Family Consent For Organ Donation Research Articles

Brain death diagnosis and management in the COVID-19 pandemic

Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic.
 Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients’ demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated. 
 Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114±92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32±15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24±15.2 (5-72) hours, and the time between diagnosis and donation was 23±7.6 (15-35) hours.
 Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.

Effect of Diabetes Mellitus Comorbidity on Mortality Risk in Tuberculosis Patients who Received Tuberculosis Treatment: A Meta-Analysis

Background: Family consent and organ donors rates are co-linear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population. Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analysed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics was applied to see discriminate accury of the developed regression model for family consent. Results: Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001) and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) factors were significantly associated to family consent to increase organ donation registration whereas; control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050) was negatively associated to family consent. Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), and donated any organ/blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) factors were not statistically significant to family consent to increase organ donation registration. Conclusion: Attitude and intention can increase family consent to organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence: Rajvir Singh, Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Post Box: 3050; email: rajvir.aiims@gmail.com. Mobile: 97455897044. Journal of Epidemiology and Public Health (2022), 07(04): 520-534 https://doi.org/10.26911/jepublichealth.2022.07.04.09

Factors Associated with Family Consent to Organ Donation in Qatar: Results from a Household Survey

Background: Family consent and organ donors rates are co-linear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population. Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analysed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics was applied to see discriminate accury of the developed regression model for family consent. Results: Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001) and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) factors were significantly associated to family consent to increase organ donation registration whereas; control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050) was negatively associated to family consent. Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), and donated any organ/blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) factors were not statistically significant to family consent to increase organ donation registration. Conclusion: Attitude and intention can increase family consent to organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence: Rajvir Singh, Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Post Box: 3050; email: rajvir.aiims@gmail.com. Mobile: 97455897044. Journal of Epidemiology and Public Health (2022), 07(04): 520-534 https://doi.org/10.26911/jepublichealth.2022.07.04.09

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.

Impact of COVID-19 Pandemic on Organ Donation in Hong Kong: A Single-Center Observational Study

The coronavirus disease 2019 (COVID-19) pandemic was expected to have a negative impact on organ donation. With the differences in health care systems and lockdown policies in various regions, the pandemic's effect on organ donation and transplant service may vary. Most of the deceased donor organ referrals in our hospital came from non-intensive care units (ICUs). The objective of this study is to report our experience and quantify the effects of the COVID-19 pandemic on deceased donor organ donation in our center. This was a retrospective observational study comparing the deceased donor organ donation activity during the period January 23 to November 30, 2020 with the same period in 2018 in Queen Elizabeth Hospital, Hong Kong. There was a 26.9% reduction in deceased donor organ donor referral in 2020 compared with 2018. No significant difference in the proportion of referrals from ICU or non-ICU areas between the 2 time periods was observed. The brain death confirmation rate was significantly higher in 2020 (40.8% vs 20.2%, P=.003). Nine patients had family consent for organ donation in 2020 (vs 7 patients in the same period in 2018). There were no significant differences in consent rate and number of recovered organs between the 2 periods. With effective measures to limit the spread of COVID-19 in a community, it is possible to support the needs of both patients with COVID-19 and deceased donor organ donation services.

Cash, Funeral Benefits or Nothing at All: How to Incentivize Family Consent for Organ Donation

Incentives, such as funeral expense reimbursements and direct payments for surviving families, have been suggested to increase organ supply from post-mortem donors. Following Heyman and Ariely’s 2004 findings on the impact of gift labeling and reward magnitude on behaviors in altruistic environments, this study utilizes a full factorial survey design to examine subjects’ moral assessment of funeral benefits and cash prizes, and the effects these incentives had on the willingness to provide family consent (WTC). Regression analysis showed that funeral aids, when presented as gifts, outperformed direct payments in all ethical principles. Furthermore, a full funeral service without a revealed value was found to increase WTC by 8.5% from the current system.

