Consent Rate For Organ Donation Research Articles

Approaching the Families of Potential Deceased Organ Donors: An Overview of Regulations and Practices in Council of Europe Member States.

The primary aim of this study was to describe regulations and practices concerning the family approach to discuss donation, specifically after the neurological determination of death, one of the most challenging steps in the donation pathway. A secondary objective was to assess the impact of legislation on consent rates for organ donation. The Council of Europe surveyed 39 member states about national regulations, practices, and consent rates; 34 replied. Opt-out legislation is present in 19, opt-in in 9 and a mixed system in six countries. An opt-out register is kept by 24 countries and an opt-in register by 18 countries, some keeping both. The mean consent rate was 81.2% of all family approaches. Most countries regulate how death using neurological criteria is confirmed (85.3%), while regulation of other aspects of the deceased donation pathway varies: the timing of informing the family about brain death (47.1%) and organ donation (58.8%), the profile of professional who discusses both topics with the family (52.9% and 64.7%, respectively) and the withdrawal of treatment after brain death (47.1%). We also noted a mismatch between what regulations state and what is done in practice in most countries. We suggest possible reasons for this disparity.

Regional Variation in Pediatric Deceased Organ Donation Consent Rates Is Costing Lives.

* Abbreviations: CQI — : continuous quality improvement OPO — : organ procurement organization In this issue of Pediatrics , Godown et al1 present compelling data revealing wide variation in pediatric deceased organ donor consent rates among organ procurement organizations (OPOs), shining a spotlight on an important problem that effects both pediatric lives and health disparities. In the face of a declining number of pediatric deceased organ donors, variation in the successful consent of eligible donors is further exacerbating the current donor organ shortage. This well-designed study serves as a “call to arms” for OPO collaboration to optimize pediatric donor recruitment and save lives. In this retrospective cohort study, using data from the Scientific Registry of Transplant Recipients between 2008 and 2019, the authors1 found that 4.1% of families of eligible pediatric donors were not approached to request consent for organ donation. Wide variation existed between OPOs, such that, whereas at least one OPO approached 100% of families to request consent, another approached only 87.4% of families. Wide variability … Address correspondence to Michael J. Englesbe, MD, FACS, UH S Floor 6, Transplant Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Email: englesbe{at}med.umich.edu

Validation of the factors influencing family consent for organ donation in the UK.

Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47-1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23-0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22-0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.

The healthcare professionals' support towards organ donation. An analysis of current practices, predictors, and consent rates in Apulian hospitals.

The paper investigates the critical care staff's support towards organ donation by analysing how their attitude, knowledge, confidence, engagement, and training can act as predictors of donation consent rates. Our study focused on hospitals in the Apulia Region, Italy. The study employs a quantitative methodology based on a survey of healthcare professionals. The rate of consent to organ and tissue donation at the hospital level, given as a ratio of the permissions received to the proposals performed, was extracted from GEDON software related to the year 2019 report. For each Apulian participating hospital, we calculated a median score for each of the five predictors (namely, attitude, knowledge, confidence, engagement, and training) and investigated the association with hospital consent rates. The results highlight that the engagement of the intensive care units' healthcare personnel stands as the only influential predictor of the consent rate. In Italy's Apulia Region, efforts are needed to increase consent rates for organ donation. Strategies should concentrate on continuous support, as well as specific training of hospital staff involved in the donation process.

Comparison of 1 vs 2 Brain Death Examinations on Time to Death Pronouncement and Organ Donation

Objective To fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation. Methods Twelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates. Results A total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p &lt; 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019). Conclusions A single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.

Causes of lowered family consent rate for organ donation

Background: The number of deceased donors that have increased annually until 2016 has started to decline in the last three years. This study therefore intends to analyze the trend of potential brain death reported to Korea Organ Donation Agency (KODA) and use the analysis results as a basic data for the activation of organ donation. Methods: A comparative analysis was performed for the first period (P1: 2014 to 2016) where the number of donations continued to increase and the second period (P2: 2017 to 2019) that showed decline in donations compared to 2016. Results: The cases of potential brain death reported to KODA was 5,548 in P1 and 7,126 in P2, a 28.4% increase from the previous period. Among these, the cases of medically suitable for organ donation increased by 36.5%, from 4,053 in P1 to 5,534 in P2. Decreased the consent rate from 52.9% in P1 to 37.2% in P2. The discontinuation of donation process even after family consent increased by 17.6% (from 74 cases in P1 to 87 cases in P2), mostly due to legal issues and death before the judgment of brain death. Conclusions: The decrease in families’ consent for organ donation turned out to be the biggest cause of declining donation. The major reasons for refusal to donation such as can be attributed to the lack of understanding of the medical state of brain death, a negative image of sharing and donation that is pervasive in Korean society, and the distrust between community members. Therefore, there is a need for education and promotion at a national level to enhance the awareness of the value of life and to en courage the public to practice the value of sharing.

