professionals educated and experienced both in clinical psychology and in health ethics to carry out this task is discussed. PRACTICAL IMPACT This review could contribute to optimize the quality of the ethical reflection support by initiating an evolution from an empirical, partial and individual-dependent support to a more systematized, professionalized and exhaustive support.
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Affiliation(s)
- Antoine Baumann
- Assistance Publique - Hôpitaux de Paris, France; Université de Lorraine, France
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Wind T, Jansen N, Flodén A, Haase-Kromwijk B, Shaw D, Gardiner D. An Inventory of Deceased Donor Family Care and Contact Between Donor Families and Recipients in 15 European Countries. Transpl Int 2022; 35:10188. [PMID: 35185370 PMCID: PMC8842228 DOI: 10.3389/ti.2021.10188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022]
Abstract
Families of organ donors play an important role in the deceased organ donation process. The aim of this study was to gain insight into donor family care by creating an inventory of practice in various European countries. A questionnaire about donor family care and contact between donor families and recipients was developed. Representatives of the organ donor professionals of 15 European countries responded (94%). The donor coordinator plays a key role in care for the donor family. All countries provide information about the donation results to the families, although diminished due to privacy laws. Anonymous written contact between donor families and recipients is possible in almost all countries and direct contact in only a few. Remembrance ceremonies exist in most countries. Half of the respondents thought the aftercare could improve. This first inventory shows that differences exist between countries, depending on the organisation of the donation process, the law and the different role of the professionals. Direct contact between donor families and recipients is rarely supported by the donation organisation. To date there has been limited research about the experience of donor family aftercare and we would urge all donation organisations to consider this as a priority area.
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Affiliation(s)
- Tineke Wind
- Maastricht University Medical Centre, Maastricht, Netherlands
- *Correspondence: Tineke Wind,
| | - Nichon Jansen
- Institute of Health and Care Science, Dutch Transplant Foundation, Leiden, Netherlands
| | - Anne Flodén
- Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
- Department of Anaestesiology, Södra Älvsborgs Hospital, Borås, Sweden
| | | | - David Shaw
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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7
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Poursaadati M, Maarefvand M, Niyasar M, Khubchandani J. Organ donation-related psychosocial interventions: Towards a research-based guideline - A prospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_125_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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Singh A, Scales A, Mildner R. Fifteen-minute consultation: Paediatric organ and tissue donation. Arch Dis Child Educ Pract Ed 2021; 106:200-205. [PMID: 32847806 DOI: 10.1136/archdischild-2019-318457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 11/04/2022]
Abstract
This article explores ways in which paediatricians can help increase awareness and embed organ and tissue donation in the end-of-life care process. This can save patient lives on the organ transplant waiting list, many of whom currently die prematurely. The information benefits multidisciplinary staff including doctors, nurses and allied professionals to (1) recognise triggers for making referral to the specialist nurse for organ donation in order to make timely assessment for suitability for organ and/or tissue donation, (2) plan a multidisciplinary approach for families to make decisions for the gift of life and (3) help provide on-going support to families and staff.
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Affiliation(s)
- Anju Singh
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angie Scales
- NHS Blood and Transplant, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Reinout Mildner
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
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Knhis NDS, Martins SR, Magalhães ALP, Ramos SF, Sell CT, Koerich C, Brehmer LCDF. Family interview for organ and tissue donation: good practice assumptions. Rev Bras Enferm 2021; 74:e20190206. [PMID: 34161535 DOI: 10.1590/0034-7167-2019-0206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/30/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify information that can support creating good practice assumptions to develop family interview for organ and tissue donation. METHODS this scoping study, conducted in two Brazilian hospitals in the southern, between April and December 2017, included integrative review and consultation with 15 families who experienced interview for organ donation. For data analysis, thematic content analysis was used. RESULTS three categories emerged: communication of death, which shows the need to know the history of hospitalization of patients; emotional support, the team must have mastery of the stages of mourning; information about donation, professionals need to know the stages of the donation process and respect families' time. FINAL CONSIDERATIONS good practice assumptions point to the need for team training, respect for family time and the use of simple language.
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Affiliation(s)
| | | | | | - Saulo Fábio Ramos
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | | | - Clarice Koerich
- Universidade Federal de Santa Catarina, Hospital Universitário Polyodoro Ernani de São Thiago. Florianópolis, Santa Catarina, Brazil
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10
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Gardiner D, McGee A, Shaw D. Two fundamental ethical and legal rules for deceased organ donation. BJA Educ 2021; 21:292-299. [PMID: 34306730 DOI: 10.1016/j.bjae.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- D Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A McGee
- Queensland University of Technology, Brisbane, QLD, Australia
| | - D Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Obstacles to obtaining Informed Consent from the Perspective of Transplant Coordinators: A Qualitative Study. HEPATITIS MONTHLY 2021. [DOI: 10.5812/hepatmon.111210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: The lack of consent to donate body organs leads to an increase in the death rate of patients on the waiting list for transplantation. Unwillingness of families is known as the main obstacle to organ donation, and the media has an essential role in motivating organ donation. Objectives: This study aimed to explore obstacles to obtaining consent for organ donation from transplant coordinators’ perspective throughout Iran. Methods: In this qualitative study, 13 in-depth semi-structured face-to-face interviews were conducted with transplant coordinators from November 2018 to March 2019. The participants were investigated using a purposive sampling method. The participants’ age and work experience ranged between 32 - 49 years and 6 - 25 years, respectively. Open-ended questions were asked from the participants in a private room. An experienced interviewer explained the study’s objectives to the coordinators, and each interview lasted on average 50 minutes. The interview scripts were analyzed using a content analysis method. Results: The findings highlighted the difficulty of obtaining consent from brain-dead patients’ families. The obstacles could be internal or external. External determinants were healthcare providers’ lack of empathy, inadequate consultation from doctors outside the hospital, media content, and uninformed comments from relatives. Internal determinants were hoping for recovery, denial, and disagreement among family members. Conclusions: The healthcare team should have a better connection with families to obtain organ donation consent from them. Therefore, a training program must be developed for the treatment team so that they show more supportive behavior and improve quality of care in hospitals before and after brain death.
