Organ Procurement Coordinators Research Articles

P.443: Evaluating the effect of psychological characteristics, education, and experiences on the performance of organ procurement coordinators in the family approach.

P.443: Evaluating the effect of psychological characteristics, education, and experiences on the performance of organ procurement coordinators in the family approach.

Exploration of Profession Experience Among In-Hospital Organ Procurement Coordinators in China: A Qualitative Study

The gap between the supply and demand of organs is continuously increasing. The emergence of organ procurement coordinators (OPCs), to a certain extent, has decreased the gap. In China, a majority of OPCs work in hospitals that are qualified for transplants, namely in-hospital OPCs (Ih-OPCs). Their profession experiences are closely related to donation rates and indirectly reveal aspects that should be further improved. However, no data are available in China. We sought to explore Ih-OPCs' subjective feeling of the practice experience and provide targeted interventions for administrators. A project team was established and then interview outlines were listed by virtue of discussion and literature review. Furthermore, a total of 13 Ih-OPCs were selected as participants for interview. After that, the conversation was analyzed and encoded, and themes were finally identified according to phenomenology. A total of 3 themes including positive emotions, negative emotions, and personal needs were identified, which were furthermore divided into 7 minor themes ranging from professional identity, competence improvement, recruitment methods, quality of life, workload evaluation, career prospects, and training courses. Social support and public understanding play a pivotal role in strengthening positive emotions. Meanwhile, the administrators should put more emphasis on negative emotions and personal needs, and management system should be further optimized.

Organ donation: A study of its representations among organ procurement coordinators and their staff

Making the life-saving treatment of transplantation available to patients who need it re-quires the cooperation of individuals and families who decide to donate organs. Healthcare workers navigate organizational, bureaucratic and relational aspects of this process, including cases in which a deceased individual has not specified a wish about organ donation and their surviving family members must be asked for consent to donate during a delicate phase of mourning. This research aims to understand the experience of these health workers regarding their work. We collected 18 interviews from organ donation healthcare workers in five of the major hospitals in Rome. The transcripts underwent a multivariate text analysis to identify the repre-sentations of organ donation and the symbolic categories organizing the practice of these workers. This research elucidated a symbolic space constructed of four factors: the "Context", in-volving family and health workers; the "Work purposes", including the procedures and the relationships; the "Transplant", which involves omnipotence and limits; the "Donation", which involves ideals versus reality. The characterizing elements of these representations, belonging to organ donation work-ers, are the prestige, the certification of brain death, the communication, the transplant, and the salvation. In the lives of these workers, to be a "bridge between life and death2 evokes feelings of prestige rather than difficult feelings associated with confronting one's limitations. These aspects concern the difficulties met by the health staff in their work, and they are useful ele-ments to design a focused training and support program for organ donor workers.

A narrative study on the life of organ procurement coordinator

Background: Organ procurement coordinators (OPC) are the first person to approach the family when a potential brain death pa tient is referred and play a key role in attracting the donation of organs and the family's consent. Thus, it is necessary to listen to their real stories and to understand their experience. Methods: This study used a narrative inquiry method developed by Clandinin and Connelly (2000) as a method to inquire the lives of OPC and to understand the meaning of such an experience. Three coordinators who have been worked at Korea Organ Dona tion Agency as a coordinator for more than 3 years and are working in Youngnam region. Data collection was done for 3 months from May 2019 to August 2019. Results: The meaning of their relationship with organ families were that in their first encounter with donor family, they are trying their best to sympathize with their pain, to support them emotionally, and to relieve their pain. However, there was a conflict over what seemed to be trying to persuade organ donation by coordinator and a negative perception about organ donation. About re lationship with the hospital include the confusion about working place where they have to move to a different hospital every day and the conflict with the hospital staff. Conclusions: This study was conducted to understand the experience of OPC through narrative inquiry. We tried to understand the work of OPC by approaching the whole course of their life comprehensively, not as a part of task and to understand the vivid experience of the OPC. The result of this study can be used as a basic data for the direction and design of future studies.