儒家“誠”基礎上的器官家庭捐獻

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文首先探討了儒家的“誠”與作為人之本性的“仁”之間的關係，指出“誠”是“仁”的前提與基礎。筆者認為“誠”賦予“仁”三個基本特徵：“真摯性”、“無外在目的性”和“客觀性”。這三個特徵都與儒家家庭和家庭成員間的“親親之愛”緊密聯繫。其後，本文提出儒家排斥“鄉願”式的器官捐獻。同時，文章指出，由於“誠”的要求，儒家認為對家庭成員的“親親之愛”應該是對非家庭成員的仁愛的前提、基礎和不可或缺的必要條件。因而，個人捐獻原則是與“誠”的價值觀存在一定的矛盾，而家庭捐獻原則才是符合儒家倫理的。最後，本文對人體器官的家庭捐獻原則進行了制度設計。Organ donation is the gift of an organ to help someone who needs a transplant to survive. Yet with limited organs available, the following question arises. Who should be given priority in terms of donation procedures—the individual who has personally committed to offer his/her organs to anyone in need, or the legal next of kin, i.e., family members? This essay approaches this question with reference to the Confucian ethics of sincerity (cheng), which is viewed as a precondition for the ethics of humanness (ren), arguing that family members should be given priority in decisions on organ donation. The author recommends that a policy of family consent for organ donation be implemented, as such a policy would reflect the significant role that family should play in making decisions on critical issues such as organ donation. The essay concludes that rather than emphasizing the right of individuals to decide what will happen after they die, a policy of family involvement would encourage more people to become donors and avoid conflict in cases of disagreement between donors and family members.DOWNLOAD HISTORY | This article has been downloaded 75 times in Digital Commons before migrating into this platform.

COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): protocol for an intervention study

BackgroundDiscussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation.MethodsThis multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a “designated requester”; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a “balanced” approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national “Family Donation Conversation” workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals’ adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days.DiscussionThe pragmatic design of this study may identify ‘what works’ in usual clinical settings when requesting organ donation in critical care areas, both in terms of changes in practice healthcare professionals are willing and able to adopt, and the effect this may have on desired outcomes. The findings of this study will be indicative of the potential benefits of the intervention and be relevant and transferrable to clinical settings in other states and countries.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000815763 (24 July 2013). ClinicalTrials.gov: NCT01922310 (14 August 2013) (retrospectively registered).

Taking Care of Relationships in the Intensive Care Unit: Positive Impact on Family Consent for Organ Donation

BackgroundOrgan donation refusal from relatives of potential donors with brain death significantly reduces organ availability. The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. We analyzed the impact of a new systematic communication approach between medical staff and patients' relatives on the rate of consent to organ donation. MethodsThe study was conducted as a single-center, non-randomized, controlled, before-and-after study at an 18-bed intensive care unit (ICU) of a university hospital. We compared the rate of consent for organ donation before and after the introduction of the new communication approach. ResultsA total of 291 brain-dead patients were studied. The consent rate increased from 71% in the pre-intervention period (2007–2012) to 78.4% in the post-intervention period (2013–2015), with an 82.75% increase in the 2014 to 2015 period. During these periods, no significant variation of consent to organ donation was recorded at the national and regional levels. ConclusionsThe introduction of a new communication approach between medical staff and relatives of brain-dead patients was associated with a significant increase in the rate of consent to donation. Our results highlight the importance of empathy with relatives in the ICU.

What Would Be The Best Time For Taking Family Consent For Tissue Donation From Brain Dead Cases?

Introduction: Giving the consent for tissue donation from brain dead cases is usually more difficult than for organ donation in our country because of the people fear about body disfiguration. We did this study to find out the best time for taking family consent for tissue donation. Methods: All of the brain dead cases detected in our territory are transferred to our Organ Procurement Unit (OPU) ICU for organ donation after family consent. We compared the brain dead family consent rate for tissue donation when the request was done during the first interview at the original hospital with the request after transferring the case to our ICU. Results: Rate of consent for tissue donation increased from %43 to %90 with changing the time and place of interview. Conclusion: The time of taking family consent for organ donation is not a good time for taking consent for tissue donation. It is better to give some time to the family to adapt themselves to their loved one death and organ donation more and then let them decide about tissue donation.

Family Informed Consent to Organ Donation—Who Performs Better: Organ Procurement Organizations, In-Hospital Coordinators, or Intensive Care Unit Professionals?

Successful organ donation in countries adopting informed consent legislation depends on adequate interviewing of potential donors' families. As the number of both referral and effective donors in Brazil increases, health care managers argue whether educational efforts should be directed toward training in-hospital coordinators (IHC)—based on the “Spanish model”—or on the creation of extra-hospital-based professionals (Organ Procurement Organizations [OPOs], the “American model”). Meanwhile, many potential donor families are still approached by intensive care unit (ICU) professionals not trained in donation interviews. The aim of our study was to compare performances in obtaining informed consent from potential donors' families, according to the type of health care professional conducting the interviews: OPO, IHC, or ICU staff. In this retrospective 2-year study performed in Rio de Janeiro, Brazil, we observed an increase in referrals (285 to 411) and consent rates (48.1% to 55.7%). Each year, OPO professionals conducted most family interviews (58.6% and 60.4%, respectively) and obtained better consent rates (63.5% and 64.5%, respectively), when compared to IHC (41.8% and 53.7%, respectively) or untrained ICU professionals (22.1% and 13.4%, respectively). Our results show that adequate professional training is necessary for obtaining family consent for organ donation. Both established international policies for organ procurement and donation, namely the “Spanish model” with its IHCs or the “American model” of extra-hospital OPOs, may equally achieve this task. However, family interviews performed by untrained ICU professionals result in low donation rates and should be discouraged.

