scholarly journals The Rule of Threes: three factors that triple the likelihood of families overriding first person consent for organ donation in the UK

2017 ◽  
Vol 19 (2) ◽  
pp. 101-106 ◽  
Author(s):  
James Morgan ◽  
Cathy Hopkinson ◽  
Cara Hudson ◽  
Paul Murphy ◽  
Dale Gardiner ◽  
...  
Keyword(s):  
Organ Donation ◽  
Odds Ratio ◽  
The Body ◽  
Multivariable Logistic Regression Analysis ◽  
Specialist Nurse ◽  
Factors Associated ◽  
Family Approach ◽  
The Family ◽  
The Uk ◽  
Circulatory Death

Between 1 April 2012 and 31 March 2015, 263 of the 2244 families in the UK whose loved ones had registered to donate organs for transplantation after their death on the NHS Organ Donor Register chose to override this decision; an override rate of 11.7%. Multivariable logistic regression analysis was applied to data relating to various aspects of the family approach in order to identify factors associated with such overrides. The factors associated with family overrides were failure to involve the Specialist Nurse for Organ Donation in the family approach (odds ratio 3.0), donation after circulatory death (odds ratio 2.7) and Black, Asian or Minority Ethnicity (odds ratio 2.7). This highlights the need to further engage with these groups in exploring donation as an end of life choice, and suggests that there may be, from the perspective of the family, fundamental differences between donation after brainstem death and circulatory death. It further adds to the body of data linking involvement of the Specialist Nurse for Organ Donation in the family approach to improved UK consent rates.

Contemporary issues in law and ethics: Exploring the family veto for organ donation

2019 ◽  
Vol 29 (11) ◽  
pp. 361-367
Author(s):  
Debbie Cay
Keyword(s):  
Organ Donation ◽  
The Body ◽  
Ethical Aspects ◽  
Moral Legitimacy ◽  
Law And Ethics ◽  
The Family ◽  
The Uk ◽  
The Impact

This article explores current issues surrounding the impact of family veto for organ donation in the UK. A critical, reflective analysis of the theoretical, legal and ethical aspects aims to evaluate how the deceased’s explicit wish to donate may be revoked. Under current UK legislation and upon death, money and property are protected; however, the body is not. When investigating personal wishes, interests and decisions must be weighed against the moral legitimacy of the family veto.

Improving organ donation rates by modifying the family approach process

2014 ◽  
Vol 76 (6) ◽  
pp. 1473-1475 ◽  
Author(s):  
Aileen Ebadat ◽  
Carlos V.R. Brown ◽  
Sadia Ali ◽  
Tim Guitierrez ◽  
Eric Elliot ◽  
...  
Keyword(s):  
Organ Donation ◽  
Family Approach ◽  
The Family

scholarly journals Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a Multicenter Prospective Observational Cohort Study (Preprint)

2019 ◽  
Author(s):  
Angela M M Kotsopoulos ◽  
Piet Vos ◽  
Nichon E Jansen ◽  
Ewald M Bronkhorst ◽  
Johannes G van der Hoeven ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prediction Model ◽  
Organ Donation ◽  
Prediction Models ◽  
Circulatory Arrest ◽  
Time To Death ◽  
Family Approach ◽  
The Impact ◽  
Circulatory Death ◽  
Previous Prediction

BACKGROUND Controlled donation after circulatory death (cDCD) is a major source of organs for transplantation. A potential cDCD donor poses considerable challenges in terms of identification of those dying within the predefined time frame of warm ischemia after withdrawal of life-sustaining treatment (WLST) to circulatory arrest. Several attempts have been made to develop models predicting the time between treatment withdrawal and circulatory arrest. This time window determines whether organ donation can occur and influences the quality of the donated organs. However, the selected patients used for these models were not always restricted to potential cDCD donors (eg, patients with cancer or severe infections were also included). This severely limits the generalizability of those data. OBJECTIVE The objectives of this study are the following: (1) to develop a model predicting time to death within 60 minutes in potential cDCD patients; (2) to validate and update previous prediction models on time to death after WLST; (3) to determine timing and patient characteristics that are associated with prognostication and the decision-making process that leads to initiating end-of-life care; (4) to evaluate the impact of timing of family approach on organ donation approval; and (5) to assess the influence of variation in WLST processes on postmortem organ donor potential and actual postmortem organ donors. METHODS In this multicenter observational prospective cohort study, all patients admitted to the intensive care unit of 3 university hospitals and 3 teaching hospitals who met the criteria of the cDCD protocol as defined by the Dutch Transplant Foundation were included. The target of enrolment was set to 400 patients. Previously developed models will be refitted in our data set. To further update previous prediction models, we will apply least absolute shrinkage and selection operator (LASSO) as a tool for efficient variable selection to develop the multivariable logistic regression model. RESULTS This protocol was funded in August 2014 by the Dutch Transplant Foundation. We expect to have the results of this study in July 2020. Patient enrolment was completed in July 2018 and data collection was completed in April 2020. CONCLUSIONS This study will provide a robust multimodal prediction model, based on clinical and physiological parameters, that can predict time to circulatory arrest in cDCD donors. In addition, it will add valuable insight in the process of WLST in cDCD donors and will fill an important knowledge gap in this essential field of health care. CLINICALTRIAL ClinicalTrials.gov NCT04123275; https://clinicaltrials.gov/ct2/show/NCT04123275 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16733