Análisis del perfil de la enfermera coordinadora de procuramiento de órganos en Chile

RESUMEN Introducción: En Chile, los coordinadores de procuramiento son mayoritariamente enfermeras y la tasa de donación es muy baja respecto a su población. Objetivo: Analizar la coherencia entre el perfil del enfermero/a coordinador de procuramiento definido por el Ministerio de Salud y el observado en los coordinadores chilenos. Material y Método: Estudio descriptivo, cuantitativo, muestreo no probabilístico, de enfermeras que se desempeñaban cómo Coordinadores de Procuramiento en servicios asistenciales públicos y privados de Chile. Las Variables estudiadas fueron de carácter sociodemográficas, de caracterización profesional, de capacitación, estructura de la unidad de procuramiento, y de requisitos del cargo de coordinador. Datos recolectados en el mes de octubre del año 2017, en el III Encuentro Nacional de Coordinadores de Procuramiento y Trasplantes, a través de un cuestionario estructurado, que permitió contrastar el perfil obtenido con el perfil definido por el Ministerio de Salud (MINSAL) Resultados: Los coordinadores de procuramiento, son en un 82.4% de sexo femenino, promedio de edad de 36+ 11 años .El 90.2% se desempeña en un Hospital Público. El 100% tiene título enfermera acreditada, un 30 % entre 1 y 4 años de egresados, y un 37 % menos de 5 años de experiencia laboral. Sin experiencia clínica en cuidados de alta complejidad, como unidades de Urgencia (82.3%) o cuidados intensivos (58.8%). El 66,5% consideró que la formación inicial, fue suficiente para asumir el cargo. Conclusiones: En los aspectos estudiados, el perfil profesional de los enfermeros coordinadores locales difiere del perfil definido por la autoridad de salud.

Posthumous HIV Disclosure and Relational Rupture

In response to Anne L. Dalle Ave and David M. Shaw, we agree with their general argument but emphasize a moral risk of HIV disclosure in deceased donation cases: the risk of relational rupture. Because of the importance that close relationships have to our sense of self and our life plans, this kind of rupture can have long-ranging implications for surviving loved ones. Moreover, the now-deceased individual cannot participate in any relational mending. Our analysis reveals the hefty moral costs that disclosure can bring, which should influence what information is given to would-be donors and how organ procurement coordinators approach these conversations.

Providing Social Support in a Persuasive Context: Forms of Social Support Reported by Organ Procurement Coordinators

Eighty-five organ procurement coordinators (OPCs) completed face-to-face interviews designed to elicit the emotional and instrumental social support strategies communicated to potential donor families throughout the request for deceased organ donation. OPCs identified six forms of emotional support and eight forms of instrumental support, with greater reported use of instrumental support strategies. In terms of instrumental support, OPCs most frequently ensured in-hospital comfort (61.2%) or met the nutritional needs of family members (51.8%). With respect to emotional support, OPCs most often expressed sympathy (31.8%) to families and provided support in the form of physical contact (27.1%) with family members. Identifying the forms of social support used by OPCs is a first step toward understanding the strategies that are more (or less) effective in achieving persuasive and support goals.

“When Every Organ Counts: There Is Only One Time to Get it Right”; Integration of Customized High-Fidelity Simulation Into Organ Procurement Staff Training

Background: Despite a wider public acceptance for organ donation, the number of people waiting for transplants is increasing creating a need for more donors and better stewardship of organs in consented donors. In a scenario where every organ counts, Organ Procurement Organizations (OPOs) are challenged to reform their educational training programs beyond the current “see one-do one-teach one” approach. High-fidelity simulation creates a safe and non-threatening training environment where mistakes can be safely made and learnt from in real-time with no organs lost. Simulation also allows for customizing scenarios to address individual learning needs of participants in a small-group format. The use of high-fidelity simulation focusing on the crucial skills needed to manage the unique physiological and psycho-social issues occurring during organ donor management have not been studied systematically. Methods: We developed a High-fidelity simulation based orientation and training program for newly hired organ procurement coordinators (OPC) at OneLegacy (the Organ Procurement Organization in Southern California). We administered a questionnaire to assess baseline knowledge and to identify knowledge deficits regarding Catastrophic Brain Injury Guidelines (CBIG). To assess incremental knowledge gain, a 30 min subject related theory session was then administered, followed by the completion of a post-theory test. Incorrect answers from the pre and post-theory were used to develop customized case scenarios. Using a high fidelity simulation environment consisting of a physiology based human patient simulator, realistic recreation of an ICU environment and using real ICU equipment, OPCs were challenged to resolve individualized objectives in the simulation session that followed immediately. Sessions were recorded, with playback and detailed debriefing facilitated by an instructor. A post-simulation test was administered after the debriefing session to assess further knowledge gain. Knowledge regarding definition, goals, and clinical triggers for CBIG, referral, clinical management was ascertained using 11 multiple choice questions based on the theory content provided. Results: This training program was trialed with four newly hired OPCs, all with similar experience and professional nursing background. All participants completed the tests, simulation sessions, and debriefing sessions. Knowledge regarding definition, goals, and clinical triggers for CBIG, referral, clinical management with the number of correctly answered questions improving from 9.5 ± 1.65 on pre-test to 10 ± 1.22 on post-theory test and 10± 0.5 on post-simulation test (p value 0.12, paired t-test). All four participants strongly agreed that simulation facilitated their learning and was an effective training method. Conclusions: Integration of customized High-fidelity Simulation into new hire orientation training identifies learning needs and used in conjunction with theory content provides the learner an individualized learning environment with real-time feedback of their performance. It enables instructors to establish measurement criteria for standard practice and documentation of professional competency. Simulation based was perceived as extremely helpful by the newly hired organ procurement coordinators. High-fidelity simulation can be an effective education and training tool for organ procurement staff orientation and training to improve overall organ donor management “when every organ counts”.