Seeking consent for organ donation: Process evaluation of implementing a new Specialist Requester nursing role.

To explain the differences in organ donation consent outcomes of a new nursing role (Specialist Requesters) derived from the United States (US) compared with the existing nursing role (Specialist Nurses in Organ Donation). Thirty-month observational qualitative process evaluation: Implementation theory-informed analysis. Qualitative content analysis of free text describing challenges, processes and practice from 996 bespoke routinely collected potential organ donor 'approach forms' from two regions: one where there was no difference, and one with an observed difference in consent outcomes. Region A consent rate: Specialist Requester 75.8%, Specialist Nurse in Organ Donation71.8%. Region B consent rate: Specialist Requester 71.4%, Specialist Nurse in Organ Donation 82%. Region A Specialist Requesters turned the family position from no or uncertain to support organ donation in 73% of cases, compared with 27.4% in Region B. Two Specialist Requesters in Region A were highly effective. Region B experienced problems with intervention fidelity and implementation. The benefits of the Specialist Requester role remain unclear. Positive differences in consent rates achieved by Specialist Requesters in the originator region reduced over time and have yet to be successfully replicated in other regions. The impact of Specialist Requesters on consent outcomes varied across regions and it was not known why. Specialist Requesters in Region A were better at getting family member(s) to support organ donation. In Region B, Specialist Nurse in Organ Donation consent rates were higher and problems with intervention fidelity were identified (recruitment, staffing, less experience). Policy makers need to understand it is not just a matter of waiting for the Specialist Requester intervention to work. Ongoing training and recruiting the right people with the right skills need to be addressed and consistently reviewed.

Deemed consent to organ donation: what critical care nurses need to know.

British Journal of NursingVol. 29, No. 15 NHS Blood and TransplantDeemed consent to organ donation: what critical care nurses need to knowPhil Walton, Cathy Miller, Steven Maycock, Kristian NicolPhil WaltonLegislation Project Lead—Organ Donation & Nursing, NHS Blood and TransplantSearch for more papers by this author, Cathy MillerLegislation Project Lead—Education and Governance, NHS Blood and TransplantSearch for more papers by this author, Steven MaycockCharge Nurse, Intensive Therapy Unit/High Dependency Unit, Withybush General Hospital, HaverfordwestSearch for more papers by this author, Kristian NicolPractice Development Charge Nurse, Intensive Care, Kettering General Hospital NHS Foundation TrustSearch for more papers by this authorPhil Walton; Cathy Miller; Steven Maycock; Kristian NicolPublished Online:13 Aug 2020https://doi.org/10.12968/bjon.2020.29.15.910AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health and Social Care. Consultation outcome. Organs and tissues to be excluded from the opt-out organ donation system: government response. 2020. https://tinyurl.com/y5szt79g (accessed 5 August 2020) Google ScholarHulme W, Allen J, Manara AR, Murphy PG, Gardiner G, Poppitt E. Factors influencing the family consent rate for organ donation in the UK. Anaesthesia. 2016;71(9):1053-1063. https://doi.org/10.1111/anae.13535 Crossref, Medline, Google ScholarHuman Tissue Authority. Codes of practice and standards. 2020. https://tinyurl.com/yx8zngc3 (accessed 3 August 2020 Google ScholarNational Institute for Health and Clinical Excellence. Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. Clinical guideline CG135. 2016. https://www.nice.org.uk/guidance/cg135 (accessed 3 August 2020) Google ScholarNHS Blood and Transplant. Timely Identification and Referral of potential organ donors. 2014. https://tinyurl.com/yxa54cvzf (accessed 3 August 2020) Google ScholarNHS Blood and Transplant. Approaching the families of potential organ donors. 2015. https://tinyurl.com/y4cgeoqg (accessed 3 August 2020) Google ScholarNHS Blood and Transplant. Organ donation and transplantation activity report 2018/19. 2019. https://tinyurl.com/vazfuw6 (accessed 3 August 2020) Google ScholarNoyes J, Morgan K, Walton P, Roberts A, Mclaughlin L, Stephens M. Family attitudes, actions, decisions and experiences following implementation of deemed consent and the Human Transplantation (Wales) Act 2013: mixed-method study protocol. BMJ Open. 2017;7:e017287. https://doi.org/10.1136/bmjopen-2017-017287 Crossref, Medline, Google ScholarNoyes J, McLaughlin L, Morgan K et al.. Short-term impact of introducing a soft opt-out organ donation system in Wales: before and after study. BMJ Open. BMJ Open. 2019;9:e025159. https://doi.org/10.1136/bmjopen-2018-025159 Medline, Google Scholar FiguresReferencesRelatedDetailsCited byEmbedding changes in legislation for organ and tissue donation across England and JerseyCathy Miller, Louise Hubner, Sonya Paterson, Bobbee Cotter, Phil Walton, Helen Bentley, Claire Roberts18 March 2021 | British Journal of Nursing, Vol. 30, No. 5 13 August 2020Volume 29Issue 15ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 13 August 2020 Published in print 13 August 2020 Information© MA healthcare LimitedPDF download