scholarly journals Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a Multicenter Prospective Observational Cohort Study

10.2196/16733 ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. e16733
Author(s):  
Angela M M Kotsopoulos ◽  
Piet Vos ◽  
Nichon E Jansen ◽  
Ewald M Bronkhorst ◽  
Johannes G van der Hoeven ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prediction Model ◽  
Organ Donation ◽  
Prediction Models ◽  
Circulatory Arrest ◽  
Time To Death ◽  
Family Approach ◽  
The Impact ◽  
Circulatory Death ◽  
Previous Prediction

Background Controlled donation after circulatory death (cDCD) is a major source of organs for transplantation. A potential cDCD donor poses considerable challenges in terms of identification of those dying within the predefined time frame of warm ischemia after withdrawal of life-sustaining treatment (WLST) to circulatory arrest. Several attempts have been made to develop models predicting the time between treatment withdrawal and circulatory arrest. This time window determines whether organ donation can occur and influences the quality of the donated organs. However, the selected patients used for these models were not always restricted to potential cDCD donors (eg, patients with cancer or severe infections were also included). This severely limits the generalizability of those data. Objective The objectives of this study are the following: (1) to develop a model predicting time to death within 60 minutes in potential cDCD patients; (2) to validate and update previous prediction models on time to death after WLST; (3) to determine timing and patient characteristics that are associated with prognostication and the decision-making process that leads to initiating end-of-life care; (4) to evaluate the impact of timing of family approach on organ donation approval; and (5) to assess the influence of variation in WLST processes on postmortem organ donor potential and actual postmortem organ donors. Methods In this multicenter observational prospective cohort study, all patients admitted to the intensive care unit of 3 university hospitals and 3 teaching hospitals who met the criteria of the cDCD protocol as defined by the Dutch Transplant Foundation were included. The target of enrolment was set to 400 patients. Previously developed models will be refitted in our data set. To further update previous prediction models, we will apply least absolute shrinkage and selection operator (LASSO) as a tool for efficient variable selection to develop the multivariable logistic regression model. Results This protocol was funded in August 2014 by the Dutch Transplant Foundation. We expect to have the results of this study in July 2020. Patient enrolment was completed in July 2018 and data collection was completed in April 2020. Conclusions This study will provide a robust multimodal prediction model, based on clinical and physiological parameters, that can predict time to circulatory arrest in cDCD donors. In addition, it will add valuable insight in the process of WLST in cDCD donors and will fill an important knowledge gap in this essential field of health care. Trial Registration ClinicalTrials.gov NCT04123275; https://clinicaltrials.gov/ct2/show/NCT04123275 International Registered Report Identifier (IRRID) DERR1-10.2196/16733

scholarly journals Factors Associated with Procedural Thromboembolisms after Mechanical Thrombectomy for Acute Ischemic Stroke

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 353
Author(s):  
Taek Min Nam ◽  
Ji Hwan Jang ◽  
Young Zoon Kim ◽  
Kyu Hong Kim ◽  
Seung Hwan Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Area Under The Curve ◽  
Multivariable Logistic Regression Analysis ◽  
Cutoff Value ◽  
Factors Associated ◽  
Procedural Time

