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Walton P, Pérez-Blanco A, Beed S, Glazier A, Ferreira Salomao Pontes D, Kingdon J, Jordison K, Weiss MJ. Organ and Tissue Donation Consent Model and Intent to Donate Registries: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1416. [PMID: 37138558 PMCID: PMC10150845 DOI: 10.1097/txd.0000000000001416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 05/05/2023] Open
Abstract
Consent model and intent to donate registries are often the most public facing aspects of an organ and tissue donation and transplantation (OTDT) system. This article describes the output of an international consensus forum designed to give guidance to stakeholders considering reform of these aspects of their system. Methods This Forum was initiated by Transplant Québec and cohosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This article describes the output of the consent and registries domain working group, which is 1 of 7 domains from this Forum. The domain working group members included administrative, clinical, and academic experts in deceased donation consent models in addition to 2 patient, family, and donor partners. Topic identification and recommendation consensus was completed over a series of virtual meetings from March to September 2021. Consensus was achieved by applying the nominal group technique informed by literature reviews performed by working group members. Results Eleven recommendations were generated and divided into 3 topic groupings: consent model, intent to donate registry structure, and consent model change management. The recommendations emphasized the need to adapt all 3 elements to the legal, societal, and economic realities of the jurisdiction of the OTDT system. The recommendations stress the importance of consistency within the system to ensure that societal values such as autonomy and social cohesion are applied through all levels of the consent process. Conclusions We did not recommend one consent model as universally superior to others, although considerations of factors that contribute to the successful deployment of consent models were discussed in detail. We also include recommendations on how to navigate changes in the consent model in a way that preserves an OTDT system's most valuable resource: public trust.
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Affiliation(s)
- Phil Walton
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | | | | | | | - Jennifer Kingdon
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Kim Jordison
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
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Anthony SJ, Lin J, Pol SJ, Wright L, Dhanani S. Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario. Can J Anaesth 2021; 68:611-621. [PMID: 33575991 PMCID: PMC7878166 DOI: 10.1007/s12630-021-01928-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/24/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In Ontario, an individual's registered wish for organ donation is legally valid consent following death. Family veto occurs when the deceased donor's substitute decision-maker (SDM) overrides this consent to donate, evoking a legal and ethical conflict. The objective of this study was to examine the experiences of Organ and Tissue Donation Coordinators (OTDCs) working with SDMs who vetoed a deceased donor's consent for organ donation. METHODS Qualitative focus groups were conducted with ten OTDCs in Ontario, Canada who reported experience with family veto. An interpretative phenomenological approach informed data analysis. Themes emerged through team consensus and were further refined through collaborative and reflexive engagement. RESULTS Four themes emerged regarding family veto: 1) the significance of the OTDC role, 2) emotional distress and the "understandable" family veto, 3) barriers contributing to family veto, and 4) strategies towards a culture of organ donation. Findings highlighted the importance of patient advocacy in the OTDC role, while revealing the emotional distress of experiencing family veto. OTDCs identified timing and healthcare providers' perceived ambivalence toward organ donation as critical barriers to family authorization. Value-positive language, role reframing, and increased education were offered as strategies to address these barriers and reduce family veto. CONCLUSION This study highlights important considerations about organ donation authorization processes in Ontario. Findings support practice changes towards reducing family veto and further research nationally. Collaborations with key stakeholders are warranted to align healthcare practices, donation policies, and education initiatives towards a shared goal of increasing organ donation.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
| | - Jia Lin
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah J Pol
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda Wright
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Cooper R, Pollock NJ, Affleck Z, Bain L, Hansen NL, Robertson K, Chatwood S. Patient healthcare experiences in the Northwest Territories, Canada: an analysis of news media articles. Int J Circumpolar Health 2021; 80:1886798. [PMID: 33734041 PMCID: PMC8725720 DOI: 10.1080/22423982.2021.1886798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The factors that influence patient healthcare experiences are complex and connected to place. In northern Canada, the socio-historical context and the inequitable distribution of health services are unique influences on patients. The objective of this study was to examine the characteristics of patient healthcare experiences as reported through news media in the Northwest Territories. We used a case series design to examine patient healthcare experiences reported in news media articles. We conducted a systematic search for articles published between 2008 and 2017 in the online database of a media outlet in the Northwest Territories. We used descriptive statistics to summarise the article characteristics and thematic analysis to understand patient experiences in 128 articles related to 71 cases. Most often, cases involved women, concerned mental health, suicidality, or chronic diseases, and were predominantly negative. Patient experiences included problems associated with medical travel, communication difficulties with providers, lack of cultural safety, and barriers in accessing care resulting in poor-quality care, particularly for Indigenous patients. Broadly, these experiences are rooted in the colonial history in the North. Understanding patient experiences and including Indigenous patients in health system decision-making can help focus policies and clinical care on cultural safety and equity.
