Early identification and referral of organ donors in five private hospitals: A survey to determine the knowledge and views of critical care professional nurses pre and post a PowerPoint training intervention

Abstract

South Africa (SA) has a rich history in solid organ transplantation, with the first heart transplant performed at Groote Schuur Hospital, Cape Town, in 1967. [1] Organ donation is a prerequisite for transplantation, and it is therefore concerning that the number of organ donors in the Western Cape Province and nationally has decreased over the last decade. [2] Prompt identification and referral of potential brain stem dead donors in the intensive care units (ICUs) and emergency departments is of utmost importance, according to international studies. [3-5] The consent rate among families of potential donors in SA decreased from 55% in 1991 to 50% in 2001, and to 32% in 2011. [6,7] SA has a very low donor rate of 1.7 per million population, [2] in comparison with Spain, the world leader in organ donation, with a 40 per million population rate. [8] Spain is an international leader in the management of deceased organ donation, and by 2015 the country had trained 16 000 healthcare professionals regarding organ donation. [8] This illustrates that training and increased knowledge play a role in the early identification and referral of potential organ donors. In SA, there are currently 22 procuring organ transplant coordinators (OTCs), [9] which is clearly inadequate for a population of 57.73 million. [10] The three OTCs (specifically responsible for organ procurement) for private hospitals in Cape Town visit 32 private hospitals from all the hospital groups in the Cape Peninsula and surrounding area on a monthly

How do we use high-frequency oscillation: Primary ventilation, rescue therapy or switch directly to early extracorporeal membrane oxygenation?

“…Furthermore, Cawood et al [10] describe more air leaks (11.8%) than reported in the literature. Pressure-wave damping between the upper airways and alveoli depends on the homogeneity and pathophysiological process in the lung.…”

“…This degree of acidosis has deleterious immunological, vascular and cardiac effects. It is therefore appropriate to escalate treatment, and Cawood et al [10] confirm the efficacy of HFO to clear CO 2 .…”

“…In this issue, Cawood et al [10] describe a 2-year single-centre experience of rescue HFO in a South African (SA) PICU without ECMO availability. The study confirms improved oxygenation when using HFO, in agreement with international evidence.…”

Getting better – health profession knowledge is key to improving deceased donation practices in South Africa

“…Without recognition of the potential for donation by the treating clinical team, the process simply does not start. In their well-structured article, Prins and Human [1] have shown gaps in knowledge, and the need for education on the key steps in the organ donor pathway in South Africa (SA).…”

“…End-of-life care is provided by a team interacting with the patient and family. The barriers highlighted by Prins and Human [1] (perceived extra work that taking a donor family through the consent process entails, lack of policy and guidance) are very real, and it is important that clinicians, nurses, hospital managers and transplant teams work within a system that ensures that the exploration of organ and tissue donation is a standard of care offered routinely at the end of life. This starts with assessing knowledge.…”