Implementation of a National Organ Procurement Program: The Lebanese Model

Organ shortage is universal. It represents the main obstacle to organ transplantation since, despite all the scientific advances to date; the latter relies exclusively on human organs.In Lebanon, the National Organization for Organ and Tissue Donation and Transplantation-Lebanon (NOOTDT-Lb) has been working to promote organ donation by proposing a Lebanese model that comprises two complementary divisions for deceased and living donations. The deceased donation system: For the past three years NOOTDT-Lb has been implementing, with the financial help of the Spanish government through the “Agencia Espagnola de Cooperacion International para el Desarrollo” (AECID) and technical support of the “Donation and Transplant Institute - Barcelona” (DTI) a national program for organ procurement from deceased donors. Adapted from the universally successful Spanish model, this program depends on the active cooperation of the different players involved. It consists of: 1) Hospital organ procurement units with Hospital Organ Procurement Coordinators in committed hospitals, 2) Preset protocols that guide each step of the organ donation procedure; 3) a fair and transparent organ allocation system with an annual review by an allocation committee where NOOTDT-Lb and all the transplanting centers are represented; and 4) a registry for donation and transplantation. To back this system up, NOOTDT-Lb ensures continuing education programs for healthcare personnel that are intended to update their knowledge and stimulate their interest in promoting deceased donation. NOOTDT-Lb, with the help of the Donation and Transplantation Institute (DTI), also carries out regular audits of the committed hospitals. In addition, The Ministry of Health (MOH) has removed all financial disincentives to donation and is actively working to introduce the topic of organ donation into the hospital accreditation system. The living donation system:NOOTDT-Lb has tried to promote living donation as well by facilitating genetically related donation and attempting to regulate non-genetically related donation through national medical and ethical committees. A ministerial decree covering these regulations was issued in agreement with the Lebanese Order of Physicians and under the supervision of NOOTDT-Lb. In conclusion, the program is progressing slowly but steadily. Its implementation obviously requires more public awareness but after reviewing our 2010 and 2011 results it has become clear to us that full and active adherence of the healthcare professionals remains a prerequisite to a successful program.

Professional Education and Hospital Development for Organ Donation

Because of the strict Organ Transplantation Act, only 81 brain dead (BD) organ donations had been performed in Japan for 13 years since 1997. The Act was revised on July 17, 2010, allowing, organs to be donated after BD with consent from the family, if the subject had not denied organ donation previously. This act has lead to an expectation of a 6–7-fold increase in BD donation. The 82 organ procurement coordinators (OPC) in Japan include 32 belonging to the Japanese Organ Network (JOT) and the others to each administrative division. JOT has guideline manuals of standard roles and procedures of OPC during organ procurement from BD and cardiac death donors.To manage the increased organ donations after the revision of the act, we have modified the education system. First, we modified the guideline manuals for OPC to correspond to the revised Transplant Act and governmental guidelines. Second, all OPC gathered in a meeting room to learn the new organ procurement system to deal with the revised Transplant Act and guidelines. Third, a special education program for 2 months was provided for the 10 newcomers. Last, the practical training in each donor case for newcomers was performed by older OPC.Topics of the education program were the revised transplant act and guidelines, family approach to organ donation, BD diagnosis, donor evaluation and management, organ procurement and preservation, allocation system, hospital development and family care.In the future, each OPC will be divided into special categories, such as the donor family OPC, the donor management OPC, and the operating room OPC. Therefore, we need to construct separate special education programs for each category.

