Intensive care staff, the donation request and relatives’ satisfaction with the decision: a focus group study

Abstract

BackgroundEffectiveness of the donation request is generally measured by consent rates, rather than by relatives’ satisfaction with their decision. Our aim was to elicit Dutch ICU staffs’ views and experiences with the donation request, to investigate their awareness of (dis)satisfaction with donation decisions by relatives, specifically in the case of refusal, and to collect advice that may leave more relatives satisfied with their decision.MethodsFive focus groups with a total of 32 participants (IC physicians, IC nurses and transplant coordinators) from five university hospitals in the Netherlands. Transcripts were examined using standard qualitative methods.ResultsFour themes (donation request perceived by ICU staff from the perspective of relatives; donation request perceived by ICU staff from their own perspective; aftercare; donation in society) divided into 14 categories were identified.According to ICU staff, relatives mentioned their own values more frequently than values of the potential donor as important for the decision. ICU staff observed this imbalance, but reacted empathically to the relatives’ point of view. ICU staff rarely suggested reconsideration of refusal and did not ask relatives for arguments.ICU staff did not always feel comfortable with a request in the delicate context of brain death. Sometimes the interests of patient, relatives and those on the waiting list were irreconcilable.ICU staff were mostly unaware of relatives’ regret following their decisions. Aftercare did not provide this type of information.Donation request by IC physicians was influenced by the way organ donation has been regulated in society (law, donor register, education, media).ConclusionsOur findings lead to the hypothesis that giving relatives more time and inviting them to reconsider their initial refusal will lead to a more stable decision and possibly more consent.

Organ donation and transplantation: Awareness and roles of healthcare professionals—A systematic literature review

“…The primary and most important phase in the organ donation and transplantation (ODT) process is the identification and transformation of potential donors into actual donors. HCPs’ involvement in this process cannot be overemphasised as they are considered to be the primary intermediaries between organ donors and transplant recipients (Abidin et al., ; De Groot et al., ). The success, therefore, or otherwise of the ODT process, rests (albeit not exclusively) with HCPs (Douville et al., ).…”

“…HCPs’ attitudes towards the ODT process are underpinned by a web of factors. These include HCPs’ knowledge and understanding of organ donation, their professional status (e.g., doctors, nurses), years of clinical experience and the setting or environment of clinical practice (e.g., emergency department, intensive care units; Bidigare & Oermann, ; De Groot et al., ; Demir et al., ; Jelinek et al., ). Jelinek et al.…”

“…Despite claims that the ODT process is a rewarding experience that should be promoted and facilitated by HCPs (De Groot et al., ; Jelinek et al., ; Pont Castellana et al., ), it often generates stress, emotional discomfort, moral dilemmas and conflict of interests for many HCPs (De Groot et al., ; Pont Castellana et al., ). This is especially the case where and when the broaching, requesting and obtaining of consent take place in clinical settings, such as emergency department (EDs), and are adjudged by HCPs as inappropriate or unsuitable, particularly for families of potential organ donors (Jelinek et al., ).…”

“…Where patients become potential organ donors, their families need enough time to grieve and come to terms with their loss. They also need sufficient time to process the information received from HCPs before being able to decide whether or not to donate their loved ones’ organ(s) for the purpose of transplantation (Abidin et al., ; De Groot et al., ).…”

“…It will strive to examine how healthcare professionals’ roles, knowledge, awareness, skills and competencies can impact upon the ODT process. The review will also address claims that healthcare professionals (HCPs) not only lack the clinical or contact time (Abidin, Ming, Loch, Hilmi, & Hautmann, ; De Groot et al., ), but are inadequately prepared and informed about the ODT process. Hence, healthcare professionals frequently fail to: (i) engage in projects that inform populations about organ donation as a voluntary gift (Ladin & Hanto, ); (ii) identity and refer potential organ donors (Collins, ); (iii) sensitively broach the subject of organ donation without jeopardising the process (Meyer, Bjork, & Eide, Cf.…”