An assessment of advance relatives approach for brain death organ donation

2017 ◽  
Vol 26 (2) ◽  
pp. 553-563
Author(s):  
Carine Michaut ◽  
Antoine Baumann ◽  
Hélène Gregoire ◽  
Corinne Laviale ◽  
Gérard Audibert ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Organ Procurement ◽  
Post Mortem ◽  
Potential Donor ◽  
Tissue Procurement ◽  
Study Population ◽  
Network Administrators

Background: Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. Research aim: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. Research design: A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called ‘Prélor’. Participants: The study population comprised 460 physicians and nurses in the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Units and the Emergency Departments. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics and the Prélor Network administrators. Main findings: A slight majority of 53.5% of respondents had previously participated in an advance relatives approach: 83% of the physicians and 42% of the nurses. A majority of healthcare professionals (68%) think that the main justification for advance relatives approach is the comprehensive care of the dying patient and the research of his or her most likely opinion (74%). The misunderstanding of the related issues by relatives is an obstacle for 47% of healthcare professionals and 51% think that the answer given by the relatives regarding the most likely opinion of the person regarding post-mortem organ donation really corresponds to the person opinion in only 50% of the cases or less. Conclusion: Time given by advance approach should be employed to help and enable relatives to authentically bear the values and interests of the potential donor in the post-mortem organ donation discussion. Nurses’ attendance of advance relatives approach seems necessary to enable them to optimally support the families facing death and post-mortem organ donation issues.

scholarly journals Evaluating the Impact of COVID-19 Pandemic on Organ Donation and Transplantation Activities in Iran

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Marzieh Latifi ◽  
Farzaneh Bagherpour ◽  
Arefeh Jafarian ◽  
Amirali Hamidiyeh ◽  
Ehsan Javandoost ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Organ Procurement ◽  
Chief Executive ◽  
Time Intervals ◽  
Potential Donor ◽  
Before And After ◽  
The Impact ◽  
Family Consent ◽  
New Strategies

Background: Coronavirus disease 2019 (COVID-19) pandemic has had a great impact on reducing organ transplantation activities. Objectives: The aim of this study was to determine the donation and transplantation activities before and after COVID-19 outbreak in Iran. Methods: This retrospective study compared the donation and transplantation activities in two specific 9-month periods (December 2018 to March 2019 vs. March-December 2020). The questionnaire included the numbers of brain death confirmations, family consents, organ recoveries, and transplanted solid organs. The questionnaire was sent by email to the chief executive of the organ procurement unit. Results: A total of 15 organ procurement units responded to the survey. The largest reduction was seen in tissue transplantations (62.5%) during two time intervals. Brain death due to head trauma significantly decreased in two time intervals and suicide increased by 14.44% during the COVID-19 pandemic compared to 2018-2019 period. Significant reductions between the median of donation (P = 0.0187), median of potential donor (P = 0.005), median of family consent (P = 0.002), and median of eligible donor (P = 0.009) were observed during the two time periods. Conclusions: A significant reduction was observed in organ donation and transplantation during COVID-19 pandemic. Developing protocols and establishing new strategies for evaluation of organ donation to ensure the safety of organ recipients and medical staff is necessary.

Non-therapeutic intensive care for organ donation

2014 ◽  
Vol 23 (2) ◽  
pp. 191-202 ◽  
Author(s):  
Stéphanie Camut ◽  
Antoine Baumann ◽  
Véronique Dubois ◽  
Xavier Ducrocq ◽  
Gérard Audibert
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Organ Donation ◽  
Healthcare Professionals ◽  
University Hospital ◽  
Individual Autonomy ◽  
Post Mortem ◽  
Multiple Choice Questions ◽  
Presumed Consent ◽  
Family Approach

Background and Purpose: Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. Participants and methods: A single-centre opinion survey of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Results: Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor’s family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient’s care. But more than 75% of respondents think that the advance patient’s consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. Conclusion: The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families’ support. But they ask to require previously expressed patient’s consent and family’s approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy.