Factors that affect consent rate for organ donation after brain death: A 12-year registry

ObjectiveTo account for factors affecting family approach and consent for organ donation after brain death (BD). Material and methodsA prospective cohort study in a large, tertiary, urban hospital, where we reviewed the database of all brain-dead patients between January 2006 and December 2017 cross-matched with local organ procurement organization (OPO) records. ResultsTwo-hundred sixty-six brain-dead patients were included (55% African Americans (AAs)). Two-hundred twenty-two were approached for donation. The reason for not approaching families was medical exclusion due to cancer or multi-organ failure. Patient demographics or religion were not associated with approaching families. Lower creatinine level was the only independent factor associated with higher approach. Consent rate for organ donation was 72.5%. Consent was significantly higher in Caucasians (89% vs 62% for AAs), younger patients (46.7 vs 52.5 years old), in patients with lower creatinine at time of death (1.7 vs 2.4 mg/dL), patients for whom apnea testing was completed (92% vs 80%) and patients with diabetes insipidus (DI) (72% vs 54%). There was no significant relationship between consent and patient gender, admission diagnosis, number of examinations or completion of a confirmatory test. In a logistic regression model, only AA race independently predicted consent for donation (odds, 95% CI, 0.27, 0.12–0.57 p < .001). In a different model, apnea test completion was an additional independent predictor (3.66, 1.28–10.5 p = .015). ConclusionsApproaching families for organ donation consent was associated with medical suitability only and not with demographic or religious characteristics. AAs were 3.7 times less likely to consent for organ donation than non-AAs. Completion of apnea testing was associated with higher consent rates, an observation that needs to be explored in future studies documenting the effect on bedside family presence during this test.

Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives

IntroductionIn a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of...

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

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.

Appointing nurses trained in organ donation to improve family consent rates

BackgroundOne of the most important bottlenecks in the organ donation process worldwide is the high family refusal rate.Aims and objectivesThe main aim of this study was to examine whether family guidance by trained donation practitioners increased the family consent rate for organ donation.DesignThis was a prospective intervention study.MethodsIntensive and coronary care unit nurses were trained in communication about donation (ie, trained donation practitioners) in two hospitals. The trained donation practitioners were appointed to guide the families of patients with a poor medical prognosis. When the patient became a potential donor, the trained donation practitioner was there to guide the family in making a well‐considered decision about donation. We compared the family consent rate for donation with and without the guidance of a trained donation practitioner.ResultsThe consent rate for donation with guidance by a trained donation practitioner was 58.8% (20/34), while the consent rate without guidance by a trained donation practitioner was 41.4% (41/99, P = 0.110) in those patients where the family had to decide on organ donation.ConclusionsOur data suggest that family guidance by a trained donation practitioner could benefit consent rates for organ donation.Relevance to clinical practiceTrained nurses play an important role in supporting the families of patients who became potential donors to guide them through the decision‐making process after organ donation request.

Social media’s effectiveness for activating social declarations and motivating personal discussions to improve organ donation consent rates

PurposeWhile the support for organ donation and registered donors continue to increase, next of kin consent remains a critical issue for the organ donation community. Despite the increased usage of social media campaigns for organ donor registration, there is a lack of understanding of how social media can be used to motivate individuals to socially declare their support for organ donation and encourage them to engage in personal discussions about organ donation with their next of kin. The purpose of this study is to better understand the link between social and personal discussions and organ donation consent rates.Design/methodology/approachThe study uses structural equation modeling to examine the precursors to activating organ donor registration social media advocacy that leads to increased support for organ donation and motivates personal discussions about organ donation.FindingsThe results provide the organ donation and transplant community insight on the value of using social media to increase social advocacy, support for donation and social declarations and personal discussions on organ donation to improve next of kin’s consent rates.Practical implicationsSocial causes similar to organ donation increasingly turn to social media for grassroots marketing efforts to engage others in the cause and motivate action.Originality/valueThe authors proposed an omni-channel IMC Framework and a research agenda for advancing the field. As this is a new area of inquiry, the authors argue for the development of other comprehensive frameworks, both for general omni-channel IMC conceptualizations.