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Naghavi N, Mubarik MS, Rasiah R, Sharif Nia H. Prioritizing Factors Affecting Deceased Organ Donation in Malaysia: Is a New Organ Donation System Required? Int J Gen Med 2020; 13:641-651. [PMID: 32982381 PMCID: PMC7507418 DOI: 10.2147/ijgm.s253372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The gap between the demand and the supply of human organs for transplantation is on the rise in Malaysia, despite the efforts of governments to promote donor registration. Factors affecting willingness to donate are contextual and vary from country to country. This research mainly focuses on the selection of most suitable organ donation system through factors affecting willingness to donate in Malaysia. The objectives of this study are to prioritize those factors acting as the pillars of the organ donation system and further to select the most suitable organ donation system for Malaysia. Patients and Methods The data were collected from 35 experts by using a bipolar questionnaire. The study applied an analytical hierarchal process (AHP) for prioritization factors contributing to willingness to donate and then selection of a suitable organ donation system based on prioritized factors. Results Based on the AHP results, it is evident that donation perception (0.36) has the highest priority in influencing organ donation rates, followed by socioeconomic status (0.32), demographic factors (0.23), and financial incentives (0.09). Further, our results challenge the existing opt-in donation system in Malaysia and present a presumptive approach as a suitable system for increasing deceased donation rate in Malaysia. Presumptive approach promotes the role of health-care professionals in securing the family consent. Conclusion This approach is a person-oriented rather than process-oriented strategy and it relies on designated requesters' skills to evoke altruism among bereaved families. Based on results, the authors recommended that relevant government agencies focus on training nurses to discuss donation with bereaved families and raising public awareness.
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Affiliation(s)
- Navaz Naghavi
- Faculty of Business & Law, Taylor's Business School, Taylor's University, Lakeside Campus, Subang Jaya 47500, Selangor, Malaysia
| | - Muhammad Shujaat Mubarik
- Faculty of Business Administration & Social Sciences, Mohammad Ali Jinnah University, Karachi 7500, Pakistan
| | - Rajah Rasiah
- Asia-Europe Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hamid Sharif Nia
- Department of Nursing, Mazandaran University of Medical Science, Sari, Iran
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Flodén A, Stadtler M, Jones Collazo SE, Mone T, Ash R, Fridlund B. Cross-cultural adaptation and psychometric validation of the Flodén ATODAI instrument in the North American context. BMC Nurs 2020; 19:55. [PMID: 32581648 PMCID: PMC7310066 DOI: 10.1186/s12912-020-00444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background Intensive and critical-care nurses are the key to successful donor management in the critical-care setting. No studies measuring attitudes toward organ donor advocacy existed before 2011, when the 51-item Swedish “Attitudes Toward Organ Donor Advocacy Scale” was developed. The aim of this study was to translate, adapt and establish the psychometric properties of the North American version of the Flodén ATODAI (Attitudes Toward Organ Donor Advocacy Instrument) in terms of validity and reliability. Methods A multi-step approach was used: Initial translation; Back-translation; Review and synthesis of these translations; Expert panel (N = 7) rated the prefinal version of the instrument for content validity index (CVI); International panel made adjustments guided by the expert panel. Reliability testing with test and retest of the adjusted 46-item version was conducted using intraclass correlation coefficient (ICC), weighted kappa (ҡWeight), sign test, and Cronbach’s alpha coefficient (α), (N = 50); and finally Delphi technique procedure with a preselected Delphi panel (N = 15). Results The CVI was determined to be greater than the 0.05 significance level. Item level (I-CVI) ranged 0.82–1.0, with a mean of 0.97. Scale level (S-CVI) on the entire instrument was 0.97. Test-retest procedure was performed to estimate stability. In total, 34 of the items had good-to-high ICC. Accepting an ICC of ≥ 0.70 resulted in a total of 24 items. Homogeneity reliability was estimated by α and was calculated for these items where α = 0.90. In total, 20 of the items had a substantial or almost perfect ҡWeight and 23 showed a moderate ҡWeight. None of the items showed systematical differences. The Delphi technique procedure was used on the 22 items with ICC < 0.70 resulted in adjustments establishing that consensus was achieved. Conclusions Undertaking this multi-step, cross-cultural adaptation procedure has effectively ensured that the 46-item Flodén ATODAI [North American version] produces valid and reliable measurements.
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Affiliation(s)
- Anne Flodén
- Department of Anesthesiology & Department of Research, Sodra Alvsborg Hospital, Bramhultsvagen 53, 501 82 Boras, SE Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maria Stadtler
- Association of Organ Procurement Organizations (AOPO), Vienna, USA
| | | | | | | | - Bengt Fridlund
- Centre for Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Campus Växjö, Växjö, Sweden
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Zheng K, Sutherland S, Cardinal P, Meade M, Landriault A, Vanderspank-Wright B, Valiani S, Shemie S, Appleby A, Keenan S, Weiss M, Werestiuk K, Kramer AH, Kawchuk J, Beed S, Dhanani S, Pagliarello G, Chasse M, Lotherington K, Gatien M, Parsons K, Chandler J, Nickerson P, Kutsogiannis J, Sarti AJ. Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives. BMJ Open 2020; 10:e037527. [PMID: 32540892 PMCID: PMC7299025 DOI: 10.1136/bmjopen-2020-037527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care into practice in deceased organ donation. METHODS AND ANALYSIS This will be a national, qualitative study of family members of deceased organ donors in Canada. We will include family members who had been approached regarding an organ donation decision, including those who agreed and declined, at least 2 months and no later than 3 years after the patients' death. Data collection and analysis is ongoing and will continue until September 2020 to include approximately 250 participants. Family members will be identified and recruited from provincial organ donation organisation databases. Four experienced qualitative researchers will conduct telephone interviews in English or French with audio-recording for subsequent transcription. The research team will develop a codebook iteratively through this process using inductive methods, thus generating themes directly from the dataset. ETHICS AND DISSEMINATION Local research ethics boards (REB) at all participating sites across Canada have approved this protocol. The main REB involved is the Ottawa Health Science Network REB. Data collection began in August 2018. Publication of results is anticipated in 2021. Study findings will help improve healthcare provider competency in caring for potential organ donors and their families and improve organ donation consent rates. Findings will also help with the development of educational materials for a competency-based curriculum for critical care residents.
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Affiliation(s)
- Katina Zheng
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Pierre Cardinal
- Department of Critical Care, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Maureen Meade
- Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Angele Landriault
- Practice, Performance and Innovation (PPI) Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Brandi Vanderspank-Wright
- School of Nursing, University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sabira Valiani
- Department of Critical Care, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Sam Shemie
- Pediatrics, McGill University, Montreal, Quebec, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Sean Keenan
- BC Transplant, Vancouver, British Columbia, Canada
- Division of Critical Care, UBC Department of Medicine, Vancouver, British Columbia, Canada
| | - Matthew Weiss
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Quebec-Universite Laval, Quebec city, Quebec, Canada
| | | | | | - Joann Kawchuk
- Department of Critical Care, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Stephen Beed
- Department of Critical Care, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Sonny Dhanani
- Critical Care, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Michaël Chasse
- Department of Critical Care Medicine, Centre Hospitalier de L'Universite de Montreal, Montréal, Quebec, Canada
| | | | - Mary Gatien
- Horizon Health Network, Miramichi, New Brunswick, Canada
| | - Kim Parsons
- Organ Procurement and Exchange of Newfoundland and Labrador (OPEN), St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Chandler
- University of Ottawa Faculty of Law Common Law Section, Ottawa, Ontario, Canada
| | - Peter Nickerson
- University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jim Kutsogiannis
- Department of Critical Care Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Aimee J Sarti
- Department of Critical Care, Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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15
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Affiliation(s)
- Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University, Fairfax, VA, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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16
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Corpuz R, Bugental D. Life history and individual differences in male testosterone: Mixed evidence for early environmental calibration of testosterone response to first-time fatherhood. Horm Behav 2020; 120:104684. [PMID: 31945323 DOI: 10.1016/j.yhbeh.2020.104684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/06/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022]
Abstract
Male testosterone (T) decreases in response to childbirth. Longitudinal support for this has come from samples across cultures. In this study, we look at individual differences in this phenomenon. Utilizing a sample of U.S. fathers, we employ life history theory to investigate the influence of a father's early experience on his neuroendocrine response to fatherhood. We conducted three home visits (n = 226 fathers) from the third trimester of pregnancy to when infants were 10 months old. In this sample, T declined from the third trimester of (a partner's) pregnancy to the early months of the postnatal period. T recovered to pre-birth levels by the time infants reached 10 months old. We did not find any evidence that one's subjective experience of their early environment could account for any meaningful variability in T calibration. Objective, "event" measures of early harshness (i.e., death of a sibling/friend) and unpredictability (i.e., parent upheaval) each uniquely predicted a younger age of sexual debut. Neither harshness nor unpredictability had any (direct or indirect) effects on T calibration. Age of sexual debut did predict the rate of T recovery from 3 to 10 months postnatal. The younger one's sexual debut, the more accelerated their T ascent during this period. We discuss the potential reasons for, and implications of our mixed results.
