Increasing Success in Obtaining Organ Donation
Increasing Success in Obtaining Organ Donation
ABSTRACT & COMMENTARY
Synopsis: Training in effective procedures significantly increased organ donation rates, yet two-thirds of critical care staff reported no relevant training.
Source: Evanisko MJ. Am J Crit Care 1998;7:4-12.
To test the hypothesis that attitudes, know-ledge, and training affect organ donation rates, Evanisko and colleagues surveyed 1061 critical care physicians (n = 226) and nurses (n = 675) in four regions of the United States who had been involved in a potential organ donation event six months before the survey. The sample included hospitals that were trauma certified (n = 16), trauma certified and a transplant center (n = 7), and neither trauma certified nor a transplant center (n = 5). Surveys were completed in the hospitals, resulting in a high return (mean 52%; range 30-92%).
To estimate donor potential and outcome of each potential donor case, the investigators reviewed medical records in each hospital of all patients younger than 70 years who died without contraindications to donation. Several differences were found between physician and nurse respondents. Physicians, compared to nurses, were more likely to support organ donation (96.9% vs 92.9%; P = 0.032), know the number of individuals nationally who were awaiting transplant (63.7% vs 55.9%; P = 0.042), and have training in explaining brain death to a family member (37.2% vs 21.5%; P = 0.0001).
Few (32.6%) of those surveyed had received training in how to request organ donation. When hospitals with high and low organ donation rates were compared, respondents in hospitals with high organ donation rates were more likely to have been trained in how to request donation (36.8% vs 9.1%; P < 0.01), how to explain brain death to the family (29.4% vs 7.5%; P < 0.01), and how to provide family with grief counseling (28.9% vs 13.9%; P < 0.01). Donation protocols were viewed as more burdensome (P = 0.0006) in hospitals with low donation rates. Levels of factual knowledge about organ donation and brain death were low but not significantly related to organ donation rates.
COMMENT BY LESLIE A. HOFFMAN, RN, PhD
This study, which systematically examined the relationship between staff capabilities and organ donation, had two major conclusions: 1) training of hospital staff about protocols for organ donation was significantly associated with higher rates of organ donation, and 2) training was infrequent. These findings provide strong support for the development of targeted training programs that provide practical knowledge about issues related to organ donation, including specialized training in when and how to communicate with families. Key components include: 1) communicating often and honestly about the patient's prognosis; 2) waiting to introduce the topic of organ donation until the family has been clearly informed, understands, and accepts the fact of death; 3) making the request in a quiet and private setting; and 4) clearly defining the roles of the hospital staff and organ procurement organization.
Training about organ donation and, in particular, about how to request organ donation appears to affect success. Potentially, staff at hospitals with lower organ donation rates were less likely to understand the issues involved and, therefore, were less likely to feel comfortable discussing these issues with families. Such discomfort may have been sensed by families and negatively affected their decision-making. Interviews with families support this assertion. In a related article, DeJong and colleagues (Am J Crit Care 1997;7:13-23) report the results of interviews with the immediate next of kin of 160 medically suitable potential organ donors. Donor families, compared to nondonors, were more likely to state the following: discussions of organ donation were bought up at the right time; individuals who requested consent were sensitive to their needs; issues were discussed in language they understood; and questions were answered to their satisfaction. All of these points are easy to address in a program that includes training about issues, policies, and procedures involved in organ donation.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.