FAMILY APPROACH 2nd part: REQUEST FOR
ORGAN DONATION
Danica Avsec, MDKey expert for Education and Communication
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
FAMILY INTERVIEW
How to break bad news
Request for the donation
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Request for the donation
Consent for the donation To evaluate biological risk factors
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Opposition to Donation, ETPOD
Important number of lost Donors in many countries Correctable cause
Less than 10% opposition can be achieved
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
OPT IN countries, 2011 Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
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DDR
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Correctable elements
• Legislation (ETPOD)• Psycholgical aspect • AGREE model• Other socio cultural aspects
• Religious statement• Public awareness• Educational level• Additional strategies
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
OPT IN countries, 2011 Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
0
10
20
30
40
50
60
70
80
RR
DDR
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
OPT OUT countries , 2011Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Correctable elements
• Legislation• Psychological frame• AGREE model -100% agreement• Other socio cultural aspects
• Public awareness• Educational level• Religious statements
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Psychological frame
• Absolutely crucial• Way of communication• Emotional release• Empathy• Facilitating the proces of
grieving• Is essential for developing the
trustTechnical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014
Trust
• Developing the trust starts at the time of admission the patients and when first time contacting the family
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Effectiveness of communication Jones et al (2008).
• “communication can only be effectively achieved where both parties have the same, or at least similar, recollection of what was communicated”.
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Correctable elements
• Legislation• Psychological aspect• AGREE model• Other socio cultural aspects
• Religious statement• Public awarenes• Educational level
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
AGREE study
• Family interview guide for requesting organ donation for transplantation and evaluation using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument
• Organs Tissues & Cells. 2012, November, 15, 3: 163
• 100% (40 interviews and 4 interviewers) consent from Jan 2011 to Aug 2012
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Family interview guidelinesCabalero et all, ORGANS, TISSUES & CELLS, (15), 163-169, 2012
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Planning for the family interview
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Planning for the family interview
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Planning for the family interview
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
• Monitoring and assesment of the procedure is important
• Annual revision
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Correctable elements
• Legislation• Psychological aspect• AGREE model• Other socio cultural aspects
• Public awarenes• Educational level• Religious statement
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Public awareness
Starts with open discussion within familyThe most important predictor of consent is
whether a discussion about donation had been performed before donation
Families who know the donor's wishes, are more likely to donate organs
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Solidarity as an argument for Donation, ETPOD
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
More arguments for Donation, ETPOD
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
Strategies to decrease family refusal rate, ETPOD
Deceased did not wish to donate Try to find if it is true
Fear of the integrity and image of the corpse Explain the process and assure respect and care of the corpse
Religious objections Most main religious promote donation Offer the opportunity to consult a RL
Dissatisfaction with the health care procedures Accept complains Separate it from the donation
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
WHEN
1. After medical and legal diagnosis of brain death 2. The physician in charge of the patient must report the death to the family. 3. Terminology use term ‘death’ and not the term ‘brain death’ 3. Family needs to understand the patient’s death.4. Before the interview it is important to confirm that immediate relatives of the donor will attend. 5. It is advisable that the transplant coordinator is present
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
General recommendation 1 ONT Spain
1. Immediate relatives of the potential organ donor should be present at the interview.2. The request for consent to donation must never be rushed. We should wait for the right time to approach the family.3. After the physician in charge communicates the patient’s death, it is advisable to wait for families’ prompts such as: “What should we do now?”
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
General recommendations 2
4. At this moment, and not before, consent to organ donation for transplantation should be introduced to relatives by a professional from TCT. It should be explained that their deceased relative – naming him/her by their name – “can help others”. 5. An emphasis on the social and health benefits for patients on the waiting list for organ transplantation is recommended. 6. Death is hard, not donation.
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
To conclude
• Be aware : Giving bad news about dead is more difficult than asking for donation
Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
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Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014
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