- MOST CRITICAL CARE STAFF NOT READY FOR DONATION (January 1998)
- WHY DO FAMILIES REFUSE TO DONATE ORGANS? (January 1998)
The Partnership for Organ Donation Home Page
MOST CRITICAL CARE STAFF NOT READY FOR DONATION
The vast majority of doctors and nurses in emergency rooms and critical care units have neither the training nor experience to respond to the families of potential organ donors. Each day in hospitals across the U.S., 37 grieving families unexpectedly lose a loved one from a brain injury and must make a choice about donation. Half of these families will not consent to donating their loved one's organs.Essential steps in obtaining family consent are explaining brain death and requesting donation. Yet two-thirds of critical care staff have never received any training in these skills, according to a study in the January issue of the American Journal of Critical Care. Conducted by The Partnership for Organ Donation in collaboration with 28 hospitals and four organ procurement organizations (OPOs), this study is the first to examine the relationship between staff capabilities, particularly the level of training, and actual donation rates.
"Dealing with families of brain-dead patients is not easy. The death represents a loss to the healthcare professional, too. Nonetheless, the skill they bring to this situation is essential to helping these families and ultimately, to solving the organ donor shortage," say principal authors Michael J. Evanisko, MA, MPhil, and Carol L. Beasley, MPPM, of The Partnership for Organ Donation. Critical care nurses and physicians are usually responsible for identifying potential donors, referring potential donor cases to an OPO, participating in the request for donation, and supporting the family throughout the process.
The study revealed that current levels of training around donation are inadequate. Although 94 percent of the critical care physicians and nurses said they supported organ donation, and 98 percent said involved staff should be trained in how to approach families appropriately, only one-third had received any training. "If the critical care staff are knowledgeable and comfortable with brain death and organ donation, they will be able to create a more supportive and comfortable environment for these families," says Evanisko.
A questionnaire, completed by 1,061 critical care staff who had recently been involved in donation cases, assessed their factual knowledge concerning organ donation, their understanding of brain death, previous training in donation request procedures, and comfort levels with the donation process. The study also allowed for comparison of staff responses to actual donation rates in these hospitals.
The greater the percentage of staff who had received training in organ donation, the higher the donation rate. Respondents at hospitals with high donation rates were more comfortable with the hospital's donation protocols and more supportive of organ donation in general. Staff at hospitals with low donation rates were less likely to have received training in organ donation, less likely to support donation, and more likely to find donation protocols burdensome and uncomfortable. Levels of factual knowledge about organ donation and brain death were unexpectedly low in all hospitals, but were not significantly related to donation rates.
"The difference between high and low performance hospitals is the simple fact that staff have been trained," says Evanisko. "There is a desperate need for training. We hope our study will lead to the development of more skills-based training programs on organ donation for critical care staff."
Key elements of an effective donation request include: communicating clearly and unequivocally to the family that brain death has occurred so that the family realizes that brain death is death; waiting to introduce donation until after the family has accepted the fact of death (known as decoupling, since the request for donation is separated from the explanation of brain death); offering donation in a quiet and private setting; and designating clear roles for hospital staff and the OPO coordinator.
"Untrained staff may be struggling with their own feelings of loss or discomfort, instead of concentrating on the needs of grieving families," says Beasley. "Trained staff understand their roles, know how to coordinate with their OPO and endorse the idea of decoupling. They are much more likely to obtain consent from a family."
The Partnership for Organ Donation is an independent, nonprofit organization dedicated to solving the organ donor shortage through research and in-hospital projects.
The Partnership for Organ Donation Home Page
WHY DO FAMILIES REFUSE TO DONATE ORGANS?
Every 40 minutes, in a hospital somewhere in the U.S., a grieving family whose loved one has died unexpectedly from a brain injury faces a decision about organ donation. Half of the time, this family will say no, even though most Americans say they are in favor of organ donation. Massive public education campaigns have been launched to convince more families to consent to donation, but new research reveals that families experiences in the hospital strongly influence their decisions about donation.A unique study published in the January issue of the American Journal of Critical Care reveals major differences in the hospital experiences of families who consent to donation and those who refuse. The Partnership for Organ Donation and the Harvard School of Public Health asked the immediate next of kin of 164 potential organ donors including 62 who had refused to donate about their experiences with this decision. The first to reach significant numbers of families who declined donation, this study shows a direct correlation between the family's satisfaction with the care their loved one received and their willingness to consent to donation.
If we're serious about increasing donation, we have to be serious about responding to the needs of these families. Many families are having unsatisfactory experiences in hospitals when trying to make a choice about donation," say principal authors William DeJong, Ph.D., Harvard School of Public Health, and Holly G. Franz, BSN, The Partnership for Organ Donation. The study reveals major differences in the hospital experiences of donor and non-donor families, including their levels of satisfaction with the overall hospital experience, understanding of brain death and the way the donation request was handled.
For the study, next of kin of both donor and non-donor families were questioned in 30 to 60 minute structured telephone interviews four to six months after the death of their relative. Questions addressed family characteristics, beliefs and attitudes, understanding of brain death, key events during the hospitalization, and contacts with staff from the hospital and the regional organ procurement organization (OPO).
The study reveals that certain modifiable factors in the way the hospital handles donation are associated with family consent: the family's satisfaction with the overall hospital care that their relative received, specific aspects of the donation-request process, and the family's understanding of brain death. Non-donor respondents more often stated that hospital staff provided inadequate or insensitive care and that the organ donation request had been handled poorly.
Compared to the respondents who had consented to donation, non-donor respondents were significantly less likely to say that the subject of organ donation was brought up at the right time, that they were given enough time to talk about donation and make sure they were making the right decision, or that they were asked in a private setting. While 94 percent of the donor respondents said they would make the same decision today as they did when their relative died, one-third of the non-donors said they would not make the same decision or they were unsure.
"Non-donor families often had problems with the quality of care that was provided and with how the donation request was made. These are things that can be improved by healthcare providers," says DeJong.
The study also found differences between donor and non-donor families in their beliefs and attitudes about organ donation and transplantation, their knowledge of the deceased's wishes about donation, and demographic characteristics of the patient and family. There were donors in all demographic categories, though non-donor respondents were more likely to be members of racial or ethnic minorities, to be born outside the U.S. and to report an annual household income of less than $35,000.
"Although families with certain demographic characteristics more often deny consent to donation, that finding cannot become an excuse to exclude families from the donation option," says Franz. "Ideally, no matter what a family's characteristics are, healthcare providers should approach the family with the belief that a donation is possible. In our study, even families who declined donation felt it was right to ask them and valued being able to make the decision. The key is treating every family with respect and care."
The Partnership for Organ Donation is an independent, nonprofit organization dedicated to solving the organ donor shortage through research and in-hospital projects.
The Partnership for Organ Donation Home Page
