Should the family have a role in deceased organ donation decision-making? A systematic review of public knowledge and attitudes towards organ procurement policies in Europe

Goal: To assess public knowledge and attitudes towards the role of the family in deceased organ donation in Europe. Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science. These databases were last searched on December 15th, 2017. Eligibility criteria were empirical studies conducted in Europe from 2008 to 2017 and addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Each record was screened by two or more independent reviewers in three phases. Data collection from each report was performed by two or more independent reviewers. Results: Of the 1,482 results, 467 reports were assessed in full-text form, and 33 were included in this synthesis. Studies show that a majority of the public support the family′s involvement in organ retrieval decision-making and, in particular, their role as surrogate decision-maker when the deceased has expressed no preference. Conclusions: A common conceptual framework and validated well-designed questionnaires are needed to address the role of the family in future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.

Opt-out policies capacity to increase organ donors is limited

Objectives: To increase post-mortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. However, studies on the relative impact of opt-in or opt-out on deceased organ donation rates are inconclusive. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the impact of consent policies when considering the role of the family in decision-making. Design: By systematically combining the three components of the decision-making process --the default rule, the deceaseds preferences, and the family s preferences,-- we identify all situations that affect the retrieval outcome under opt-in and opt-out policies. Then, by gathering empirical data from a wide array of countries, we estimate the relative frequency of these situations. Main outcome measures: We measure the relative impact that opt-in and opt-out policies have per se on post-mortem organ retrieval. Results: Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. These policies only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The actual impact of consent policies is typically circumscribed to a range of 0% to 5% of all opportunities for organ retrieval. Conclusions: This study may warn contemporary organ retrieval policymakers that, by emphasizing the need to introduce presumed consent, they might be overestimating the influence of policy defaults and underestimating the power granted to families in expressing their preferences and making decisions about organ donation. Governments should reassess the opportunity and effectiveness of adopting opt-out policies for organ retrieval.

1650 Is There a Place for Medical Students at Organ Retrieval? 4 Years’ Experience at a Single Centre

Aim Medical students at a hospital with a national organ retrieval service (NORS) had the unique opportunity to attend organ retrieval. This retrospective survey investigated how attendance affected students’ desire to pursue a career in surgery, and what they learnt from the experience. Method Clinical medical students were invited to sign-up to shifts with the regional NORS team. If notified of a potential organ donation event the NORS co-ordinator would inform the medical student, who would then join the retrieval team and travel with them to the donation site. An electronic survey was later distributed to students, whether or not the donation proceeded. This survey collected both quantitative and qualitative information about the students’ experiences. Results 51 responses were collected from students who attended proceeding organ donations between January 2015 and October 2019. 100% of students found it a useful learning experience and would recommend it to their peers. 98% were able to scrub in for the retrieval procedure. Common learning points were improved understanding of the process of organ retrieval (n = 34), and anatomy (n = 15). Following experience of organ retrieval 59% reported being more likely to pursue a career in transplant surgery and 69% reported being more likely to pursue any surgical career. Conclusions Medical students should be included in organ retrieval, as it not only benefits their learning, but also increases interest in surgical careers. Given that only two out of the sixteen UK NORS teams involve medical students currently, there is scope for much greater adoption of student retrieval rotas.

Successful Use of Kidneys from a Deceased Donor with Active Herpes Zoster Infection

Background. The limited donor pool and increasing recipient wait list require a reevaluation of kidney organ suitability for transplantation. Use of higher infectious risk organs that were previously discarded may help improve access to transplantation and reduce patient mortality without placing patients at a higher risk of poor posttransplant outcomes. There is very little data available regarding the safe use of kidney organs from deceased donors with varicella zoster virus infection at the time of organ retrieval. Case Presentation. Here, we report a case of successful transplantation of both kidneys from a deceased donor with active herpes zoster infection at the time of organ retrieval. Recipients were treated preemptively with acyclovir. At 4 months posttransplant, both kidney recipients experienced no infectious complications and were off dialysis with functioning transplant grafts. Conclusions. The use of kidney organs from donors with active herpes zoster infection appears to be a safe option to expand the kidney donor pool.

Thoracic Organ Procurement during Multi-Organ Retrieval

Procurement of thoracic organs can be divided into two major categories- donation after brain death (DBD) or donation after circulatory determination of death (DCDD). In this section we will focus primarily on DBD, which is the commoner of these two or at times referred to as standard procurement. DCDD is a relatively new and promising field that has helped ameliorate donor shortage, aided by the latest advances in medical technology. However, DBD continues to be the major avenue of organ donation. There are several different combinations of thoracic procurement surgeries: heart, double lung, single lung/ 2-single lungs, heart-lung en bloc for transplantation, Double Lung procurement for Bronchial arterial revascularization, Heart and Lung procurement in DCDD donors with the OCS, NRP or Lungs for EVLP.

The Educational Value and Emotional Impact on Medical Students After Participating in Transplant Organ Retrieval

Introduction: Medical students and healthcare professionals lack knowledge and confidence in organ transplantation which stems in part from a lack of exposure to transplant surgery at medical school. To address this, we developed a program that allowed students to attend organ retrievals and assessed its efficacy as an educational intervention. Methods: Students were invited to attend organ retrievals through a voluntary program. Students then completed an anonymous, self-administered questionnaire (n = 40) designed to capture the perceived educational value and emotive impact of attending an organ retrieval, and its effect on career aspirations. Quantitative and qualitative data were analyzed. Results: 100% of students would recommend attending an organ retrieval to a colleague. Students strongly agreed that attending an organ retrieval was a useful learning experience (87.5%) and 90% of students felt more confident discussing organ donation with patients and relatives. 50% of students were more likely to pursue a career in transplant surgery. Students recognized a number of difficulties associated with the emotive impact of organ procurement. Conclusion: An organ retrieval program for medical students offers a novel learning opportunity, and may increase knowledge and improve attitudes toward transplantation in future healthcare professionals. However, the emotive impact of exposing students to organ retrievals must also be recognized.

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

IntroductionThe National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals.MethodsTwo high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions.ResultsAttitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD.DiscussionThe paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally.