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

Abstract

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).Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1964-7) contains supplementary material, which is available to authorized users.

A narrative review of family members’ experience of organ donation request after brain death in the critical care setting

“…The initial assumption that strictly separating the donation conversation from the brain death conversation or declaration of deatha concept known as decouplingwould increase authorization rates has been shown to be short-sighted. The available data suggest that having the donation conversation before the declaration of death is associated with authorization to donation [19,31] and that separating discussions about EOL care and donation can decrease consent rates [32]. FDMs are also less likely to authorize donation if they feel "surprised" by the request [15,33].…”

“…HCPs are encouraged to employ multimodal communication, to ensure a proper setting for family meetings, and the presence of a support person [34]. The data indicate that the communication skills of OPO requesters can influence authorization decisions among FDMs [17,19,21,28,[35][36][37], although this can also be overrated as shown in a recent study [32]. Effective communication is a skill that can be taught and learned.…”

“…This approach will also allow better insight into the positive effects of organ donation, such as involvement in community work, participation in support programs for other FMs or promoting organ donation education. Interventional studies should also be designed to examine the impact of specific support programs during decision-making (32), as well bereavement support programs, on family outcomes. Moreover, research should focus on FMs and clinicians simultaneously to best understand the dynamic that underpins decision-making.…”

“…However, discussing deceased organ donation can be challenging both for HCPs who initiate and manage the conversations [5], and for the FMs. Many studies have shown that for FMs, communication with ICU HCPs is one of the most highly valued aspects of care [6][7][8] that impacts on their experience during the patient's stay and after the patient's death [3,4,9,10].…”

Understanding the Attitudes and Factors Influencing Organ Donation Decisions Among University Students in Pakistan: A Qualitative Study

“…Even after showing a willingness to donate, a person may face certain barriers that can prevent them from registering as organ donors. While previous studies on donation after death have discovered that individuals have positive attitudes towards the donation behaviors(Hübner, Mohs, and Petersen, 2014; Khan et al, 2011;McGlade and Pierscionek, 2013), these high rates of positive attitudes have not been converted into actual behavior (Morgan and Miller, 2002;Murray, Miller, Dayoub, Wakefield, and Homewood, 2013;Potter et al, 2017). In order to understand better a person's intention to be an organ donor, there is a need to use the qualitative approach, which can help to understand the concerns and thoughts of individuals regarding posthumous organ donation.…”