Modification of the Education System for Organ Procurement Coordinators in Japan After the Revision of the Japanese Organ Transplantation Act

BackgroundFrom October 1997 to July 2010, only 86 brain-dead (BD) organ donations were obtained and no organs were retrieved from children under 15 years of age because of the strict Japan Organ Transplantation Act. The Act was revised on July 17, 2010, allowing organs to be donated after BD with family consent. ObjectiveTo manage the increased donations after the revision, the Japan Organ Transplant Network (JOT) employed 10 organ procurement coordinators (OPCs) and modified its education systems. We retrospectively reviewed the modified education programs to evaluate whether they were effective and whether the processes of organ donation were promptly performed after the revision of the Act. MethodsThe modifications of education program were: changing OPC to guideline manuals to correspond to the revised Transplant Act; OPCs were taught the new organ procurement system; and a special education program was provided for the 10 newcomers for 2 months. ResultsAfter 12 months of the revision, 58 BD organ donations were accomplished, whereas they had averaged 6.6 in a year before the revision. Two pediatric BD organ donations were accomplished without problem. One priority organ donation to a relative was performed uneventfully. After applying the modified education program, skilled JOT OPCs and leader JOT OPCs increased. ConclusionsTo manage increased organ donations after the revision of the Act, the educational system was modified and 58 brain dead organ donations were performed safely.

Asking the Difficult Questions: Message Strategies Used by Organ Procurement Coordinators in Requesting Familial Consent to Organ Donation

The present study provides an in-depth examination of the messages used by organ procurement coordinators (OPCs) in shaping familial requests for organ donation. OPCs (N = 102), recruited from a national sample of 16 organ procurement organizations, participated in a structured interview designed to uncover the communication strategies used in obtaining familial consent for donation. Analysis of interviews indicates OPCs' messages cover 4 domain areas. Specifically, OPCs report use of messages intended to (a) provide education, (b) discuss the benefits to donation, (c) learn about potential donor families, and (d) persuade families to engage in donation. Within the 4 domain areas, OPCs report use of 15 specific messages (e.g., “positively framing the donor,” “social proof,” “discuss the benefit of donation to grieving”) in requesting consent. The present study provides a detailed examination of strategies and offers recommendations for using message strategies to explore the effectiveness of the consent process from the perspective of OPCs in approaching donor families.

Difficult Communication: Compliance-Gaining Strategies of Organ Procurement Coordinators

Organ procurement coordinators (OPCs) face a formidable communication task when making familial requests for consent to organ donation, because they must provide social support for grieving family members while seeking compliance to the donation request. Structured interviews were conducted with 102 OPCs, representing 16 organ procurement organizations (OPOs) (27.6% of national organizations) across the United States. Responses were transcribed and content-analyzed along four domain areas: (a) establishing credibility, (b) message strategies, (c) timing/setting of requests, and (d) adaptation of messages to diverse families. OPO conversion rates were used as a criterion factor for OPCs' persuasive communication success and regressed onto self-reported strategy use. Results indicate message strategies varied at the OPC level of analysis and 7 techniques significantly predicted 32% of the variance in conversion rates. Two strategies (i.e., gaining early intervention, approaching with additional support) positively influenced conversion rates, whereas 5 strategies (e.g., discussing benefits as a persuasive strategy, emphasizing the need for donation in particular racial/ethnic groups) negatively influenced conversion rates. Future research is recommended to validate the study findings toward the goal of improving OPCs' communication strategies.

Why Families Decline Donation: The Perspective of Organ Procurement Coordinators

Current knowledge regarding the barriers to organ donation relies on 3 data sources: potential donor families, hospital staff, and members of the general public. The current study complements these findings by interviewing organ procurement coordinators about their experiences during the familial consent process. To characterize organ procurement coordinators' reports of barriers to obtaining familial consent for donation. Structured, face-to-face interviews. One hundred and two organ procurement coordinators recruited from a national sample of 16 organ procurement organizations. Interviews were content analyzed to describe coordinators' experiences with families who decline donation. Manifest coding was used to determine the frequency with which particular barriers were identified by coordinators. Coordinators' reports of barriers were compared with organizational conversion rates to determine which barriers were associated with performance as an organization. Organ procurement coordinators revealed 16 distinct barriers in 4 overlying categories: concerns regarding decedents' wishes, structural barriers to donation, unsupportive belief systems, and lack of public education. Three reported barriers could be used to differentiate between high- and low-performance organizations: (1) familial concerns over bodily disfigurement, (2) failure of families to understand brain death, and (3) families' cultural/racial background. These results supplement existing reports of barriers to donation and are discussed in terms of shaping future public education efforts and request processes to improve conversion rates.

