Does Training of Intensive Care Specialists Improve Organ Donation Consent Rates, When Excluding “Family Raised” Cases?

Abstract

Consent rates are a major barrier to organ donation. Currently, Australian consent remains at 60%[1] which is comparable to the UK and USA[2][3]. One of many strategies associated with improvements are the skills and training of personnel conducting the family donation conversation (FDC) [4][5][6][7][8][9]. In Australia over the last few years, structured training has been made available through the National Organ & Tissue Donation Authority and the NSW Organ and Tissue Donation Service [10][11]. This training consists of core and practical FDC courses, plus a simulation day with content referring to the language utilized during the organ donation conversation in the Intensive Care Unit (ICU). This education program has been associated with improvements in consent rates[12]. However, these conclusions are difficult to analyse because “family raised” consent has been included in the final results. The aim of this study was to describe the relationship between training, education and consent rates, with the exclusion of “Family raised” cases, whereby the organ donation discussion was initiated by a family member. Methods This was a single centre retrospective analysis of prospectively collected data from 2013 to 2017. John Hunter Hospital is a tertiary referral centre with more than 1700 ICU admissions every year. All major surgical and medical services are provided. Every referral to the organ & tissue donation service (OTDS) received from the ICU was enrolled. Information collected included: medical suitability, staff who initiated the conversation, the training and education that the leader of the FDC had at the time and the outcome of the conversation. Conversations were classified as “FDC” led if the requestor had completed two out three components of the structured national and state education program and “Not FDC” if none or only one component was attended by the staff. Descriptive Statistics for the whole sample and Chi-Square calculator for a simple 2 x 2 contingency table comparison of outcomes were used. Significant result was considered with a p < 0.05. Results A total of 315 referrals were received by the OTDS during the study period. Of them, 126 cases were deemed not suitable for donation and 37 cases were excluded because the FDC was initiated by the family member. Among the 152 ICU initiated conversations, 137 were led by an intensive care staff specialist and/or a donor coordinator. In 15 instances the FDC was initiated by a staff outside the ICU, a nurse or a social worker. (Figure 1).The overall consent rate for the period was 62%. “FDC trained” requestors conducted 81 conversations with a consent rate of 70.3%, while “Non-FDC trained” conducted 71 conversations with a consent rate of 54%. When comparing the groups on a Chi Square Test, the p-value was 0.048. (Figure 2).Conclusion When excluding family raised intention to donate, there was a statistically significant relationship between completion of training and consent rates. Expanding the sample prospectively, and in a multicentre manner may even demonstrate a stronger association.