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Affiliation(s)
- Randy Corpuz
- Department of Psychology, University of Massachusetts Boston, United States of America.
| | - Daphne Bugental
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, United States of America
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17
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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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18
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de Tantillo L, González JM, Ortega J. Organ Donation After Circulatory Death and Before Death: Ethical Questions and Nursing Implications. Policy Polit Nurs Pract 2019; 20:163-173. [PMID: 31407946 DOI: 10.1177/1527154419864717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Scientific advances have enabled thousands of individuals to extend their lives through organ donation. Yet, shortfalls of available organs persist, and individuals in the United States die daily before they receive what might have been lifesaving organs. For years, the legal foundation of organ donation in the United States has been known as the Dead Donor Rule, requiring death to be defined for organ donation purposes by either a cardiac standard (termination of the heartbeat) or a neurological one (cessation of all brain function). In this context, one solution used by an increasing number of health care facilities since 2006 is donation after circulatory death, generally defined as when care is withdrawn from individuals who have known residual brain function. Despite its increased use, donation after circulatory death remains ethically controversial. In addition, some ethicists have advocated forgoing the Dead Donor Rule altogether and allowing donation before or near death in certain circumstances. However, nurses and other health professionals must carefully consider the practical and ethical implications of broadening the Dead Donor Rule-as may be already occurring-or removing it entirely. Such changes could harm both the integrity of the health care system as well as efforts to secure organ donation commitments from the public and are outweighed by the moral and pragmatic cost. Nurses should be prepared to confront the challenge posed by the ongoing scarcity of organs and advocate for ethical alternatives including research on effective care pathways and education regarding organ donation.
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Affiliation(s)
- Lila de Tantillo
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Juan M González
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Johis Ortega
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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19
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Poppe C, Akum S, Crombez G, Rogiers X, Hoste E. Evaluation of the quality of the communication and emotional support during the donation procedure: The use of the donor family questionnaire (DFQ). J Crit Care 2019; 53:198-206. [PMID: 31271955 DOI: 10.1016/j.jcrc.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/26/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE A multi-centric study in Intensive Care units (ICU) and Emergency departments (ED) was designed to evaluate whether the provided communication and emotional support to the family in the context of organ donation met the international recommendations of the European Donor Hospital Education Program (EDHEP). MATERIALS AND METHODS Using a participatory approach and focus groups, a questionnaire was constructed: Donor Family questionnaire (DFQ). The questionnaire was distributed to 203 families. The data were analysed on item level. RESULTS Sixty-four families participated, and 89% considered the communication as tactful. Only 24.1% had a separate conversation about passing and donation, which is the recommendation. 88.5% reported they could count on emotional support in the first phase on the ICU/ED. This dropped during the parting phase and the aftercare. The physician is perceived as the most active caregiver in the emotional support during the entire procedure. CONCLUSIONS The DFQ is a useful instrument to evaluate the donor procedure. The physician is important in the first phases of the donor procedure for the medical explanation. Other disciplines could be more involved in the following phases to assure enough emotional support, but this issue requires further exploration.
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Affiliation(s)
- Carine Poppe
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | - Sandra Akum
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium
| | - Geert Crombez
- Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Xavier Rogiers
- Department of Hepato-billiary surgery, Ghent University, Belgium
| | - Eric Hoste
- Departement of Intensive care Medicine, Belgium and Research Foundation-Flanders, Ghent University, Brussels, Belgium
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20
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Martín-Delgado MC, Martínez-Soba F, Masnou N, Pérez-Villares JM, Pont T, Sánchez Carretero MJ, Velasco J, De la Calle B, Escudero D, Estébanez B, Coll E, Pérez-Blanco A, Perojo L, Uruñuela D, Domínguez-Gil B. Summary of Spanish recommendations on intensive care to facilitate organ donation. Am J Transplant 2019; 19:1782-1791. [PMID: 30614624 DOI: 10.1111/ajt.15253] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/13/2018] [Accepted: 12/27/2018] [Indexed: 01/25/2023]
Abstract
With the aim of consolidating recommendations about the practice of initiating or continuing intensive care to facilitate organ donation (ICOD), an ad hoc working group was established, comprising 10 intensivists designated by the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) and the Spanish National Transplant Organization (ONT). Consensus was reached in all recommendations through a deliberative process. After a public consultation, the final recommendations were institutionally adopted by SEMICYUC, ONT, and the Transplant Committee of the National Health-Care System. This article reports on the resulting recommendations on ICOD for patients with a devastating brain injury for whom the decision has been made not to apply any medical or surgical treatment with a curative purpose on the grounds of futility. Emphasis is made on the systematic referral of these patients to donor coordinators, the proper assessment of the likelihood of brain death and medical suitability, and on transparency in communication with the patient's family. The legal and ethical aspects of ICOD are addressed. ICOD is considered a legitimate practice that offers more patients the opportunity of donating their organs upon their death and helps to increase the availability of organs for transplantation.
