Families Of Potential Donors Research Articles

Family and staff responses to a scripted introduction to tissue donation for hospice inpatients on admission

To implement and evaluate a change in practice regarding the timing of introducing donation for inpatient hospice staff and families whereby scripted information about tissue/organ donation was given by the nurse upon admission as part of the normal admission process and then repeated at the time of death per usual protocol. Data were collected from staff for 6 months (January to June 2006). The hospice staff agreed to complete a donor services comment log at the admission and at the death of each patient to relay any concerns with the change in practice rather than just writing down complaints as was the previous practice. Data were supplemented with staff input during regular meetings. Donation rates were compiled as usual for 6 months and compared with the preceding 6 months. Data were analyzed from the written interactions. Trends identified were limited by the small sample size. The results confirmed that both nursing staff and potential donor families supported the change in practice. No families or staff called the organ procurement organization with complaints during the 6-month period. Corneal donations increased from 2 to 7, a 250% increment for the 6-month period. The assumption that discussing donation when hospice patients are admitted will lead to a decrease in donation is not supported by the results of this study. The findings suggest the need for a methodologically rigorous, theoretically driven examination of hospice donor families' reactions to the introduction of donation at admission and the subsequent decrease in stress and increase in donation rates.

Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event

The aim was to explore how relatives and physicians understood cases where organ donation had been requested and what factors were salient for the decision on donation. Physicians of 25 deceased patients and 20 relatives were interviewed. The material was analyzed using qualitative methods. Eleven patients had declared their wishes on donation before death; in 14 cases the relatives had to decide. Half of these relatives accepted donation and half refused. The donation request was of secondary importance to the families; they were totally occupied by the death and initially tried to avoid the request by regarding “no” as a nonresponse. They needed support to relieve their immediate reactions of uneasiness, start rational thought processes, and reach well-grounded answers. The basis for requesting donation was good; relatives, with regard to circumstances, had been well prepared for the death by continuous information from the physicians and had confidence in staff, accepted that the question was raised, and understood the death criteria. However, about half the physicians experienced conflicts regarding prerequisites of procuring organs and dealing with relatives. Three different approaches were displayed: prodonation, neutral, and ambivalent. Only physicians with a prodonation approach received acceptance for donation.

Potential for organ donation in the United Kingdom: audit of intensive care records

Objectives To determine the true potential for solid organ donation from deceased heartbeating donors and the reasons for non-donation from potential donors.Design An audit of all deaths in intensive care...

End-of-Life Decision Making, Organ Donation, and Critical Care Nurses

End-of-Life Decision Making, Organ Donation, and Critical Care Nurses

Organ Donation Breakthrough Collaborative

Organ Donation Breakthrough Collaborative

Sociocultural Perspective on Organ and Tissue Donation among Reservation-Dwelling American Indian Adults

Objective To discover the sociocultural patterns that influence decisions about organ and tissue donation among American Indian (AI) adults. Design This qualitative ethnographic study used a social–ecological framework. A snowball sampling technique was used to recruit 21 Oglala Lakota Sioux participants (age ≥ 19 years) living on the Pine Ridge Indian Reservation in South Dakota, USA. Face-to-face interviews were conducted using open-ended questions derived from the social–ecological perspective of Stokols (1992). Interviews were audiotaped and transcribed. Data were categorized into construct codes to identify concepts and to discover emerging themes. Results Personal and environmental themes regarding organ and tissue donation emerged. There were two personal themes: uncertain knowledge and the diabetes crisis. Participants knew very little about organ and tissue donation but there was a basic understanding of donor/recipient compatibility. The prevalence of diabetes in the community is contributing to a dire need for kidney donors. The diabetes crisis was acknowledged by every participant. There were three environmental themes: cultural transitions, healthcare system competence and outreach efforts. Traditional cultural beliefs such as entering the spirit world with an intact body were acknowledged. However, conversations reflected re-examination of traditional beliefs because of the need for kidney donors. The healthcare environmental context of organ and tissue donation emerged as a theme. Participants were not confident that the local health system was prepared to either address traditional beliefs about organ and tissue donation or implement a donation protocol. The final theme was the environmental context of outreach efforts. Participants desired relevant outreach targeted to the community and disseminated through local communication networks including the family, the media and tribal leaders. Conclusions Sociocultural factors relevant to the personal and environmental context of the social ecological model influenced beliefs about organ and tissue donation among the Lakota people in this study. Outreach programs aimed at increasing donation need to respect traditional beliefs yet present the choice about organ and tissue donation within the cultural context. Telling the stories of community members affected by both diabetes and donation is important. Promoting family conversation is critical. Healthcare systems must approach potential donor families with an understanding of traditional beliefs and respect for the process of family communication about organ and tissue donation.

