Organ and tissue donation in clinical settings: a systematic review of the impact of interventions aimed at health professionals

Abstract

In countries where presumed consent for organ donation does not apply, health professionals (HP) are key players for identifying donors and obtaining their consent. This systematic review was designed to verify the efficacy of interventions aimed at HPs to promote organ and tissue donation in clinical settings. CINAHL (1982 to 2012), COCHRANE LIBRARY, EMBASE (1974 to 2012), MEDLINE (1966 to 2012), PsycINFO (1960 to 2012), and ProQuest Dissertations and Theses were searched for papers published in French or English until September 2012. Studies were considered if they met the following criteria: aimed at improving HPs’ practices regarding the donation process or at increasing donation rates; HPs working in clinical settings; and interventions with a control group or pre-post assessments. Intervention behavioral change techniques were analyzed using a validated taxonomy. A risk ratio was computed for each study having a control group. A total of 15 studies were identified, of which only 5 had a control group. Interventions were either educational, organizational or a combination of both, and had a weak theoretical basis. The most common behavior change technique was providing instruction. Two sets of interventions showed a significant risk ratio. However, most studies did not report the information needed to compute their efficacy. Therefore, interventions aimed at improving the donation process or at increasing donation rates should be based on sound theoretical frameworks. They would benefit from more rigorous evaluation methods to ensure good knowledge translation and appropriate organizational decisions to improve professional practices.

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

“…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., ). It also pivots on a number of other factors.…”

“…In spite of the benefits, there remains a global shortage of organs for transplantation. Because this shortage does not hinge on the absence of suitable organs, the disequilibrium between ODT has been blamed, globally, on HCPs (Douville et al., ). It is, however, maintained in this review that rather than blame HCPs for this disequilibrium, it is a combination of HCPs’ attitudes and experiences as well as time constraints, conflict of interests, the altruistic nature of ODT and organ donation rules, which account for this global disequilibrium (Douville et al., ).…”

“…Because this shortage does not hinge on the absence of suitable organs, the disequilibrium between ODT has been blamed, globally, on HCPs (Douville et al., ). It is, however, maintained in this review that rather than blame HCPs for this disequilibrium, it is a combination of HCPs’ attitudes and experiences as well as time constraints, conflict of interests, the altruistic nature of ODT and organ donation rules, which account for this global disequilibrium (Douville et al., ). Some HCPs are inadequately educated and trained about the ODT process and, hence, lack awareness about organ donor inclusion/exclusion criteria, donation procedures and the criteria for brain and cardiac deaths (Jelenek Marck, Weiland, Neate & Hickey, 2012).…”

“…); and (iv) ethically seek and obtain potential donor families' consent (Collins, 2005). The net effect suggested is that healthcare professionals are not helping to reduce the chronic disequilibrium that exists between ODT globally (Douville, Godin, & V ezina-Im, 2014) or to improve the ODT process.…”

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“…Although they lacked robust methodologies, 5 studies demonstrated that interventions have a significant effect on HCP behaviors, namely in terms of referring potential donors, approaching donors' families, and securing a donated organ. 22 Another study by McGlade and associates demonstrated that a 33-hour integrated course on organ procurement and clinical care of potential organ donors improved nursing students' knowledge of organ suitability after death, their ability to obtain consent, and their understanding of organ donation legislation and the definition of death. 23 Accordingly, there is a need to consolidate organ transplant teachings into health care education and to educate HCPs about the intricate nuances of donor identification, approaching the family, and respecting the ethical and legal considerations of donation.…”