Impact of a Bereavement and Donation Service incorporating mandatory ‘required referral’ on organ donation rates: a model for the implementation of the Organ Donation Taskforce’s recommendations

Collaboration between the intensive care unit and organ donation agency to achieve routine consideration of organ donation and comprehensive bereavement follow-up: an improvement project in a quaternary Australian hospital

Objective Routine family follow-up after bereavement in the intensive care unit (ICU) and routine consideration of organ and tissue donation at end of life are both integral to good health care delivery, yet neither is widely achieved. This study evaluated an initiative to efficiently deliver these outcomes in an Australian setting through a novel collaboration between DonateLife South Australia (DLSA) and the ICU of the Royal Adelaide Hospital. Methods A Plan-Do-Study-Act method of quality improvement was used in the Royal Adelaide Hospital ICU between February 2018 and February 2019. The ICU clinical team identified adult patients and family members at medical consensus of end of life to donation specialist nursing coordinators, who assessed potential for donation and enrolled patients and family members into a bereavement follow-up program. After death, family members received bereavement information and details of a structured telephone follow-up conversation that took place 6-8 weeks later. Results Of 241 deaths, 216 were enrolled in the project. Follow-up telephone calls were completed with 124 of 201 (62%) family members, with 77 (38%) family members not contactable. Follow-up telephone interviews yielded practical suggestions to improve end-of-life care. Donation was considered in all patients enrolled in the project, and referral through DLSA increased from 24% to 90% of all ICU deaths. Associated with the collaborative initiative, consent to organ donation recorded a 63% increase on the 10-year average (from 19 to 31 donors). Corneal donation referral increased by 625%. The initiative required an additional 0.4 full-time equivalent registered nurse. Family members valued the opportunity to debrief their experience. Conclusions Collaboration between DLSA and the Royal Adelaide Hospital ICU achieved universal consideration of organ donation and high rates of structured bereavement follow-up. Follow-up calls were valued with areas for improvement identified. What is known about this topic? Death in the ICU is associated with significant psychopathology among bereaved family members, and bereavement follow-up is widely recommended. Opportunities to consider organ and tissue donation are commonly missed due to lack of consideration at end of life. What does this paper add? Collaboratively exploring donation and performing bereavement follow-up is feasible with a minimal added resource. Such comprehensive approach to good end-of-life care helps identify aspects of care that could be improved and is associated with an increase in organ and tissue donation rates. What are the implications for practitioners? Collaboration between the ICU and DonateLife achieved mutually beneficial outcomes of understanding the end-of-life experience for family members and timely consideration of organ and tissue donation. This timely consideration potentially identified some missed organ donors and then allowed family members to give feedback on their experience.

Pro-donation behaviours of nursing students from the four countries of the UK

BACKGROUND

The effectiveness of the organ donation system depends on the health professionals involved in procurement and in dealing with donors and their families. Concerns about lack of knowledge and experience of organ donation have been expressed among such professionals but there is a paucity of literature to indicate the basis of such concerns and where knowledge may be lacking. Given that regional variations in organ donation rates exist in the UK, this study investigates knowledge about and attitudes towards organ donation among student nurses in different countries of the UK and examines regional variations.

METHODS

A questionnaire was distributed to 667 student nurses (female:male = 582∶85) aged 18 to 50 years (mean [SD] 25.4 [7.1] years) recruited from a total of five Universities (Scotland, Wales, Northern Ireland, England) during the period of January to September 2011.

RESULTS

Registration behaviour among participants was shown to vary depending upon many different factors that include birthplace, residency, fear of death and concerns of medical distrust.

CONCLUSIONS

Regional variations in organ donation behaviour in the UK were found in the cohorts of student nurses who participated in this study. These variations include willingness to register and to donate specific body parts and not others. The relationship between attitude and behaviour and how this may influence the decision making process of organ donation, as well as the underlying factors that result in regional variations, require further investigation.

An analysis of knowledge and attitudes of hospice staff towards organ and tissue donation

BACKGROUND

Only a minority of hospice patients eligible to donate tissue and organs choose to do so. Hospice care staff play a key role in discussions about donation, but their willingness to engage in these discussions and their understanding of issues around tissue and organ donation is poorly understood.

AIMS

To (i) identify factors associated with the wish of hospice doctors, nurses and healthcare assistants to donate their own organs after death; (ii) survey the experience of discussing the subject with patients; (iii) determine staff members' knowledge of organ and tissue donation and (iv) identify factors associated with knowledge of organ and tissue donation.

DESIGN

Cross-sectional questionnaire survey of hospice care staff.

SETTING/PARTICIPANTS

76 of the 94 care staff of one large UK hospice completed and returned the questionnaire.

RESULTS

Staff wishing to donate their organs after death (43/76 56.6%) were more likely to be doctors or nurses than healthcare assistants (p=0.011) and more likely to have discussed organ or tissue donation with their family (p<0.001). Staff reporting ever having discussed donation with patients had more years' experience (p=0.045) and had similarly discussed donation with their own family (p=0.039). Those with greater knowledge were more likely to have discussed organ or tissue donation with a patient (p=0.042).

CONCLUSIONS

A reluctance to instigate discussions about organ and tissue donation may prevent palliative patients and their families being allowed the opportunity to donate. Suboptimal knowledge among hospice staff suggests the need for greater liaison between hospice staff, and the organ and tissue donation teams.