Changing Attitude to Organ Donation and Transplantation in University Students During the Years of Medical School in Italy

The shortage of organ donations is a major limiting factor in transplant programs. Since a favorable attitude of health professionals to organ donation can positively influence the decision of families of potential donors, educating physicians early in their careers may become crucial in this setting. The aim of this study was to compare medical student opinions on organ donation and transplantation at different stages in their undergraduate career. Methods Medical students were prospectively surveyed in their first and fourth years by an anonymous 10-item questionnaire. Results The 100 of 195 (51.3%) students completed both questionnaires including 29 men, of an overall cohort mean age 23.7 (range, 22–32 years). 91% of the students had attended classical or scientific high school and 83% were Catholic. Their attitude to transplantation remained strongly positive (96% vs 92%, fourth vs first year). 96% of the fourth year students would accept an human donor organ or an artificial organ (vs 95% of first year) and 91% would accept an animal organ (vs 84%). The students showed a positive attitude to organ donation (96% vs 91%, fourth vs first year). Most of them were prepared to donate their organs after death (88% vs 87%). 63% of the fourth year students signed a donor card. In conclusion, medical student attitudes to organ donation and transplantation are highly positive, but do not improve during the first 3 years of Medical School. An educational program is therefore needed.

Organ donation and transplantation: a survey of critical care health professionals in nontransplant hospitals

Exploration of the role of critical care professionals in improving organ donation within Canada has been limited to tertiary care centers while donor potential in smaller nontransplant hospitals remains unknown. To gain an understanding of the knowledge, attitudes, and perceived barriers that healthcare professionals in 5 nontransplant hospitals in Alberta have toward organ donation and transplantation, and to identify factors that influenced participation in the donation process. A descriptive survey of critical care professionals. Setting-Five nontransplant hospitals in Alberta, Canada. Of the 135 respondents, 98 were critical care nurses, 32 were physicians, and 5 were hospital administrators. Respondents were least knowledgeable about transplant statistics and religious beliefs regarding donation, although overall, attitudes reflected positive support for organ donation. Respondents exhibited reluctance in approaching a potential donor family, and believed inadequate resources were allocated for organ donation. Educational programs are needed to increase knowledge of organ donation and transplantation as well as the development of an in-house coordinator program in nontransplant hospitals for critical care personnel.

Organ Donation and Transplantation: A Survey of Critical Care Health Professionals in Nontransplant Hospitals

Exploration of the role of critical care professionals in improving organ donation within Canada has been limited to tertiary care centers while donor potential in smaller nontransplant hospitals remains unknown. To gain an understanding of the knowledge, attitudes, and perceived barriers that healthcare professionals in 5 nontransplant hospitals in Alberta have toward organ donation and transplantation, and to identify factors that influenced participation in the donation process. A descriptive survey of critical care professionals. Setting-Five nontransplant hospitals in Alberta, Canada. Of the 135 respondents, 98 were critical care nurses, 32 were physicians, and 5 were hospital administrators. Respondents were least knowledgeable about transplant statistics and religious beliefs regarding donation, although overall, attitudes reflected positive support for organ donation. Respondents exhibited reluctance in approaching a potential donor family, and believed inadequate resources were allocated for organ donation. Educational programs are needed to increase knowledge of organ donation and transplantation as well as the development of an in-house coordinator program in nontransplant hospitals for critical care personnel.

Improving cadaveric organ donation rates in kidney and liver transplantation in Asia

In the year 2001, cadaveric kidney and liver transplant rates (CadTx) in countries with well-established transplant programs such as the United States and Spain ranged from 51 to 61.9 and 18.7 to 31.3 per million population (pmp), respectively. However, overall kidney and liver transplant rates in Asia are significantly lower at 4.3 and 0.3 pmp, respectively. Improving CadTx rates to meet the needs of organ failure patients poses several unique challenges in Asia. Across Asia, there is a wide disparity in prehospital emergency services and intensive care facilities that allow victims of cerebrovascular accident or trauma to be sent to hospitals for optimal management. Identification of the brain-dead victim in an intensive care setting, donor referral to an organ procurement coordinator/network, making the request for organ donation, and obtaining consent for organ donation from the family are other critical issues that impact on successful cadaveric donation. While affirmative legislation regarding organ donation is existent in most Asian countries, religious, ethnic, and cultural influences on concepts of death and the sanctity of the human body remain major barriers to obtaining consent for cadaveric donation. Although there are no overt objections to CadTx among the major religions of Asia, perceptions to the contrary largely limit consent for organ donation from potential donor families. Development of transportation and communication networks, public and donor hospital education programs, legislative initiatives such as presumed consent, and establishment of effective organ procurement practices are all key initiatives that will improve CadTx rates. Broadening donor criteria as with the use of expanded criteria donors, including non–heart-beating and older donors, may further improve cadaveric donation rates by as much as 20%. Finally, ethical transplant practices that prohibit trade in organs will promote an environment conducive to cadaveric donation. Together with efforts to increase living donor TX transplant rates, it is hoped that these measures will increase the supply of organs so as to meet the needs of organ failure patients in Asia.

