208.1: Use of collaborative request model was highly correlated with organ donation consent.

Abstract

Background: There continues to be a disconnect between Australian’s self-reported support for organ donation and formal end-of-life family consent rates. In 2015, a multi-site Australian study by Lewis et al. demonstrated that consent rates were optimised by involving a clinician who had specific training in donation conversations, and in addition, was independent of the treating team. This approach is known as “Collaborative requesting” in Australia. The aim of the study was to report our single institution’s experience in introducing and augmenting the collaborative request model. Methods: The Royal Melbourne Hospital (RMH), is one of two adult tertiary trauma centres for the city of Melbourne, Australia. Additionally, the hospital has specialist neurosurgical and stroke services. Australia permits organ donation via both brain death and controlled circulatory death pathways. The hospital co-employs 4 embedded Donation Specialist Nursing Coordinators, and 3 fractionally appointed Medical Donation Specialists. Both craft groups have specialist communication training, and in addition, nursing coordinators have detailed end-to-end case donation management experience. Over a three-year period, the RMH progressively implemented the request model. Rather than using “any” independent clinician with donation communication training (the Lewis Model), the unit promoted the use of embedded Donation Specialist Nursing Coordinators as the collaborative requestors (the augmented collaborative model). Results: From January 2016 to June 2018 there were 135 donation requests raised by staff. Donation conversations raised by the family were excluded from analysis, as they have a consent rate at our hospital of over 90%. During the study period collaborative requesting increased from 50% (Jan 2016) to 96% (Jun 2018). Over the 3 study years (2016, 2017 and first half of 2018), the consent rate was highly positively correlated with the increased use of a collaborative model (r2=0.984). Conclusions: Since the introduction of embedded donation specialist nursing coordinators in RMH ICU, the hospital has seen both a clinically and statistically significant improvement in organ donation consent rates. These improvements in consent rates have been demonstrated to be highly correlated with the implementation of an augmented collaborative model within our unit. The dose-response relationship provides weight to a causational link.The excess consent rate observed in our unit in comparison to the multi-site Lewis et al study may be due to the concentration of performance of a clinical skill into a small number of requestors, and excellent end-to-end process knowledge. Further study is recommended. Conclusions: Collaborative requesting for permission to proceed with organ donation was highly correlated with improved consent rates, in this centre with the predominant use of Specialist Nursing Coordinator collaborators.