Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event

2007 ◽  
Vol 22 (4) ◽  
pp. 296-304 ◽  
Author(s):  
Margareta A. Sanner
2012 ◽  
Vol 1 (2) ◽  
pp. 19 ◽  
Author(s):  
Peter J. Schulz ◽  
Ann Van Ackere ◽  
Uwe Hartung ◽  
Anke Dunkel

Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no card is found on a potential donor, families have to be approached about donation. The aim of this paper is to model the role that some family communication factors play in the family decision to consent or not to organ donation by a brain dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open answers and comments. Eight heads of intensive care units (ICU) of Swiss hospitals and one representative from <em>Swisstransplant</em> were interviewed. Questions asked respondents to estimate the prevalence and effect of communication factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family of the deceased person is almost always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives’ predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians’ approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about it, make people think about organ donation and try to change unfavourable predispositions.


2020 ◽  
Vol 48 (3) ◽  
pp. 153-161
Author(s):  
V. L. Vinogradov ◽  
K. K. Gubarev ◽  
A. I. Zakhlevnyy ◽  
D. S. Svetlakova

Rationale: The imbalance between the need for donor organs and their current availability is a growing problem for all countries. An assessment of potential donor numbers is considered to be an important step towards better understanding of the problem as a whole at the national scale. This would help to build up a concept of a successful strategy to resolve this inequity.Aim: To analyze the use of external audit of the efficacy of identification of potential organ donors with confirmed brain death.Materials and methods: As a part of a pilot project aimed to increase the efficacy of donor bases of the Russian Federal Medical Biological Agency (FMBA), we retrospectively analyzed 5932 medical files of patients who died from 2014 to 2018 in the departments of resuscitation and intensive care units of 26 medical establishments serving as a donor bases in Moscow, Orenburg, Saratov, Abakan, Stavropol and FMBA of Russia. The probability of brain death was assessed with a special QAPDD (Quality Assurance Program in the Deceased Donation Process) technique focused on organ donation after brain death which is used for external audit in Spanish hospitals.Results: Clinical manifestation of brain death were identified in 20.3% (95% confidence interval (CI) 18.4–22.4) of the patients aged 18 to 65 years with severe primary and secondary brain injury who died in the departments of resuscitation and had been maintained on mechanical ventilation at least 12 hours until their death was confirmed. The rate of potential donor identification with clinical manifestations of brain death in the donating in-patient departments was 12% (95% CI 10.5–13.7) of those who died with severe primary and secondary brain injury. The external audit performed in 26 donating in-patient departments, has shown that 41% (95% CI 35.8–46.4) of potential donors with brain death were not identified.Conclusion: With the use of the QAPDD technique in our study, we found that 41% of potential donors were not identified in the Russian in-patient clinics participating in organ donation. Based on the information obtained during the audit of medical files in intensive care units, we can make realistic conclusions on the current system of organ donation, identify potential pitfalls in the identification procedures of potential donors, increase the efficacy of donation process, and to improve the system as a whole. The process could become effective only through the activities of specially trained donor hospital transplant coordinators.


Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy

This chapter discusses death and dying, and includes discussion on confirming death using neurological criteria (brainstem death), withdrawing and withholding treatment, organ donation after brain death (DBD), and organ donation after circulatory determination of death (DCD). Death is common in the intensive care unit (ICU) and it is important to identify patients whose condition meets the criteria for brainstem death testing as well as patients where continued treatment is not considered to be in their overall best interests. Confirming death using neurological criteria allows the relatives to be presented with the certainty of a diagnosis of death whether organ donation is possible or not. Decisions to withraw treatment are common in the ICU and are associated with approximately 50% of all deaths in the ICU. The decision is made by the multidisciplinary team in consultation with the patient’s relatives and taking into account the patient’s values and preferences. In both situations the possibility of organ donation should be considered and explored, and, when it is a possibility, it should be routinely offered to the relatives as an end-of-life care option.


2019 ◽  
Vol 19 (6) ◽  
pp. 1782-1791 ◽  
Author(s):  
María C. Martín‐Delgado ◽  
Fernando Martínez‐Soba ◽  
Nuria Masnou ◽  
José M. Pérez‐Villares ◽  
Teresa Pont ◽  
...  

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