FAMILY APPROACH 2nd part: REQUEST FOR ORGAN DONATION Danica Avsec, MD Key expert for Education and...

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


Request for the donation

Consent for the donation To evaluate biological risk factors


Opposition to Donation, ETPOD

Important number of lost Donors in many countries Correctable cause

Less than 10% opposition can be achieved


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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10

20

30

40

50

60

70

80

RR

DDR


Correctable elements

• Legislation (ETPOD)• Psycholgical aspect • AGREE model• Other socio cultural aspects

• Religious statement• Public awareness• Educational level• Additional strategies


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


OPT OUT countries , 2011Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013



• Legislation• Psychological frame• AGREE model -100% agreement• Other socio cultural aspects

• Public awareness• Educational level• Religious statements


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


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”.



• Legislation• Psychological aspect• AGREE model• Other socio cultural aspects

• Religious statement• Public awarenes• Educational level


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


http://www.editricecompositori.it/flex/FixedPages/Common/OrgansArchivio.php/L/EN/an/a%3A2%3A%7Bs%3A1%3A%22a%22%3Bs%3A4%3A%222012%22%3Bs%3A1%3A%22n%22%3Bs%3A2%3A%2245%22%3B%7D

Family interview guidelinesCabalero et all, ORGANS, TISSUES & CELLS, (15), 163-169, 2012


Planning for the family interview






• Monitoring and assesment of the procedure is important

• Annual revision



• Legislation• Psychological aspect• AGREE model• Other socio cultural aspects

• Public awarenes• Educational level• Religious statement


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


Solidarity as an argument for Donation, ETPOD


More arguments for Donation, ETPOD


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


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


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?”


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.


To conclude

• Be aware : Giving bad news about dead is more difficult than asking for donation


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FAMILY APPROACH 2nd part: REQUEST FOR ORGAN DONATION Danica Avsec, MD Key expert for Education and...

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