Why families decline donation: the perspective of organ procurement coordinators

Current knowledge regarding the barriers to organ donation relies on 3 data sources: potential donor families, hospital staff, and members of the general public. The current study complements these findings by interviewing organ procurement coordinators about their experiences during the familial consent process. To characterize organ procurement coordinators' reports of barriers to obtaining familial consent for donation. Structured, face-to-face interviews. One hundred and two organ procurement coordinators recruited from a national sample of 16 organ procurement organizations. Interviews were content analyzed to describe coordinators' experiences with families who decline donation. Manifest coding was used to determine the frequency with which particular barriers were identified by coordinators. Coordinators' reports of barriers were compared with organizational conversion rates to determine which barriers were associated with performance as an organization. Organ procurement coordinators revealed 16 distinct barriers in 4 overlying categories: concerns regarding decedents' wishes, structural barriers to donation, unsupportive belief systems, and lack of public education. Three reported barriers could be used to differentiate between high- and low-performance organizations: (1) familial concerns over bodily disfigurement, (2) failure of families to understand brain death, and (3) families' cultural/racial background. These results supplement existing reports of barriers to donation and are discussed in terms of shaping future public education efforts and request processes to improve conversion rates.

Roles of Sex and Ethnicity in Procurement Coordinator—Family Communication during the Organ Donation Discussion

Interpersonal relations with health care providers influence families' decisions to consent to solid-organ donation. However, previous research has been based on retrospective interviews with donation-eligible families and has not directly examined the interpersonal interactions between families and organ procurement coordinators. To increase understanding of the interpersonal interaction between procurement coordinators and families during the organ donation discussion, with special attention to the influence of the sex and race of the procurement coordinator and the race of the potential donor's family. A descriptive study in which standardized patients portrayed family members interacting with actual procurement coordinators in simulated donation request scenarios. Thirty-three videotaped interactions between standardized patients and 17 procurement coordinators involving 2 different scenarios depicting deceased donation were evaluated. Video recordings were rated by independent coders. Coders completed the Impact Message Inventory-Form C, the Participatory Style of Physician Scale, and the Siminoff Communication and Content and Affect Program-Global Observer Ratings scale. African American procurement coordinators, particularly African American women, were rated as more controlling and work-oriented than white procurement coordinators. Male procurement coordinators were more affiliative with the white family than the African American family, whereas female procurement coordinators were slightly less affiliative with the white family. African American procurement coordinators expressed more positive affect when interacting with the African American family than the white family, whereas the opposite was true for white procurement coordinators. Research is needed to cross-validate these exploratory findings and further examine cultural mistrust between procurement coordinators and families of ethnic minorities, especially given the negative attitudes of many minorities toward donation.

Airway pressure release ventilation during adult donor care

Airway pressure release ventilation is most commonly used during donor care to treat hypoxemia and to avoid high peak airway pressure. The traditional concept of cyclic inhalation/exhalation is replaced by a continuous positive airway inflation interspersed by brief episodes in which the positive pressure is reduced. The variables, Pressure-high, Pressure-low, Time-high, and Time-low, are manipulated to ensure adequate donor oxygenation and carbon dioxide removal. Organ procurement coordinators may find this method of mechanical ventilation in place when donor care is assumed or initiate it as a useful tool in providing donor support.

Airway Pressure Release Ventilation during Adult Donor Care

Airway pressure release ventilation is most commonly used during donor care to treat hypoxemia and to avoid high peak airway pressure. The traditional concept of cyclic inhalation/exhalation is replaced by a continuous positive airway inflation interspersed by brief episodes in which the positive pressure is reduced. The variables, Pressure-high, Pressure-low, Time-high, and Time-low, are manipulated to ensure adequate donor oxygenation and carbon dioxide removal. Organ procurement coordinators may find this method of mechanical ventilation in place when donor care is assumed or initiate it as a useful tool in providing donor support.

Thromboelastography during Adult Donor Care

Thromboelastography is a test of blood coagulation used to evaluate all components of clot formation and possible abnormal clot dissolution. It supplements traditional laboratory testing by demonstrating the integration of coagulation factors, platelets (number and function), and other factors during coagulation. Analysis of abnormalities demonstrated by thromboelastography can guide organ procurement coordinators in titrating appropriate quantities of fresh frozen plasma, cryoprecipitate, or platelet transfusions during treatment of coagulation in adult donors.

Thromboelastography during adult donor care

Thromboelastography is a test of blood coagulation used to evaluate all components of clot formation and possible abnormal clot dissolution. It supplements traditional laboratory testing by demonstrating the integration of coagulation factors, platelets (number and function), and other factors during coagulation. Analysis of abnormalities demonstrated by thromboelastography can guide organ procurement coordinators in titrating appropriate quantities of fresh frozen plasma, cryoprecipitate, or platelet transfusions during treatment of coagulation in adult donors.