Is there an association between consent rates in Swiss hospitals and critical care staffs' attitudes towards organ donation, their knowledge and confidence in the donation process?

This study investigated the critical care staff’s attitude, knowledge and involvement with donation, skills and confidence with donation-related tasks and their association with consent rates at the hospital level. In 2015, we conducted a cross-sectional survey among critical care staff of hospitals involved in organ donation using an anonymous online questionnaire with a response rate of 56.4% (n = 2799). The hospital level consent rate was obtained from the Swiss Monitoring of Potential Donors database (2013–2015). For each hospital, we calculated a mean score for each predictor of interest of the Hospital Attitude Survey and investigated the association with hospital consent rates with generalized linear mixed-effect models. In univariable analysis, one score point increase in doctors' confidence resulted in a 66% (95% CI: 45%–80%) reduction in the odds to consent, and one score point increase in nurses' attitudes resulted in a 223% (95% CI: 84%–472%) increase in the odds to consent. After simultaneously adjusting for all major predictors found in the crude models, only levels of education of medical and nursing staff remained as significant predictors for hospital consent rates. In Switzerland, efforts are needed to increase consent rates for organ donation and should concentrate on continuous support as well as specific training of the hospital staff involved in the donation process.

Family Attitudes, Actions, Decisions and Experiences Following Implementation of Deemed Consent and the Human Transplantation Act (Wales) 2013

Family Attitudes, Actions, Decisions and Experiences Following Implementation of Deemed Consent and the Human Transplantation Act (Wales) 2013

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus.

Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of brain death, donation rates and occurrence of central diabetes insipidus accompanying brain death in children. This retrospective study was conducted at a twelve-bed tertiary-care combined medical and surgical pediatric intensive care unit of the Ondokuz Mayis University Medical School, Samsun, Turkey. In 37 of 341 deaths (10.8%), a diagnosis of brain death was identified. The primary insult causing brain death was post-cardiorespiratory arrest in 8 (21.6%), head trauma in 8 (21.6%), and drowning in 4 (18.9%). In all patients, transcranial Doppler ultrasound was utilised as an ancillary test and test was repeated until it was consistent with brain death. In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The four patients not diagnosed with CDI had acute renal failure, and renal replacement treatment was carried out. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. In the current study the consent rate for organ donation is relatively low compared to the rest of the world. The prevalence of central diabetes insipidus in this pedaitric brain death population is higher than reports in the literature, and acute renal failure accounted for the lack of central diabetes insipidus in four patients with brain death. Further studies are needed to explain normouria in brain-dead patients.

Specialist nurses can double consent rates for organ donation

Specialist nurses can double consent rates for organ donation

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

Abstract Introduction: Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of brain death, donation rates and occurrence of central diabetes insipidus accompanying brain death in children. Methods: This retrospective study was conducted at a twelve-bed tertiary-care combined medical and surgical pediatric intensive care unit of the Ondokuz Mayıs University Medical School, Samsun, Turkey. In 37 of 341 deaths (10.8%), a diagnosis of brain death was identified. The primary insult causing brain death was post-cardiorespiratory arrest in 8 (21.6%), head trauma in 8 (21.6%), and drowning in 4 (18.9%). In all patients, transcranial Doppler ultra-sound was utilised as an ancillary test and test was repeated until it was consistent with brain death. Results: In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The four patients not diagnosed with CDI had acute renal failure, and renal replacement treatment was carried out. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. Conclusion: In the current study the consent rate for organ donation is relatively low compared to the rest of the world. The prevalence of central diabetes insipidus in this pedaitric brain death population is higher than reports in the literature, and acute renal failure accounted for the lack of central diabetes insipidus in four patients with brain death. Further studies are needed to explain normouria in brain-dead patients.

Central Diabetes Insipidus Accompanying Brain Death in Children

Introduction Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of central diabetes insipidus accompanying brain death in children. Methods This retrospective study was conducted at a 12-bed tertiary-care combined medical and surgical pediatric intensive care unit of a university hospital. Results In 37 of 341 deaths (10.8%), the diagnosis of brain death was identified. The primary insult causing brain death was hypoxic-ischaemic brain injury in 12 (32.4%), traumatic brain injury in 8 (21.6%), intracranial lesions in 7 (18.9%). In all patients, transcranial doppler ultrasound was utilized as an ancillary test. In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. Conclusion The prevalence of central diabetes insipidus in our pedaitric brain death population is higher than reports in literature and acute renal failure accounted for the lack of central diabetes insipidus in 4 patients with brain death. We believe that the persistence of cerebral blood flow after brain death may result in normouria in at least some patients. Futher studies are needed to explain normouria in brain death patients.

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

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.