scholarly journals Knowledge and Attitude Regarding Organ Donation among Medical Students

2016 ◽  
Vol 14 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Vaishaly K. Bharambe ◽  
Hetal Rathod ◽  
Kalpana Angadi
Keyword(s):  
Medical Students ◽  
Brain Death ◽  
Organ Donation ◽  
Health Care Professionals ◽  
Ethical Issues ◽  
Organ Procurement ◽  
Organ Transplant ◽  
Medical College ◽  
Knowledge And Attitude ◽  
High Level

AbstractIntroduction. All over the world people on organ transplant waiting lists die due to shortage of donor organs. The success of organ donation program needs education of the population regarding organ donation for which healthcare professionals are most suitable. The present study was taken up to assess the knowledge and attitude of 1st, 2ndand 3rdyear medical students about organ donation. Methods. A specially designed self-administered questionnaire was distributed amongst all willing 1st, 2nd and 3rdyear medical students at our Medical College and later analyzed statistically. Results. A total of 157, 145 and 92 students from each year of medical education respectively gave their consent for participation in the study. Awareness regarding organ donation was found to be 98.7-100%, 69.4% claimed television as their source of information regarding organ donation and 46.7% stated that it is possible for patient to recover from brain death. The awareness regarding eye, liver, heart and kidney donations was found to be 92.4%, 87%, 87% and 97.8%, respectively. 87% of medical students were aware of need for legal supervision, and awareness regarding the existing laws was found to be 57.6%. Conclusion. Medical students had a high level of awareness and a positive attitude towards organ donation. However, knowledge regarding “brain-death”, organs and tissues donated, legislation and ethical issues was poor. A teaching intervention designed to specifically address these issues could help increase the confidence of the health-care professionals and may result finally in increased organ procurement rates.

Comparison of 1 vs 2 Brain Death Examinations on Time to Death Pronouncement and Organ Donation

Neurology ◽  
2021 ◽  
Vol 96 (10) ◽  
pp. e1453-e1461
Author(s):  
Panayiotis N. Varelas ◽  
Mohammed Rehman ◽  
Chandan Mehta ◽  
Lisa Louchart ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Brain Function ◽  
Brain Injuries ◽  
Organ Procurement ◽  
Tertiary Hospital ◽  
Consent Rate ◽  
Organ Procurement Organization ◽  
Time To Death ◽  
Elapsed Time

ObjectiveTo fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.MethodsTwelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.ResultsA total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019).ConclusionsA single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.

scholarly journals Organ Donation in the Context of Brain Death in Muslim Countries: Bioethical Positions

2020 ◽  
Vol 5 (07) ◽  
pp. 222-224
Author(s):  
Alqahtani Ibtesam Mohammed
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Organ Transplantation ◽  
Organ Procurement ◽  
Modern Medicine ◽  
Organ Transplants ◽  
Clear Cut ◽  
Muslim Countries ◽  
The Right ◽  
End Stage

One of the miracles of modern medicine for patients with end stage organ failure is organ transplantation. The Organ Procurement and Transplantation Network (OPTN) defines organ donation as giving an organ, tissue, cells, or part of an organ from a living or deceased person (i.e., the donor) to a living person in need (i.e., the recipient). In the last two decades, the number of organ transplants has gradually increased; however, the demand for organ transplantation exceeds the number of available donors. Organs from brain dead donors have been suggested as an alternative option for increasing donation rates when living donors are not available. This article explores the debate surrounding brain death organ donation in Muslim countries. Because organ transplantation is based on Ijtihad, Muslim jurists have no clear-cut text in the Holy Quran or Sunna to use as a foundation for judgment. This has made organ transplants an issue among Muslim scholars and researchers, splitting them into two opinion groups, with one side seeing organ transplantation as legal and the other believing it to be illegal. However, all individuals have the right to choose whether they want to help others by sacrificing parts of themselves and donating their organs. Autonomy, justice, and beneficence must be employed in organ transplantation decision-making.

