Elsevier

Transplantation Proceedings

Volume 48, Issue 10, December 2016, Pages 3245-3250
Transplantation Proceedings

Recent Advances in Transplantation
Organ donation
Taking Care of Relationships in the Intensive Care Unit: Positive Impact on Family Consent for Organ Donation

https://doi.org/10.1016/j.transproceed.2016.09.042Get rights and content

Highlights

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    Organ donations from brain-dead donors are limited by family consent.

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    Communication techniques influence the rate of consent.

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    Increased consent rate was recorded with the use of a new communication technique.

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    The importance of empathy with relatives in the intensive care unit is stressed.

Abstract

Background

Organ donation refusal from relatives of potential donors with brain death significantly reduces organ availability. The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. We analyzed the impact of a new systematic communication approach between medical staff and patients' relatives on the rate of consent to organ donation.

Methods

The study was conducted as a single-center, non-randomized, controlled, before-and-after study at an 18-bed intensive care unit (ICU) of a university hospital. We compared the rate of consent for organ donation before and after the introduction of the new communication approach.

Results

A total of 291 brain-dead patients were studied. The consent rate increased from 71% in the pre-intervention period (2007–2012) to 78.4% in the post-intervention period (2013–2015), with an 82.75% increase in the 2014 to 2015 period. During these periods, no significant variation of consent to organ donation was recorded at the national and regional levels.

Conclusions

The introduction of a new communication approach between medical staff and relatives of brain-dead patients was associated with a significant increase in the rate of consent to donation. Our results highlight the importance of empathy with relatives in the ICU.

Section snippets

Methods

Our ICU is an 18-bed, multidisciplinary ICU. It is a referral center for acute respiratory failure as well as a trauma center. The study design is a non-randomized, controlled, before-and-after study.

Relatives of brain-dead patients were approached according to an internal protocol, inspired by NICE guidelines [12], which temporarily distinguishes two phases: communicating brain death and proposing organ donation (Tables 1 and 2). These guidelines deal with delivering the end-of-life

Results

Data collected through the Transplants Informative System, the Italian Ministry of Health, and the Regional Transplants Center (Lazio) are reported in the two graphs. Data refer to reported brain deaths and percentage of organ donation refusals at a National, Regional level (Lazio) and to the Regional Hospital “Agostino Gemelli” University Foundation.

A total of 291 brain-dead patients eligible as organ donors were studied. Between 2013 and 2015, 131 patients with brain death and eligible as

Discussion

The results of our study confirm those of previous studies [4], which showed that families who discussed more topics and families who had more contact with medical staff were more likely to accept organ donation.

Most importantly, our results are in accordance with the systematic review by Simpkins [5], which identified the main factors associated with reduced rates of refusal. Most of these factors are part of the new approach that we applied in the intervention period, such as provision of

Conclusions

We applied a new approach to medical staff-patient-relative communication in our ICU, based on the introduction of a multidisciplinary team and an increased attention for the patient and his family. In our single-center study, the introduction of the systematic approach to communication between relatives and medical staff was associated with a nearly 2-fold decrease in the rate of donation refusals.

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