Cloninger's Temperament and Character Inventory Correlates with Personality Characteristics of Organ Donation Advocates

Temperament and Character Inventory (TCI) and background questionnaire data were collected from a sample of men and women organ donation advocates (N = 362) as part of a national study to investigate their personality characteristics, temperaments, and attitudes about organ donation advocacy. Goals included identifying unique traits for advocates, and response consistency between the TCI and questionnaire. The TCI results included high scores on Cooperativeness and Self-Directedness, and low on Harm Avoidance dimensions. The questionnaire results indicated that most advocates were White, married, college-educated females, who typically spent less than 2 hr with potential donor families, were satisfied with life and job, and believed they would be in a donation position 2 years from the time surveyed. TCI and questionnaire measures were correlated for Self-Transcendence and Spirituality, Helpfulness and Job Satisfaction, and Compassion and Identification variables.

An examination of factors predicting prioritization for liver transplantation.

With the recent transition of the liver transplant allocation system to the Model for End-Stage Liver Disease, a major change is its reliance entirely on objective criteria. In previous reports, potential donor families and members of the transplant community have questioned the fairness of the subjective nature of previous systems. Therefore, we examined the United Network for Organ Sharing database to determine if the previous allocation system benefited a particular group in prioritization for transplant. We included adult patients with chronic liver disease listed for transplant in the year 2000. Patients who had ever been listed as status 2A or 2B were analyzed. A multivariable analysis examined the patient characteristics that predicted being uplisted to status 2A. Of the 9244 patients, 2376 (25.7%) had received a liver transplant as a status 2A or had been listed as status 2A. In the multivariate analysis, the strongest patient characteristics that predicted status 2A were listing in the western United States and shorter duration of registration. Other predictors include blood type O, college education, unemployment, and coverage with private insurance or a health maintenance organization/preferred provider organization. In addition, patients with Laennec's cirrhosis were less likely to be uplisted to status 2A. Age, gender, and race were not predictors of uplisting to status 2A. In conclusion, these data show the wide range of practice patterns with the use of status 2A, and these findings suggest that certain patient groups might have received preference in the previous liver transplant allocation system.

Social Work Practice in the Donation of Human Tissue for Transplantation

ABSTRACT In Queensland, Australia, senior social workers have pioneered the coordination of tissue donation at coronial autopsies, seeking consent for the donation of heart valve, bone and eye tissue after sudden deaths which have been reported to the coroner. The urgent need for tissue for transplantation is balanced with the counselling, information and practical needs of potential donor families in their shock and grief. Social work assessment, advocacy, liaison, counselling, crisis intervention and particularly communication skills have been utilised, both as an integral component of obtaining informed consent and in working with families' experience of grief and loss in sudden, traumatic bereavement. This tissue donation program, over a period of eight years, has maximised the availability of tissue with its high donation rates, while upholding the rights and needs of potential donor families through provision of an effective social work service. The paper will reflect upon key social work knowledge and processes which have respected the subjective experience of client and worker while working within a medical model.

Development of cadaver renal transplantation in India

SUMMARY: We have established a successful cadaver transplant programme in Chennai that could serve as a model for any developing country. A survey of public opinion showed that the higher the educational level, the more willing was the subject to donate. This was because of greater awareness of the possibility of successful transplantation, and indicated the need for education of the public on this aspect. the first step is to enact suitable legislation. Families of potential donors might hesitate to consent to donation if they doubt the legality of the procedure. In India, the doctor commands respect and is more likely to be able to obtain consent than a coordinator. the patient is permitted to stay on dialysis at any convenient city, so long as he or she can reach Chennai within 24h of being called. to improve the yield, we accept kidneys from donors in acute renal failure, if we know renal function was normal at the time of entry to the hospital. We also accept non‐heart beating donors. Marginal kidneys are accepted and both kidneys are transplanted to one recipient. the success with all these procedures is as good as with the others. We were able to perform 88 renal transplants in 4.5 years with a 1 year graft survival of 72%, and a 4 year survival of 63%. Ten donors were in acute renal failure and the 1 year graft survival was 70%. Nine dual transplants were performed with 75% 1 year graft survival.

Factors influencing families' consent for donation of solid organs for transplantation.