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Affiliation(s)
| | | | - Nuria Masnou
- Donation and Transplant Coordination Unit, Doctor Josep Trueta University Hospital, Gerona, Spain
| | | | - Teresa Pont
- Donation and Transplant Coordination Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - Julio Velasco
- Intensive Care Unit, Son Espases University Hospital, Palma de Mallorca, Spain
| | | | - Dolores Escudero
- Intensive Care Unit, Central de Asturias University Hospital, Oviedo, Spain
| | - Belén Estébanez
- Donation and Transplant Coordination Unit, La Paz University Hospital, Madrid, Spain
| | | | | | - Lola Perojo
- Organización Nacional de Trasplantes, Madrid, Spain
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21
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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]
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22
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Cox CE, White DB, Hough CL, Jones DM, Kahn JM, Olsen MK, Lewis CL, Hanson LC, Carson SS. Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation: A Randomized Clinical Trial. Ann Intern Med 2019; 170:285-297. [PMID: 30690645 PMCID: PMC7363113 DOI: 10.7326/m18-2335] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Treatment decisions commonly have to be made in intensive care units (ICUs). These decisions are difficult for surrogate decision makers and often lead to decisional conflict, psychological distress, and treatments misaligned with patient preferences. Objective To determine whether a decision aid about prolonged mechanical ventilation improved prognostic concordance between surrogate decision makers and clinicians compared with a usual care control. Design Multicenter, parallel, randomized, clinical trial. (ClinicalTrials.gov: NCT01751061). Setting 13 medical and surgical ICUs at 5 hospitals. Participants Adult patients receiving prolonged mechanical ventilation and their surrogates, ICU physicians, and ICU nurses. Intervention A Web-based decision aid provided personalized prognostic estimates, explained treatment options, and interactively clarified patient values to inform a family meeting. The control group received information according to usual care practices followed by a family meeting. Measurements The primary outcome was improved concordance on 1-year survival estimates, measured with the clinician-surrogate concordance scale (range, 0 to 100 percentage points; higher scores indicate more discordance). Secondary and additional outcomes assessed the experiences of surrogates (psychological distress, decisional conflict, and quality of communication) and patients (length of stay and 6-month mortality). Outcomes assessors were blinded to group allocation. Results The study enrolled 277 patients, 416 surrogates, and 427 clinicians. Concordance improvement did not differ between intervention and control groups (mean difference in score change from baseline, -1.7 percentage points [95% CI, -8.3 to 4.8 percentage points]; P = 0.60). Surrogates' postintervention estimates of patients' 1-year prognoses did not differ between intervention and control groups (median, 86.0% [interquartile range {IQR}, 50.0%] vs. 92.5% [IQR, 47.0%]; P = 0.23) and were substantially more optimistic than results of a validated prediction model (median, 56.0% [IQR, 43.0%]) and physician estimates (median, 50.0% [IQR, 55.5%]). Eighty-two intervention surrogates (43%) favored a treatment option that was more aggressive than their report of patient preferences. Although intervention surrogates had greater reduction in decisional conflict than control surrogates (mean difference in change from baseline, 0.4 points [CI, 0.0 to 0.7 points]; P = 0.041), other surrogate and patient outcomes did not differ. Limitation Contamination among clinicians could have biased results toward the null hypothesis. Conclusion A decision aid about prolonged mechanical ventilation did not improve prognostic concordance between clinicians and surrogates, reduce psychological distress among surrogates, or alter clinical outcomes. Decision support in acute care settings may require greater individualized attention for both the cognitive and affective challenges of decision making. Primary Funding Source National Institutes of Health.
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Affiliation(s)
| | - Douglas B White
- University of Pittsburgh, Pittsburgh, Pennsylvania (D.B.W., J.M.K.)
| | | | - Derek M Jones
- Duke University, Durham, North Carolina (C.E.C., D.M.J.)
| | - Jeremy M Kahn
- University of Pittsburgh, Pittsburgh, Pennsylvania (D.B.W., J.M.K.)
| | - Maren K Olsen
- Duke University and the Center for Health Services Research in Primary Care at the Durham VA Medical Center, Durham, North Carolina (M.K.O.)
| | | | - Laura C Hanson
- University of North Carolina, Chapel Hill, North Carolina (L.C.H., S.S.C.)
| | - Shannon S Carson
- University of North Carolina, Chapel Hill, North Carolina (L.C.H., S.S.C.)
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23
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Keel I, Schürch R, Weiss J, Zwahlen M, Immer FF. Is there an association between consent rates in Swiss hospitals and critical care staffs' attitudes towards organ donation, their knowledge and confidence in the donation process? PLoS One 2019; 14:e0211614. [PMID: 30735508 PMCID: PMC6368376 DOI: 10.1371/journal.pone.0211614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/17/2019] [Indexed: 11/19/2022] Open
Abstract
This study investigated the critical care staff’s attitude, knowledge and involvement with donation, skills and confidence with donation-related tasks and their association with consent rates at the hospital level. In 2015, we conducted a cross-sectional survey among critical care staff of hospitals involved in organ donation using an anonymous online questionnaire with a response rate of 56.4% (n = 2799). The hospital level consent rate was obtained from the Swiss Monitoring of Potential Donors database (2013–2015). For each hospital, we calculated a mean score for each predictor of interest of the Hospital Attitude Survey and investigated the association with hospital consent rates with generalized linear mixed-effect models. In univariable analysis, one score point increase in doctors' confidence resulted in a 66% (95% CI: 45%–80%) reduction in the odds to consent, and one score point increase in nurses' attitudes resulted in a 223% (95% CI: 84%–472%) increase in the odds to consent. After simultaneously adjusting for all major predictors found in the crude models, only levels of education of medical and nursing staff remained as significant predictors for hospital consent rates. In Switzerland, efforts are needed to increase consent rates for organ donation and should concentrate on continuous support as well as specific training of the hospital staff involved in the donation process.
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Affiliation(s)
- Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Roger Schürch
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
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24
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Cay D. Contemporary issues in law and ethics: Exploring the family veto for organ donation. J Perioper Pract 2019; 29:361-367. [PMID: 30638138 DOI: 10.1177/1750458918818998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article explores current issues surrounding the impact of family veto for organ donation in the UK. A critical, reflective analysis of the theoretical, legal and ethical aspects aims to evaluate how the deceased’s explicit wish to donate may be revoked. Under current UK legislation and upon death, money and property are protected; however, the body is not. When investigating personal wishes, interests and decisions must be weighed against the moral legitimacy of the family veto.