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Affiliation(s)
- Rhiannon Cooper
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Institute for Circumpolar Health Research, Yellowknife, Canada
| | - Nathaniel J. Pollock
- School of Public Health, University of Alberta, School of Public Health, Edmonton, Canada
- School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada
| | - Zander Affleck
- Institute for Circumpolar Health Research, Yellowknife, Canada
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Laura Bain
- Institute for Circumpolar Health Research, Yellowknife, Canada
| | - Nanna Lund Hansen
- Center for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kelsey Robertson
- Institute for Circumpolar Health Research, Yellowknife, Canada
- School of Public Health, University of Alberta, School of Public Health, Edmonton, Canada
| | - Susan Chatwood
- School of Public Health, University of Alberta, School of Public Health, Edmonton, Canada
- Institute of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
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Weiss MJ, English SW, D'Aragon F, Lauzier F, Turgeon AF, Dhanani S, McIntyre L, Shemie SD, Knoll G, Fergusson DA, Anthony SJ, Haj-Moustafa A, Hartell D, Mohr J, Chassé M. Survey of Canadian intensivists on physician non-referral and family override of deceased organ donation. Can J Anaesth 2020; 67:313-323. [PMID: 31768789 DOI: 10.1007/s12630-019-01538-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Intensive care physicians play an important role in the identification and referral of potential organ donors in Canada. Nevertheless, little is known about intensivists' attitudes or behaviours in situations where families override previously expressed consent to donate; nor why physicians elect not to refer patients who are potential donors to provincial organ donation organizations (physician non-referral). METHODS We integrated questions regarding family override and physician non-referral into an online, self-administered survey of Canadian intensivists. We report results descriptively. RESULTS Fifty percent of targeted respondents (n = 550) participated. Fifty-five percent reported having witnessed family override situations and 44% reported having personally not referred patients who were potential donors. Fifty-six percent of respondents stated they would not pursue donation in the face of family override; 2% stated they would continue with the donation process. Fear of loss of trust in the donation system (81%) and obligation to respect the grief and desires of surrogate decision makers (71%) were frequently reported reasons to respect family override requests. Respondents who chose not to refer patients often did so based on organ dysfunction they assumed would preclude donation (59%), or a perception that the family was too distressed to consider donation (42%). No respondents reported that personally held beliefs against organ donation influenced their decision. CONCLUSION Physicians caring for patients who are potential organ donors commonly encounter both family override and physician non-referral situations. Knowledge translation of optimal practices in identification and referral could help ensure that physician practices align with legal requirements and practice recommendations.
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Affiliation(s)
- Matthew J Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada.
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.
- Transplant Québec, Montréal, QC, Canada.
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada.
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frederick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Montréal Children's Hospital, McGill University Health Centre and Research Institute, Montreal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adnan Haj-Moustafa
- Carrefour de l'Innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - David Hartell
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
| | - Jim Mohr
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Michaël Chassé
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Carrefour de l'Innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
- Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, University of Montréal, Montréal, QC, Canada
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Crawshaw J, Presseau J, van Allen Z, Pinheiro Carvalho L, Jordison K, English S, Fergusson DA, Lauzier F, Turgeon AF, Sarti AJ, Martin C, D'Aragon F, Li AHT, Knoll G, Ball I, Brehaut J, Burns KEA, Fortin MC, Weiss M, Meade M, Marsolais P, Shemie S, Zaabat S, Dhanani S, Kitto SC, Chassé M. Exploring the experiences and perspectives of substitute decision-makers involved in decisions about deceased organ donation: a qualitative study protocol. BMJ Open 2019; 9:e034594. [PMID: 31874899 PMCID: PMC7008441 DOI: 10.1136/bmjopen-2019-034594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In Canada, deceased organ donation provides over 80% of transplanted organs. At the time of death, families, friends or others assume responsibility as substitute decision-makers (SDMs) to consent to organ donation. Despite their central role in this process, little is known about what barriers, enablers and beliefs influence decision-making among SDMs. This study aims to explore the experiences and perspectives of SDMs involved in making decisions around the withdrawal of life-sustaining therapies, end-of-life care and deceased organ donation. METHODS AND ANALYSIS SDMs of 60 patients admitted to intensive care units will be enrolled for this study. Ten hospitals across five provinces in Canada in a prospective multicentre qualitative cohort study. We will conduct semistructured telephone interviews in English or French with SDMs between 6 and 8 weeks after the patient's death. Our sampling frame will stratify SDMs into three groups: SDMs who were not approached for organ donation; SDMs who were approached and consented to donate and SDMs who were approached but did not consent to donate. We will use two complementary theoretical frameworks-the Common-Sense Self-Regulation Model and the Theoretical Domains Framework- to inform our interview guide. Interview data will be analysed using deductive directed content analysis and inductive thematic analysis. ETHICS AND DISSEMINATION This study has been approved by the Centre Hospitalier de l'Université de Montréal Research Ethics Board. The findings from this study will help identify key factors affecting substitute decision-making in deceased organ donation, reasons for non-consent and barriers to achieve congruency between SDM and patient wishes. Ultimately, these data will contribute to the development and evaluation of tools and training for healthcare providers to support SDMs in making decisions about organ donation. TRIAL REGISTRATION NUMBER NCT03850847.
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Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kim Jordison
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Francois Lauzier
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Aimee J Sarti
- Critical Care Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Claudio Martin
- Medicine (Critical Care), Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Frédérick D'Aragon
- Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Alvin Ho-Ting Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ian Ball
- Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen E A Burns
- Critical Care, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marie-Chantal Fortin
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
| | - Matthew Weiss
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
- Trauma-Emergency-Critical Care Medicine, Université Laval Faculté de médecine, Quebec City, Quebec, Canada
| | - Maureen Meade
- Medicine (Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - Pierre Marsolais
- Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Sam Shemie
- Critical Care, McGill University, Montreal, Québec, Canada
| | | | | | - Simon C Kitto
- Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Innovation Hub, Centre de Recherche du CHUM, Montréal, Québec, Canada
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
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