Background and objective: Procedural thromboembolisms after mechanical thrombectomy (MT) for acute ischemic stroke has rarely been studied. We retrospectively evaluated factors associated with procedural thromboembolisms after MT using diffusion-weight imaging (DWI) within 2 days of MT. Materials and Methods: From January 2018 to March 2020, 78 patients with acute ischemic stroke who underwent MT were evaluated using DWI. Procedural thromboembolisms were defined as new cerebral infarctions in other territories from the occluded artery on DWI after MT. Results: Procedural thromboembolisms were observed on DWI in 16 patients (20.5%). Procedural thromboembolisms were associated with old age (73.8 ± 8.18 vs. 66.8 ± 11.2 years, p = 0.021), intravenous (IV) thrombolysis (12 out of 16 (75.0%) vs. 25 out of 62 (40.3%), p = 0.023), heparinization (4 out of 16 (25.0%) vs. 37 out of 62 (59.7%), p = 0.023), and longer procedural time (90.9 ± 35.6 vs. 64.4 ± 33.0 min, p = 0.006). Multivariable logistic regression analysis revealed that procedural thromboembolisms were independently associated with procedural time (adjusted odds ratio (OR); 1.020, 95% confidence interval (CI); 1.002–1.039, p = 0.030) and IV thrombolysis (adjusted OR; 4.697, 95% CI; 1.223–18.042, p = 0.024). The cutoff value of procedural time for predicting procedural thromboembolisms was ≥71 min (area under the curve; 0.711, 95% CI; 0.570–0.851, p = 0.010). Conclusions: Procedural thromboembolisms after MT for acute ischemic stroke are significantly associated with longer procedural time and IV thrombolysis. This study suggests that patients with IV thrombolysis and longer procedural time (≥71 min) are at a higher risk of procedural thromboembolisms after MT for acute ischemic stroke.

The Timing Factor in the Consent Process

1996 ◽  
Vol 6 (2) ◽  
pp. 84-87 ◽  
Author(s):  
Patricia A Niles ◽  
Burton J Mattice
Keyword(s):  
Organ Donation ◽  
Medical Profession ◽  
Organ Procurement ◽  
Organ Donor ◽  
Apparent Difference ◽  
Next Of Kin ◽  
Consent Rate ◽  
Family Approach ◽  
The Family ◽  
Organ Procurement Organizations

Organ procurement organizations have been educating the medical profession on the importance of timing during the donation request process. Separating the request for donation from the notification of death has been encouraged when approaching families for consent for organ donation. This study evaluated the timing of the family approach and consent rates. A 23-month study was performed on all organ donor referrals in a 1.1 million population base. During the study period there were 203 referrals: 67 were medically unsuitable, next-of-kin was not available in 2 cases, 7 were coroner refusals, and 127 were suitable for donation. In this latter group, families were offered the option of organ donation. No apparent difference when donation was requested before or after the death pronouncement was found. Data indicated, however, that when the family is told of the death and is asked for donation simultaneously, the consent rate decreases 32% to 37%.

scholarly journals Pre-mortem interventions for donation after circulatory death and overall benefit: A qualitative study

2016 ◽  
Vol 11 (4) ◽  
pp. 149-158
Author(s):  
Aisha Gathani ◽  
Greg Moorlock ◽  
Heather Draper
Keyword(s):  
Qualitative Study ◽  
Organ Donation ◽  
Healthcare Professionals ◽  
Donation After Circulatory Death ◽  
Potential Donor ◽  
Strength Of Evidence ◽  
Respect For Autonomy ◽  
Brainstem Death ◽  
The Family ◽  
Circulatory Death

This article explores how the type of consent given for organ donation should affect the judgement of a patient's overall benefit with regards to donation of their organs and the pre-mortem interventions required to facilitate this. The findings of a qualitative study of the views of 10 healthcare professionals, combined with a philosophical analysis inform the conclusion that how consent to organ donation is given is a reliable indicator only of the strength of evidence about views on donation and subsequent willingness to undergo pre-mortem interventions. It is not an indicator of the strength of actual desire to donate. Clinical management of living patients prior to donation after circulatory death must therefore respect the values, wishes and beliefs of the potential donation after circulatory death donor. Our participants, however, suggested that the information currently provided is sufficient to authorise donation and that this consent, however provided, was sufficient to proceed with pre-mortem interventions. Respect for autonomy underpinned this ‘all or nothing’ approach. Although the legal requirements for donation authorisation and the protection of patients without capacity are clear, practice and policy regarding consent in donation after circulatory death may be based on donation following brainstem death where the patient is already dead when the family is approached. Custom and practice in donation after circulatory death may need to be revised to protect the interests of the dying potential donor.

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