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Affiliation(s)
- Debbie Cay
- Maidstone & Tunbridge Wells Hospitals Trust, Kent, UK
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25
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Effects of phased education on attitudes toward organ donation and willingness to donate after brain death in an Asian country. Asian J Surg 2019; 42:256-266. [DOI: 10.1016/j.asjsur.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/15/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022] Open
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26
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Kentish-Barnes N, Chevret S, Cheisson G, Joseph L, Martin-Lefèvre L, Si Larbi AG, Viquesnel G, Marqué S, Donati S, Charpentier J, Pichon N, Zuber B, Lesieur O, Ouendo M, Renault A, Le Maguet P, Kandelman S, Thuong M, Floccard B, Mezher C, Galon M, Duranteau J, Azoulay E. Grief Symptoms in Relatives Who Experienced Organ Donation Requests in the ICU. Am J Respir Crit Care Med 2018; 198:751-758. [DOI: 10.1164/rccm.201709-1899oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, Saint-Louis University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Biostatistics and Clinical Epidemiology Research (ECSTRA) Team, U1153, INSERM, Paris Diderot University, Sorbonne University, Paris, France
| | | | - Liliane Joseph
- Transplant Coordination Team, Bicêtre University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | | | - Gérald Viquesnel
- Surgical Intensive Care Unit, Côte de Nacre Hospital, Caen, France
| | - Sophie Marqué
- Medical and Surgical Intensive Care Unit, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Stéphane Donati
- Medical and Surgical Intensive Care Unit, Sainte Musse Hospital, Toulon, France
| | - Julien Charpentier
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Nicolas Pichon
- Medical and Surgical Intensive Care Unit, Dupuytren University Hospital, Limoges, France
| | - Benjamin Zuber
- Medical and Surgical Intensive Care Unit, André Mignot Hospital, Versailles, France
| | - Olivier Lesieur
- Medical and Surgical Intensive Care Unit, La Rochelle Hospital, La Rochelle, France
| | - Martial Ouendo
- Medical and Surgical Intensive Care Unit, Amiens-Picardy University Hospital, Amiens, France
| | | | - Pascale Le Maguet
- Surgical Intensive Care, Cavale Blanche University Hospital, Brest, France
| | - Stanislas Kandelman
- Anesthesia and Intensive Care Department, Beaujon University Hospital, Assistance Publique – Hôpitaux de Paris, Clichy, France
| | - Marie Thuong
- Intensive Care Unit, Hospital René-Dubos, Pontoise, France
| | - Bernard Floccard
- Anesthesia and Intensive Care, Hospices Civils de Lyon – Edouard Herriot Hospital, Lyon, France; and
| | - Chaouki Mezher
- Medical and Surgical Intensive Care, Belfort-Montbelliard Hospital, Montbelliard, France
| | | | | | - Elie Azoulay
- Famiréa Research Group and
- Biostatistics and Clinical Epidemiology Research (ECSTRA) Team, U1153, INSERM, Paris Diderot University, Sorbonne University, Paris, France
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27
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Milaniak I, Wilczek-Rużyczka E, Przybyłowski P. Role of Empathy and Altruism in Organ Donation Decisionmaking Among Nursing and Paramedic Students. Transplant Proc 2018; 50:1928-1932. [DOI: 10.1016/j.transproceed.2018.02.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
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28
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de Moraes EL, Dos Santos MJ, de Barros E Silva LB, de Lima Pilan LAS, de Lima EAA, de Santana AC, Martins MS. Family Interview to Enable Donation of Organs for Transplantation: Evidence-based Practice. Transplant Proc 2018; 50:705-710. [PMID: 29571742 DOI: 10.1016/j.transproceed.2018.02.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In this study we propose a theoretical and practical basis for the best practices for interviewing relatives of brain-dead eligible organ donors. METHODS This investigation was a reflective study of the methodologic factors of the family interview that affect their decision regarding the donation of a deceased patient's organs for transplantation. The articles that formed the empirical basis of the trial were obtained from PubMed, which is a free-access tool of the MEDLINE database of the United States National Library of Medicine. Published articles that allowed us to reflect on evidence-based family interview practice were selected. RESULTS Thirty-six scientific articles were used to guide our assessment the family interview, providing evidence for its adequate execution in view of the following prerequisites: When should the family interview be performed? Where should it be done? How many and which people should participate in the interview? Who should perform it? How should it be done? CONCLUSION Scientific studies offer evidence to donation and transplantation specialists that can help them in their daily work regarding their interactions with relatives in the process of decisionmaking and family consent.
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Affiliation(s)
- E L de Moraes
- Department of Professional Orientation, Nursing School, University of São Paulo, São Paulo, Brazil.
| | - M J Dos Santos
- Department of Professional Orientation, Nursing School, University of São Paulo, São Paulo, Brazil
| | - L B de Barros E Silva
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - L A S de Lima Pilan
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - E A A de Lima
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - A C de Santana
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M S Martins
- Adventist University Center, São Paulo, Brazil
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29
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Shaw D, Gardiner D. Increasing organ donation rates by revealing recipient details to families of potential donors. JOURNAL OF MEDICAL ETHICS 2018; 44:101-103. [PMID: 28882902 DOI: 10.1136/medethics-2017-104262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
Many families refuse to consent to donation from their deceased relatives or over-rule the consent given before death by the patient, but giving families more information about the potential recipients of organs could reduce refusal rates. In this paper, we analyse arguments for and against doing so, and conclude that this strategy should be attempted. While it would be impractical and possibly unethical to give details of actual potential recipients, generic, realistic information about the people who could benefit from organs should be provided to families before they make a decision about donation or attempt to over-rule it.
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
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Luberda K, Cleaver K. How modifiable factors influence parental decision-making about organ donation. Nurs Child Young People 2018; 29:29-36. [PMID: 29115763 DOI: 10.7748/ncyp.2017.e810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/09/2022]
Abstract
A global shortage of organs from children and adults available for transplantation is compounded by the failure of next of kin to consent for organs to be donated after death. Non-modifiable and modifiable factors influence decision-making in this area. Modifiable factors are of interest when examining families' decision-making about the donation of organs from their deceased child. A scoping review was undertaken to determine how modifiable factors influence parental decision-making about organ donation. Thematic analysis identified two themes: interactions with healthcare professionals and pre-disposition to organ donation. Satisfaction with experiences of hospital care, the information provided and the way it was communicated, as well as interactions pertaining to emotional support were all found to be modifiable factors that influenced decision making. Likewise, a predisposition to organ donation and knowing the deceased's wishes were associated with the consent decision. Nurses working in critical care environments need to be able to support parents during this difficult time. This article aims to raise awareness of modifiable factors that influence parental decision-making, highlighting their relevance for children's nursing practice.
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Dicks SG, Ranse K, Northam H, van Haren FMP, Boer DP. A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study. Health Psychol Open 2018; 5:2055102917753706. [PMID: 29399367 PMCID: PMC5788101 DOI: 10.1177/2055102917753706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of 'communication' between researchers contributes to information being 'lost' and then later 'rediscovered'. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.
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Affiliation(s)
| | | | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University, Australia
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Webster PA, Markham LE. Never Declared Brain Dead Potential Organ Donors-An Additional Source of Donor Organs? Prog Transplant 2017; 28:43-48. [PMID: 29226765 DOI: 10.1177/1526924817746683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Patients never declared brain dead may represent an additional source of donor organs. OBJECTIVE To determine the number of likely brain dead potential donors who are never declared brain dead and to compare them with brain dead and donation after cardiac death potential organ donors. DESIGN, SETTING, AND PARTICIPANTS This study was a retrospective chart review of all catastrophically brain-injured patients referred to a single-organ procurement organization (OPO) over a 4-year period. This study identified 159 likely brain dead potential organ donors, 902 brain dead potential organ donors, and 357 potential donation after circulatory death donors over a 4-year period. INTERVENTIONS None. MAIN OUTCOME MEASURES This study did not predetermine outcome measures before data collection because the study group, likely brain dead potential organ donors, had not previously been described. RESULTS Likely brain dead potential donors were significantly older than brain dead potential donors ( P < .0001) but were otherwise not different demographically. They were more likely to be a late referral to the OPO ( P < .0001) and less likely to be in the donor registry ( P < .0001). The most commonly identified factors associated with a failure to declare brain death were an unwillingness to continue supportive care by the family, premention of donation, a nontimely imminent death referral, known prior objection to donation, terminal instability, and a lack of cooperation with the OPO.
