Requesting donation: the satisfaction of the next-of-kin of potential organ donors

Abstract

The rate of organ donation is slowing in the UK, increasing pressure on healthcare staff to speak with families about donation. Intensive care staff are not confident that they have the necessary communication skills. They fear they may increase families’ distress1 and are not clear of the most helpful way to approach families.2 The need for suitable training has been recognized.3 There is a need to investigate the potential donor families’ experiences to identify helpful practice when delivering bad news and requesting donation. Retrospective in-depth semi-structured interviews were carried out by a clinical psychologist with bereaved next-of-kin of potential organ donors (n = 29). Twenty Northwest Intensive Care Units were involved. Kin were sequentially identified and interviewed 6 months after their bereavement. The interview was organized in temporal order, from arrival to departure. Key questions focusing on satisfaction with care and communication were repeated. Next-of-kin recalled their experiences and reactions and rated their satisfaction (1 = very dissatisfied, 7 = very satisfied) with unit practices. Protocol one recorded the accounts, responses to prompts and spontaneous comments. Protocol two recorded the ratings of satisfaction with the questions. Whether consenting or refusing to donate, all kin found the request acceptable. Staff's tension when making the request was evident to families. The majority of kin rated themselves satisfied with the meeting to discuss donation (mean 6.3, SD 1.3), and explanations given (mean 6.0, SD 1.4). There was a relationship between satisfaction and the request being made separately from the news of death (P The practices, which are generally considered helpful to families, were not uniformly represented across units. There was evidence of potential unhelpful practice. The results suggest that increased distress is not related to the donation per se, but to whether the families have accepted the fact of death. Study results support the recommendations for training for staff involved in breaking bad news and requesting donation.