242.5: Organ donation after circulatory death: Understanding the vox populi.

Abstract

Background: Since its reintroduction, Donation after Circulatory Death (DCD) has proven an important initiative to increasing donation numbers, however reaching its full potential remains elusive. Early on, DCD was met with resistance at both an institutional and individual level. Culture and policy reform allowed growth of DCD programs, however reservations regarding DCD persist. The current study aims to achieve a greater understanding of DCD perceptions among intensive care staff at multiple centres. Methods: This qualitative study utilised semi-structured interviews with intensive care staff at two interstate tertiary centres in Australia with a similar case mix. Intensive care physicians, donation specialist nursing coordinators and critical care nurses were recruited through email invitation, and a trained interviewer used a semi-structured interview guide to explore perceptions surrounding DCD. Interviews were digitally recorded and transcribed verbatim for thematic analysis. Results: Twenty-eight participants were interviewed; seventeen intensive care physicians, eight donation coordinators and three critical care nurses. Responses to the Likert scale questions were averaged with Donation after Brain Death having greater acceptance than DCD. Interview responses generated four main themes: 1) Logistic and circumstantial obstacles surrounding DCD implementation; 2) Cultural and environmental influences on DCD decision making; 3) Influence of staff-member attitudes and beliefs regarding DCD; and 4) Influence of families of potential donors on DCD. All four themes were represented in both centres though with different proportions. Discussion: Respondents’ concerns with DCD stemmed from the unpredictability of DCD progressing to donation within accepted timeframes, and the burden this may place on family and hospital staff. Although logistic and circumstantial obstacles affected both centres these were more salient in Adelaide. Adelaide has no local thoracic transplantation service and relies on interstate teams to retrieve thoracic organs. The potential cost of mobilising a retrieval team weighed upon the decision to attempt DCD in cases where progression to DCD within the timeframe was not assured. Staff at both centres felt introducing DCD into end-of-life care had the potential to influence dosing of analgesia and sedation. Despite these concerns, both centres used a range of strategies, such as supportive leadership and clear policies, to achieve effective DCD programs. Conclusions: Whilst DCD may garner discomfort among some ICU staff, a supportive culture can allow DCD to occur with minimal institutional resistance. Further study exploring the prevalence of institutional resistance to DCD in other centres may generate discussion in how to optimise DCD programs nationally and internationally. Royal Adelaide Hospital.