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Affiliation(s)
- Patricia A Webster
- 1 Critical Care Department, Midwest Transplant Network, Westwood, KS, USA
| | - Lori E Markham
- 2 Clinical Services Department, Midwest Transplant Network, Westwood, KS, USA
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Dicks SG, Ranse K, Northam H, Boer DP, van Haren FM. The development of a narrative describing the bereavement of families of potential organ donors: A systematic review. Health Psychol Open 2017; 4:2055102917742918. [PMID: 29379629 PMCID: PMC5779939 DOI: 10.1177/2055102917742918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.
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Affiliation(s)
| | | | | | | | - Frank Mp van Haren
- University of Canberra, Australia.,Australian National University, Australia
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Can F, Hovardaoglu S. Organ Donation: A Comparison of Donating and Nondonating Families in Turkey. Transplant Proc 2017; 49:1969-1974. [DOI: 10.1016/j.transproceed.2017.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/26/2017] [Accepted: 09/02/2017] [Indexed: 12/21/2022]
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Organ donation in children: The next frontier. Indian Pediatr 2017; 54:721. [DOI: 10.1007/s13312-017-1161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shaw DM. A Virtuous Death: Organ Donation and Eudaimonia. JOURNAL OF BIOETHICAL INQUIRY 2017; 14:319-321. [PMID: 28815381 DOI: 10.1007/s11673-017-9802-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Affiliation(s)
- David M Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland, and Department of Health, Ethics and Society, CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.
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"Effective" Requesting: A Scoping Review of the Literature on Asking Families to Consent to Organ and Tissue Donation. Transplantation 2017; 101:S1-S16. [PMID: 28437367 DOI: 10.1097/tp.0000000000001695] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Families are often asked to consent to the donation of their deceased relative's organs or tissues. These end-of-life conversations are important because they affect consent rates as well as the psychological impact of the decision for families. This scoping review of the literature on requesting family consent was prepared to support of the development of leading practice recommendations for end-of-life conversations with families of potential donors. A scoping review maps research activity in a field across a range of commentary and empirical study designs but does not attempt meta-synthesis of empirical data or quality assessment. METHODS We performed a scoping review of the peer-reviewed literature from January 2000 to February 2015 on the questions of what constitutes an "effective" request and the factors that affect consent rates and family satisfaction with their decision and the process. This review includes a final set of 168 articles addressing (a) whether, when, and how to ask families for consent to donation or (b) characteristics of families or decedents that affect families' decisions or family satisfaction with their decisions. RESULTS Six main themes were identified: (1) the objectives of requesting and encouraging family consent to donation, (2) the effect of the donation decision on family well-being, (3) the process of requesting family consent, (4) the impact of the quality of the care for the deceased and for the family, (5) the content and manner of the request for family consent, and (6) the characteristics of the family and deceased that affect the request for family consent. CONCLUSION This scoping review found that there is a large literature on how to modify the process and manner of the request to increase family consent rates. Another important line of inquiry focuses on the psychological impact of the decision on the family. Although a scoping review does not attempt to synthesize results or draw evidence-based conclusions, the literature generally supports the intuitive expectations that compassionate and respectful care for the deceased and family, listening for and addressing family concerns, and an attitude to donation that is positive (but not solely procurement-focused) and is best for both consent rates and family well-being. Although the presumption is often that the primary objective of asking for family consent is to secure consent and donation, some ethical commentary on requesting consent emphasizes that this objective must be balanced with the parallel obligation to protect the psychological well-being of families. This places some constraints on the approaches used in family consent discussions.
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Hancock J, Shemie SD, Lotherington K, Appleby A, Hall R. Development of a Canadian deceased donation education program for health professionals: a needs assessment survey. Can J Anaesth 2017; 64:1037-1047. [PMID: 28470557 DOI: 10.1007/s12630-017-0882-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/17/2017] [Accepted: 04/12/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The purpose of this survey was to determine how Canadian healthcare professionals perceive their deficiencies and educational requirements related to organ and tissue donation. METHODS We surveyed 641 intensive care unit (ICU) physicians, 1,349 ICU nurses, 1,561 emergency room (ER) physicians, and 1,873 ER nurses. The survey was distributed by the national organization for each profession (the Canadian Association of Emergency Physicians, the Canadian Association of Critical Care Nurses, and the National Emergency Nurses Association). Canadian Blood Services developed the critical care physician list in collaboration with the Canadian Critical Care Society. Survey development included questions related to comfort with, and knowledge of, key competencies in organ and tissue donation. RESULTS Eight hundred thirty-one (15.3%) of a possible 5,424 respondents participated in the survey. Over 50% of respondents rated the following topics as highly important: knowledge of general organ and tissue donation, neurological determination of death, donation after cardiac death, and medical-legal donation issues. High competency comfort levels ranged from 14.7-50.9% for ICU nurses and 8.0-34.6% for ER nurses. Competency comfort levels were higher for ICU physicians (67.5-85.6%) than for ER physicians who rated all competencies lower. Respondents identified a need for a curriculum on national organ donation and preferred e-learning as the method of education. CONCLUSIONS Both ICU nurses and ER practitioners expressed low comfort levels with their competencies regarding organ donation. Intensive care unit physicians had a much higher level of comfort; however, the majority of these respondents were specialty trained and working in academic centres with active donation and transplant programs. A national organ donation curriculum is needed.
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Affiliation(s)
- Jennifer Hancock
- Department of Critical Care, Queen Elizabeth II Hospital, Dalhousie University, 1276 South Park St., Halifax, NS, B3H 2Y9, Canada.
| | - Sam D Shemie
- Division of Critical Care, Montreal Children's Hospital, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada.,Canadian Blood Services, Ottawa, Canada
| | | | | | - Richard Hall
- Dalhousie University and the Nova Scotia Health Authority, Halifax, NS, Canada
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COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): protocol for an intervention study. BMC Health Serv Res 2017; 17:42. [PMID: 28095838 PMCID: PMC5240419 DOI: 10.1186/s12913-016-1964-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/17/2016] [Indexed: 11/14/2022] Open
Abstract
Background Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation. Methods This multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a “designated requester”; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a “balanced” approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national “Family Donation Conversation” workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals’ adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days. Discussion The pragmatic design of this study may identify ‘what works’ in usual clinical settings when requesting organ donation in critical care areas, both in terms of changes in practice healthcare professionals are willing and able to adopt, and the effect this may have on desired outcomes. The findings of this study will be indicative of the potential benefits of the intervention and be relevant and transferrable to clinical settings in other states and countries. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000815763 (24 July 2013). ClinicalTrials.gov: NCT01922310 (14 August 2013) (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1964-7) contains supplementary material, which is available to authorized users.