Non confirmatory electroencephalography in patients meeting clinical criteria for brain death: Scenario and impact on organ donation

ObjectiveTo describe the causes and outcome of adult patients with preserved electroencephalographic activity despite clinical findings suggesting brain death (BD), and its impact on organ donation. MethodsRetrospective study of the clinical and electroencephalography (EEG) data of all adult patients admitted to our hospital between January 2001 and December 2011 in whom a comprehensive clinical diagnosis of BD was reached following absence of brainstem reflexes and confirmatory apnea tests, were obtained. All patients with clinical findings suggesting BD and an EEG showing brain activity were selected for the analysis. We calculated the brain death interval (BDI) as the time between the first complete clinical examination and confirmatory ancillary test, or the time between the first and second complete clinical examination for BD, in order to analyze the impact on family consent for organ donation. ResultsA complete clinical examination and EEG were diagnostic in 289 patients. In 279 (96.5%), the first EEG showed electrocerebral inactivity corroborating the clinical findings of BD. The mean BDI in this group was 4.2±5.8h (median; 1.8[1.0–3.5]). This value was significantly lower than in the group in which only two full clinical evaluations were performed (p<0.0001). In 10 out 289 (3.5%), the first EEG showed at least some brain activity. The mean BDI in this group was 27.2±13.8h (median; 22.9 [19.1−31.2]). In two cases, a third EEG was necessary before obtaining electrocerebral inactivity. A BDI>6h, was positively associated with a family refusal for organ donation (p=0.02). ConclusionsThe rate of EEGs with electrocerebral activity despite clinical findings suggesting BD was only 3.5%. It occurred most frequently with severe brainstem damage. Although in this small percentage of patients, BD diagnosis was notably delayed, in the great majority of cases the use of EEG shortened the BDI. In our series, a BD diagnosis delay >6h negatively affected consent for organ donation. SignificanceThe use of EEG can decrease the time interval for brain death diagnosis.

Increasing family consent for organ donation: findings and challenges

There is a growing disparity between the number of organs and tissues needed for transplantation and the number available for donation. As a result, thousands of people die every year while waiting for a transplant. Much of the shortage can be explained by the failure of families to consent to donation. This paper reviews the research that has been conducted to elucidate reasons why families deny consent. This research, together with theoretically motivated research in the areas of persuasion and behavior change, can be used to inform the design of educational and promotional campaigns and to guide policy decisions.

Increasing family consent for organ donation: findings and challenges.

There is a growing disparity between the number of organs and tissues needed for transplantation and the number available for donation. As a result, thousands of people die every year while waiting for a transplant. Much of the shortage can be explained by the failure of families to consent to donation. This paper reviews the research that has been conducted to elucidate reasons why families deny consent. This research, together with theoretically motivated research in the areas of persuasion and behavior change, can be used to inform the design of educational and promotional campaigns and to guide policy decisions.

Improving the request process to increase family consent for organ donation.

The greatest impediment to organ donation is refusal of family consent. This study examined the impact of 3 modifiable elements of the donation request on family consent rates: (1) decoupling (i.e., the family understands and accepts brain death before discussion of organ donation is begun); (2) the procurement coordinator participates in the request for consent; and (3) donation is requested in a quiet, private place. Data on the request process were collected prospectively for 707 medically suitable potential donors who had been referred to 3 organ procurement organizations. The average rate of consent for donation was 62.2%. Higher consent rates were independently associated with the 3 characteristics studied. These components were summarized in the Request Process Scale. Multivariate regression analyses indicated that consent rates can be as high as 74% when all 3 process elements are present. Hospitals and organ procurement organizations should incorporate these elements into their standard of practice when requesting organ donation.

Improving the Request Process to Increase Family Consent for Organ Donation

The greatest impediment to organ donation is refusal of family consent. This study examined the impact of 3 modifiable elements of the donation request on family consent rates: (1) decoupling (ie, the family understands and accepts brain death before discussion of organ donation is begun); (2) the procurement coordinator participates in the request for consent; and (3) donation is requested in a quiet, private place. Data on the request process were collected prospectively for 707 medically suitable potential donors who had been referred to 3 organ procurement organizations. The average rate of consent for donation was 62.2%. Higher consent rates were independently associated with the 3 characteristics studied. These components were summarized in the Request Process Scale. Multivariate regression analyses indicated that consent rates can be as high as 74% when all 3 process elements are present. Hospitals and organ procurement organizations should incorporate these elements into their standard of practice when requesting organ donation.