P.168: Factors associated with successful family communication regarding brain death and organ donation – a single center experience in UAE.

Abstract

Background: Family communication regarding brain death and the subsequent request for organ donation is challenging under any circumstances. In the UAE it is particularly difficult as the laws regarding brain death and organ donation were only enacted recently and the community awareness regarding these concepts is fairly low. For these reasons, the rates of consent for deceased organ donation are modest. We sought to determine the factors associated with a positive response from family regarding consent for deceased organ donation. Methods: We conducted a qualitative review of patient charts of all brain death patients where we were able to obtain consent for donation. We then attempted to identify any commonalities that were felt to be associated with a positive response. Results: A total of five cases were identified starting from the year 2017 when the laws in UAE were changed to permit deceased organ donation. A number of themes emerged. 1.Understanding of the concept of brain death in the lay population is poor. 2.In all cases of successful consent, several meetings over several days were needed for families to understand and accept the diagnosis of brain death. 3.“Decoupling” the information of brain death with request for organ donation is of paramount importance. It is rare for families to accept the diagnosis of brain death in the first instance. All successful requests were only made after the family had accepted the diagnosis and was planning on withdrawal of organ support. From past experience, we have encountered several cases of refusal when the request was made too early, before the family had explicitly verbalized understanding. 4.Presence of a first-degree relative at the bedside with authority to make decisions was a common factor in all successful cases. All of our donors happen to be expatriates. 5.In all five cases, family communication was handled by health care staff who had undergone specific training in family communication. 6.In only one of the five cases at our hospital was an interpreter used. Conclusions: The main factors associated with a positive response for deceased organ donation in our hospital include •allowing families sufficient time to accept the diagnosis of brain death •decoupling •having a first-degree relative with decision-making ability available at the bedside •using health care staff trained in family communication These findings need to be confirmed by a future study with a larger sample size.