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Philpot SJ, Aranha S, Pilcher DV, Bailey M. Randomised, Double Blind, Controlled Trial of the Provision of Information about the Benefits of Organ Donation during a Family Donation Conversation. PLoS One 2016; 11:e0155778. [PMID: 27322832 PMCID: PMC4913899 DOI: 10.1371/journal.pone.0155778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/04/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction It is unclear how much information should be provided to families of potential organ donors about the benefits of organ donation. Whilst this information is material to the donation decision, it may also be perceived as coercive. Methods Randomised, double blind, controlled trial in which community members watched one of two videos of a simulated organ donation conversation that differed only in the amount of information provided about the benefits of donation. Participants then completed a questionnaire about the adequacy of the information provided and the degree to which they felt the doctor was trying to convince the family member to say yes to donation. Results There was a wide variability in what participants considered was the “right” amount of information about organ donation. Those who watched the conversation that included information about the benefits of donation were more likely to feel that the information provided to the family was sufficient. They were more likely to report that the doctor was trying to convince the family member to say yes to donation, yet were no more likely to feel uncomfortable or to feel that the doctor was uncaring or cared more about transplant recipients than he did for the patient and their family. Conclusions This study suggests that community members are comfortable with health care staff providing information to family members that may be influential in supporting them to give consent for donation.
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Affiliation(s)
- Steve John Philpot
- Alfred Health, Melbourne, Victoria, Australia
- DonateLife Victoria, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Sarah Aranha
- DonateLife Victoria, Melbourne, Victoria, Australia
| | - David V. Pilcher
- Alfred Health, Melbourne, Victoria, Australia
- DonateLife Victoria, Melbourne, Victoria, Australia
- Department Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
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Moraes ELD, Neves FF, Santos MJD, Merighi MAB, Massarollo MCKB. Experiências e expectativas de enfermeiros no cuidado ao doador de órgãos e à sua família. Rev Esc Enferm USP 2015; 49 Spec No:129-35. [DOI: 10.1590/s0080-623420150000800018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/13/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Compreender as experiências e expectativas dos enfermeiros de unidades de terapia intensiva no cuidado ao doador de órgãos para transplantes e à sua família. Método Pesquisa qualitativa, com abordagem da Fenomenologia Social realizada em 2013, com 20 enfermeiros. Resultados As experiências dos enfermeiros com as famílias dos doadores foram representadas pelas categorias: obstáculos vivenciados e intervenções realizadas no cuidado às famílias dos doadores. As expectativas desses profissionais na assistência às famílias e aos doadores de órgãos foram descritas pela categoria: cuidar para salvar vidas. Conclusão O estudo mostrou que o cotidiano dos enfermeiros de terapia intensiva no cuidado às famílias e aos doadores de órgãos é permeado por obstáculos que interferem no processo de doação. Diante desse cenário têm como expectativas oferecer uma assistência intensiva ao doador falecido e um cuidado humanizado às famílias, intencionando possibilitar a aceitação da doação de órgãos pelos familiares e viabilizar órgãos para transplantes.
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Ashkenazi T, Cohen J. Interactions between health care personnel and parents approached for organ and/or tissue donation: influences on parents' adjustment to loss. Prog Transplant 2015; 25:124-30. [PMID: 26107272 DOI: 10.7182/pit2015145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT The effect of loss on those approached for organ and/or tissue donation, particularly in the years thereafter, has received little attention. OBJECTIVE To assess whether adjustment of a parent to loss of a child is influenced by interactions with health care personnel. METHODS A self-administered questionnaire was completed by the parents of 216 decedents. Interactions in the hospital were assessed by examining the experience in the hospital, physical separation from the child, and the relationship with health care professionals. Adjustment to loss was defined by 4 components: grief, personal growth after loss, meaning of life after loss, and the meaning of organ donation. RESULTS A positive experience in the hospital was significantly associated with the meaning of donation. Increased satisfaction with the separation process was associated with better adjustment on all components. Finally, a better relationship with health care professionals was associated with less grief and with greater personal growth. These results were characterized after adjustment for time since loss, which was from 6 months to 27 years. CONCLUSIONS Interactions in the hospital appear to influence adjustment to loss significantly. Appropriate interventions may aid parents in their adjustment to life.
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Affiliation(s)
- Tamar Ashkenazi
- Israel Transplant, Ministry of Health (TA, JC) and Tel Aviv University (JC), Tel Aviv, Israel, Rabin Medical Hospital, Petah Tikva, Israel (JC)
| | - Jonathan Cohen
- Israel Transplant, Ministry of Health (TA, JC) and Tel Aviv University (JC), Tel Aviv, Israel, Rabin Medical Hospital, Petah Tikva, Israel (JC)
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de Groot J, van Hoek M, Hoedemaekers C, Hoitsma A, Smeets W, Vernooij-Dassen M, van Leeuwen E. Decision making on organ donation: the dilemmas of relatives of potential brain dead donors. BMC Med Ethics 2015; 16:64. [PMID: 26383919 PMCID: PMC4574465 DOI: 10.1186/s12910-015-0057-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 09/07/2015] [Indexed: 12/16/2022] Open
Abstract
Background This article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives. Methods A content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision. Results Three themes were identified: ‘conditions’, ‘ethical considerations’ and ‘look back’. Conditions were: ‘sense of urgency’, ‘incompetence to decide’ and ‘agreement between relatives’. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased’s body, especially when they do not know his/her preference. Donor families respect the deceased’s last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments (lack of time, information etc.). Some non-donor families would like to be supported during decision-making. Discussion The discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants (most non-donor families) stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased’s wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families. Conclusion Discrepancies between willingness to consent to donate and refusal at the bedside can be attributed to an unresolved dilemma: aiding people or protect the body of the deceased. Non-donor families felt incompetent to decide. They refused consent for donation, since their deceased had not given any directive. When ethical considerations do not lead to an unambiguous answer, situational factors were pivotal. Relatives of unregistered eligible donors are more prone to unstable decisions. To overcome ambivalence, coaching during decision-making is worth investigation.