Transplantation has become the therapy of choice for patients with organ failure. However, the low rate of consent by families of donor-eligible patients is a major limiting factor in the success of organ transplantation. To explore factors associated with the decision to donate among families of potential solid organ donors. Data collection via chart reviews, telephone interviews with health care practitioners (HCPs) or organ procurement organization (OPO) staff, and face-to-face interviews with family for all donor-eligible deaths at 9 trauma hospitals in southwestern Pennsylvania and northeastern Ohio from 1994 to 1999. Family members, HCPs, and OPO staff involved in the donation decision for 420 donor-eligible patients. Factors associated with family decision to donate or not donate organs for transplantation. A total of 238 of the 420 cases led to organ donation; 182 did not. Univariate analysis revealed numerous factors associated with the donation decision. Multivariable analysis of associated variables revealed that family and patient sociodemographics (ethnicity, patient's age and cause of death) and prior knowledge of the patients' wishes were significantly associated with willingness to donate (adjusted odds ratio [OR], 7.68; 95% confidence interval [CI], 6.55-9.01). Families who discussed more topics and had more conversations about organ donation were more likely to donate (adjusted OR, 5.22; 95% CI, 4.32-6.30), as were families with more contact with OPO staff (adjusted OR, 3.08; 95% CI, 2.63-3.60) and those who experienced an optimal request pattern (adjusted OR, 2.96; 95% CI, 2.58-3.40). Socioemotional and communication variables acted as intervening variables. Public education is needed to modify attitudes about organ donation prior to a donation opportunity. Specific steps can be taken by HCPs and OPO staff to maximize the opportunity to persuade families to donate their relatives' organs.

Organ donation and family decision-making within the Spanish donation system

This study analyses the variables associated with the decisions made by families of potential organ donors to give or deny consent for the extraction of organs. Different indicators were recorded in 68 cases of family interview for petition of consent carried out in 13 Spanish hospitals. Those variables showing the strongest relation with family decision (donation/refusal of consent) are knowledge shown by the family about the deceased's wishes with regard to donation ( p<0.001), family relationship climate ( p<0.01), expression of family's satisfaction level with medical attention received ( p<0.01) and number of relatives present at the consent request interview ( p<0.01). Logistic regression on family decision with considered variables correctly predicted relatives’ final choice in 98.4% of cases. In turn, multivariate exploratory analysis highlights a potential association between the expression of the deceased's wishes and several concurrent variables in the process (satisfaction with personal treatment and medical attention received, emotional reactions in the interviews of notification of death and consent request). It also shows that patterns of reaction and family participation in this process may vary according to the sex of the deceased relative. Results suggest that both educational efforts devoted to promoting a positive attitude toward donation in the general population and the training of health professionals involved in the generation of organs may be key factors in reducing organ shortage.

ISSUES IN POTENTIAL ORGAN DONOR MANAGEMENT

The shortage of organ donors has become a serious problem in modern medicine. Room for improvement exists in our ability to convert potential donors to actual donors based on the available numbers and a significant amount of recent research. A significant percentage of the potential donors represent head-injured patients, so a significant amount of responsibility falls on surgeons to optimize the opportunity for donation. There are clear steps along the pathway from potential to actual donor where physicians can have a significant effect on the rate of successful donation: 1. Identify all potential donors and institute a review system to verify that all potential donors are being identified in your area. 2. Establish an acceptable method to rapidly and accurately determine brain death in potential donors using the local available services. 3. Approach all potential donor families for consent, decouple death notification and consent request, use a member of the hospital team and an OPO representative to approach the family, and make the request in a private setting. 4. Use an aggressive, proactive approach to the medical management of the potential donor using the techniques described to limit the number of medical failures and maximize the number of organs donated per donor. Institute a review process to evaluate any medical failures that occur. Given the difference between the numbers of potential versus actual donors, the authors' significant contact with potential donors, and the clear opportunities for improvement in their approach, the surgical community must address these issues surrounding the optimal management of potential donors and their families.

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

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.

Current considerations in the issue of brain death.

Brain death is an anatomically and physiologically complex process. The societal and psychological implications of brain death and organ donation are equally complex, and they have profound ramifications. Because the vast majority of organ donors die as a consequence of catastrophic intracranial processes, neurosurgeons are in a unique position to positively influence the supply of transplantable organs. Enhanced knowledge of the physiology of evolving brain death will improve the care of potential organ donors and increase the probability of successful transplantation. Likewise, better information about patient and family directives, beliefs, grieving, concurrent exposure to other health care workers, and experiences in the hospital environment will assist the neurosurgeon in providing the family with the opportunity for donation. Neurosurgeons can also play a leading role in the multidisciplinary approach required to support the families of potential organ donors during the transition from neurointerventional therapy to somatic support. New federal regulations on organ donation and a review of the literature about the "art of asking" are presented.

The need for increasing organ donation among African Americans and Hispanic Americans: An overview

J Emerg Nurs 1999;25:21-7.