Ethical Issues in Critical Care and Cardiac Arrest: Clinical Research, Brain Death, and Organ Donation

2006 ◽  
Vol 26 (4) ◽  
pp. 452-459 ◽  
Author(s):  
Luke Donatelli ◽  
Romergryko Geocadin ◽  
Michael Williams
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Brain Death ◽  
Clinical Research ◽  
Organ Donation ◽  
Ethical Issues

Donation Education for Medical Students: Enhancing the Link between Physicians and Procurement Professionals

2005 ◽  
Vol 15 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Christian C. Essman ◽  
Daniel J. Lebovitz
Keyword(s):  
Medical Students ◽  
Organ Donation ◽  
Ethical Issues ◽  
Organ Procurement ◽  
Tissue Donation ◽  
Current Crisis ◽  
Educational Approach ◽  
Organ And Tissue Donation ◽  
Donation Process ◽  
Organ Procurement Organizations

Purpose Increasing healthcare professionals' knowledge about organ and tissue donation; the national mandates regarding referral compliance; and the effect on donors, donor families, and transplant recipients is a challenging task. Physicians not routinely involved in organ donation or transplantation are some of the most difficult professionals for organ procurement organizations to access. A course for medical students was developed to initiate the transfer of information, comfort, and familiarity with the organ and tissue donation process. Methods Discussions with a local medical school revealed that little organized education on organ and tissue donation existed. An elective course was developed consisting of 2-hour lectures, once a week for 6 weeks. Topics included an overview of tissue and organ donation, history and significance of the current crisis, determination of brain death and its role in organ donation, tissue donation, pretransplant and posttransplant processes, ethical issues, and the donor family and recipient experience. Results A thorough course proposal was presented to the medical school's Chairman of Surgery and Chairman of Transplantation. The proposal was approved for first- and second-year medical students. Conclusion Offering medical students a unique and comprehensive course may attract curious students who could become future champions for donation. This type of educational approach may significantly influence future interactions between physicians and organ procurement organizations. If more organ procurement organizations implement this type of program, the medical students' knowledge of donation will not only affect and benefit the local organ procurement organization's service area but other procurement organizations throughout the country as well.

scholarly journals The donor potential of twenty six donor bases in the Russian Federation: external audit (a pilot project)

2020 ◽  
Vol 48 (3) ◽  
pp. 153-161
Author(s):  
V. L. Vinogradov ◽  
K. K. Gubarev ◽  
A. I. Zakhlevnyy ◽  
D. S. Svetlakova
Keyword(s):  
Intensive Care ◽  
Brain Injury ◽  
Brain Death ◽  
Organ Donation ◽  
Intensive Care Units ◽  
Pilot Project ◽  
Secondary Brain Injury ◽  
External Audit ◽  
Potential Donor ◽  
Donation Process

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.

Organ Donation, Brain Death and the Family: Valid Informed Consent

2015 ◽  
Vol 43 (2) ◽  
pp. 369-382 ◽  
Author(s):  
Ana S. Iltis
Keyword(s):  
Informed Consent ◽  
Brain Death ◽  
Organ Donation ◽  
Organ Procurement ◽  
Organ Donor ◽  
Public Understanding ◽  
Organ Procurement Organization ◽  
The Family ◽  
Driver's License ◽  
Brain Dead

In July 2013, parents in Ohio objected to their 21-year-old son becoming an organ donor. Elijah Smith was involved in an accident and pronounced dead using neurological criteria. The organ procurement organization (OPO) went to court and argued that because the young man was brain dead and because his driver's license indicated that he wished to be a donor, the court should allow them to use his organs. The mother argued that her son did not understand what he was signing when he signed his license and that his signature did not reflect an informed decision. The court disagreed with her, saying that he had indicated a wish to donate his organs and that no one but Elijah could revoke that wish. His organs were removed.Elijah's mother suspected that he did not understand what he was signing. She might have been right, given what we know about the process for obtaining permission for organ donation and the limited public understanding of brain death.

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