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Affiliation(s)
- Jack de Groot
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands. .,Department of Spiritual and Pastoral Care 20, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Maria van Hoek
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
| | - Cornelia Hoedemaekers
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands.
| | - Andries Hoitsma
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands.
| | - Wim Smeets
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands. .,Department of Spiritual and Pastoral Care 20, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Myrra Vernooij-Dassen
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands. .,Kalorama Foundation, Nijmegen, The Netherlands.
| | - Evert van Leeuwen
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
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Vijayalakshmi P, Nagarajaiah, Ramachandra, Math SB. Indian ICU nurses' perceptions of and attitudes towards organ donation. BRITISH JOURNAL OF NURSING 2015; 24:694-7. [PMID: 26153809 DOI: 10.12968/bjon.2015.24.13.694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Poreddi Vijayalakshmi
- Clinical Instructor at College of Nursing, Department of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nagarajaiah
- Former Additional Professor at College of Nursing, Department of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ramachandra
- Additional Professor at College of Nursing, Department of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Suresh Bada Math
- Additional Professor at College of Nursing, Department of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
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Siminoff LA, Molisani AJ, Traino HM. A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation. Pediatrics 2015; 136:e108-14. [PMID: 26034251 PMCID: PMC4485007 DOI: 10.1542/peds.2014-3652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although existing studies suggest that factors affecting families' decisions regarding pediatric organ donation mirror those for adult patients, health professionals working in this area maintain that pediatric and adult decision-makers differ in significant ways. This study compared the request process, experiences, and authorization decisions between family decision-makers (FDMs) of adult and pediatric donors and nondonors. METHODS Perceptions of the donation request were collected via telephone interviews with 1601 FDMs approached by staff from 9 US organ procurement organizations (OPOs). Authorization regarding donation (ie, authorized/refused) was obtained from FDM reports and verified by using OPO records. Tests of association were used to estimate differences between FDMs of adult and pediatric patients. A logistic regression analysis was conducted to identify variables predicting FDM authorization. RESULTS FDMs of children were significantly more likely to authorize donation than were FDMs of adults (89.7% vs 83.2%; χ(2) = 6.2, P = .01). Differences were found between pediatric and adult families' initial feelings toward donation, donation-related topics discussed, communication behaviors and techniques used, perceptions of the request, and receipt and preference of grief information. The likelihood of FDM authorization increased with the number of topics discussed and communication skills employed during requests. Authorization was not predicted by patient age (ie, adult versus pediatric). CONCLUSIONS FDMs of children are willing to donate and experience no more psychological distress from the request for donation than do FDMs of adults. Communication emerged as a critical factor of family authorization, reinforcing its importance in requests for donation.
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Affiliation(s)
- Laura A. Siminoff
- Department of Public Health, Temple University, Philadelphia, Pennsylvania; and
| | - Anthony J. Molisani
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia
| | - Heather M. Traino
- Department of Public Health, Temple University, Philadelphia, Pennsylvania; and
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Forsberg A, Lennerling A, Fridh I, Rizell M, Lovén C, Flodén A. Attitudes towards organ donor advocacy among Swedish intensive care nurses. Nurs Crit Care 2015; 20:126-33. [PMID: 25611200 DOI: 10.1111/nicc.12128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/20/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the attitudes of Swedish intensive care nurses towards organ donor advocacy. BACKGROUND The concept of organ donor advocacy is critical to nurses who care for potential donors in order to facilitate organ donation (OD). DESIGN A retrospective cross-sectional study was employed. METHODS Inclusion criteria in this survey were to be a registered nurse and to work in a Swedish intensive care unit (ICU). Participants were identified by the Swedish association of health professionals. A number of 502 Swedish ICU nurses answered the 32-item questionnaire Attitudes Towards Organ Donor Advocacy Scale (ATODAS), covering the five dimensions of organ donor advocacy: attitudes towards championing organ donation at a structural hospital level, or at a political and research level, attitudes towards actively and personally safeguarding the will and wishes of the potential organ donor, or by using a more professional approach and finally to safeguard the will and wishes of the relatives. Data were analysed with the SPSS version 18·0 and the results were assessed by using Student's t-test and post hoc test, analysis of variance (ANOVA), χ(2) , Pearson's correlation and regression analysis. RESULTS The most favoured advocacy action was safeguarding the POD's will and wishes by a professional approach, closely followed by actively and personally safeguarding the POD's will and wishes. Nurses at local hospitals reported a more positive attitude towards organ donor advocacy overall compared with nurses at larger regional or university hospitals. Important factors leading to positive attitudes were seniority, working experience, participating in conversations with relatives, caring for brain-dead persons and private experiences from OD or organ transplantation. CONCLUSIONS Intensive and critical care nurses with short working experience in university hospitals showed the least positive attitude towards organ donor advocacy. This is problematic because many ODs and all transplantations are performed in university hospitals. RELEVANCE TO CLINICAL PRACTICE This study emphasizes the importance of organizing the care of PODs and their relatives in a way that promotes advocacy.
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Affiliation(s)
- Anna Forsberg
- Department of Health Sciences, Lund University and Department of Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
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Marck CH, Neate SL, Skinner MR, Dwyer BM, Hickey BB, D'Costa R, Weiland TJ, Jelinek GA. Factors relating to consent for organ donation: prospective data on potential organ donors. Intern Med J 2015; 45:40-7. [DOI: 10.1111/imj.12628] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- C. H. Marck
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - S. L. Neate
- Emergency Department; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | | | - B. M. Dwyer
- Organ and Tissue Authority; Canberra Australian Capital Territory Australia
| | - B. B. Hickey
- Intensive Care Unit; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - R. D'Costa
- Intensive Care Unit; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - T. J. Weiland
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - G. A. Jelinek
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
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Abstract
Numbers of deceased organ donors in Australia have increased, but rates of consent to donation remain at around 60%. Increasing family consent is a key target for the Australian Organ and Tissue Authority. Reasons for donation decisions have been reported in the international literature, but little is known of reasons for Australian families’ decisions. Potential organ donors in four Melbourne hospitals were identified and 49 participants from 40 families (23 consenting and 17 non-consenting) were interviewed to understand reasons for consent decisions. Themes for consent to organ donation included that: donation was consistent with the deceased's explicit wishes or known values, the desire to help others or self—including themes of altruism, pragmatism, preventing others from being in the same position, consolation received from donation and aspects of the donation conversation and care that led families to believe donation was right for them. Themes for non-consent included: lack of knowledge of wishes, social, cultural and religious beliefs; factors related to the donation process and family exhaustion; and conversation factors where negative events influenced decisions. While reasons for consent were similar to those described in international literature, reasons for non-consent differed in that there was little emphasis on lack of trust of the medical profession, concerns regarding level of care provided to the potential donor, preserving the deceased's body, fears of body invasion or organ allocation fairness.
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Adanir T, Erdogan I, Hunerli G, Unveren G, Dasci H, Cetin H, Ozsan I, Aydin U. The Effect of Psychological Support for the Relatives of Intensive Care Unit Patients on Cadaveric Organ Donation Rate. Transplant Proc 2014; 46:3249-52. [DOI: 10.1016/j.transproceed.2014.05.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
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Weiss J, Coslovsky M, Keel I, Immer FF, Jüni P. Organ donation in Switzerland--an analysis of factors associated with consent rate. PLoS One 2014; 9:e106845. [PMID: 25208215 PMCID: PMC4160222 DOI: 10.1371/journal.pone.0106845] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions.
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Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
| | - Peter Jüni
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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