A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation

Oczkowski, Simon; Arnold, Emmy; Centofanti, John; Durepos, Pamela; Sarti, Aimee; Arseneau, Erika; Dhanani, Sonny; Cook, Deborah J.; Meade, Maureen O.

doi:10.1007/s12630-019-01332-9

Cited by 8 publications

(11 citation statements)

References 32 publications

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“…Another barrier to family authorization was a perceived ambivalence from some HCPs towards organ donation, suggesting conflicting personal and professional priorities. 12,15,39 In a study by Oczkowski et al, 39 intensive care unit (ICU) staff acknowledged differing viewpoints and personal willingness to participate in donor-related activities. Weiss et al 12 found the most common reasons for physician non-referrals in organ donation were due to assuming the donation process would be dysfunctional, not wanting to impact the family's trust in the donation system, believing the family was under too much distress, and a misunderstanding of the law regarding authorization.…”

Section: Legal and Ethical Conflictmentioning

confidence: 99%

“…Research indicates collaborative efforts between hospitals and donation organizations and positive relationships between HCPs and OTDCs to be critical drivers for creating a culture of donation in healthcare settings. 15,[39][40][41][42] These findings suggest a real need for inter-organizational and inter-professional goal sharing and priority setting.…”

Section: Legal and Ethical Conflictmentioning

confidence: 99%

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Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

Anthony

Lin

Pol

et al. 2021

Can J Anesth/J Can Anesth

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Purpose In Ontario, an individual's registered wish for organ donation is legally valid consent following death. Family veto occurs when the deceased donor's substitute decision-maker (SDM) overrides this consent to donate, evoking a legal and ethical conflict. The objective of this study was to examine the experiences of Organ and Tissue Donation Coordinators (OTDCs) working with SDMs who vetoed a deceased donor's consent for organ donation. Methods Qualitative focus groups were conducted with ten OTDCs in Ontario, Canada who reported experience with family veto. An interpretative phenomenological approach informed data analysis. Themes emerged through team consensus and were further refined through collaborative and reflexive engagement. This article is accompanied by an editorial. Please see Can J Anesth 2021, this issue.

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Section: Legal and Ethical Conflictmentioning

confidence: 99%

Section: Legal and Ethical Conflictmentioning

confidence: 99%

Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

Anthony

Lin

Pol

et al. 2021

Can J Anesth/J Can Anesth

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“…The integration of donation in high-quality end-of-life care has been identified as an important driver of success in organ donation. 14 The interface between organ donation and the 3WP—each with different attendant activities—includes the potential for synergistic interactions. Although promoting consent to organ donation is not an expressed intent of the 3WP, these 2 programs both respect patients as unique and can offer mutually reinforcing care plans that are consistent with, and take directions from, an individual’s values and preferences.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to donate may be devastating to families who consent to organ donation 20 and also ICU clinicians. 14 Both the 3WP and organ donation organizations encourage valuing the pursuit as much as the realization of this wish. Enhanced postmortem family care through the 3WP is an opportunity to support consenting families of patients for whom donation is not possible.…”

Section: Discussionmentioning

confidence: 99%

Organ Donation at the End of Life: Experiences From the 3 Wishes Project

Takaoka

Honarmand

Vanstone

et al. 2020

J Intensive Care Med

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Purpose: The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ donation as experienced by families, clinicians, and organ donation coordinators. Methods: In a multicenter evaluation of the 3WP in 4 Canadian ICUs, we conducted a thematic analysis of transcripts from interviews and focus groups with clinicians, organ donation coordinators, and families of dying or died patients for whom donation was considered. Results: We analyzed transcripts from 26 interviews and 2 focus groups with 18 family members, 17 clinicians, and 6 organ donation coordinators. The central theme describes the mutual goals of the 3WP and organ donation—emphasizing personhood and agency across the temporal continuum of care. During family decision-making, conversations encouraged by the 3WP can facilitate preliminary discussions about donation. During preparation for donation, memory-making activities supported by the 3WP redirect focus toward personhood. During postmortem family care, the 3WP supports families, including when donation is unsuccessful, and highlights aspirational pursuits of donation while encouraging reflections on other fulfilled wishes. Conclusions: Organ donation and the 3WP provide complementary opportunities to engage in value-based conversations during the dying process. The shared values of these programs may help to incorporate organ donation and death into a person’s life narrative and incorporate new life into a person’s death narrative.

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“…The beneficial impact of standardization in healthcare, and specifically in deceased donation has been shown with increased donation and transplantation rates. 15 We launched a prospective observational cohort study of deceased donor management in Canadian ICUs to describe national and provincial norms, as well as the variability in practices. Our aims were to provide donation clinicians and administrators with benchmarks for assessing their own practices; to inform clinicians about practices they might not have considered; to highlight opportunities for future education and knowledge translation initiatives; and to support the appeals for clinical research in this emerging field.…”

Section: Résumémentioning

confidence: 99%

Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study

D’Aragon

Lamontagne

Cook

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices. Methods This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces.

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A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation

Cited by 8 publications

References 32 publications

Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

Organ Donation at the End of Life: Experiences From the 3 Wishes Project

Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study

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