Grief Reactions of Potential Organ Donors' Bereaved Relatives: An Observational Study

Requesting Relatives' Consent for Intensive Care for Organ Donation: An Empirical Analysis of Spanish Transplant Coordinators' Practices

BACKGROUND

Intensive care to facilitate organ donation (ICOD) involves the initiation or continuation of intensive care for patients with devastating brain injury for donation purposes. In the Spanish system, relatives undergo an early interview to request consent for this procedure. If they consent, a waiting time is agreed upon in the expectation that death by neurological criteria occurs and donation after brain death takes place. Otherwise, relatives can decide on donation after circulatory determination of death or withdrawal of life support. This study analyzes how Spanish transplant coordinators interact with relatives in early interviews and follow-ups on potential donation pathways.

METHODS

Semistructured interviews were conducted with a random stratified sample of 23 Spanish transplant coordination teams to explore strategies, practices, and perceptions of ICOD consent requests. The interviews were recorded, transcribed, and analyzed using content analysis.

RESULTS

Previous coordination with other units and information retrieval regarding patient and relatives' situations is crucial. The development of early interviews includes an introduction to the family, identification of decision makers, empathizing with relatives and offering condolences, reaffirming the fatal prognosis, explaining the possibility of donating based on the patient's will, confirming the family's understanding and resolving doubts, and ensuring comfort and assessing family needs.

CONCLUSIONS

Approaching families to obtain ICOD consent is a regular practice for Spanish coordination teams. It involves a highly professional and diversified set of strategies based on establishing a support relationship for relatives. Our study provides strategies that serve as a reference for obtaining ICOD consent from families in other settings.

Alleviating the emotional burden on families during organ donation requests in neurologic patients declared with brain death: the role of timing and circumstances of death

Organ donation requests to families often occur during moments of profound grief and create an emotional burden that is compounded by the varying emotional responses to circumstances surrounding death. These responses, in turn, interact with the timing of the request to influence authorization decisions. Understanding the interplay between timing and circumstances of death is crucial for improving authorization rates and addressing the organ donor shortage. The Organ Retrieval and Collection of Health Information for Donation database was used to identify 3,289 potential donors with neurologic mechanisms of brain death. Multivariate logistic regression with interaction between timing and circumstance was used to estimate authorization rates. Results show no significant differences in authorization for requests made within 12 h of death, regardless of circumstance. However, significant differences in authorization were observed between requests made at the time of brain death and those made 12 or more hours later for natural causes, as well as those at 24 or more hours for homicide, motor vehicle accidents, and non-motor vehicle accidents. These findings indicate that the optimal timing for organ donation requests may depend on the emotional intensity of the situation. While quicker requests may be more effective in less emotionally charged cases, extending the time for families to grieve in highly distressing circumstances does not appear to negatively impact authorization rates. Tailoring the timing of donation requests to the circumstances of death, balancing sensitivity with the need for prompt decision-making, could reduce families' emotional burden, ease pressure in decision-making, and help address the shortage of organ donors.

Transforming organ donation and transplantation: Strategies for increasing donor participation and system efficiency

Organ transplantation is a critical medical procedure that saves and improves lives, yet the system faces significant challenges that result in many missed opportunities. This comprehensive review examines the factors contributing to these missed opportunities and the concerns of potential donors. The shortage of donors remains a major issue, exacerbated by low registration rates, family consent refusals, and strict medical and health criteria. Inefficiencies within the organ procurement and transplantation process, including logistical delays and suboptimal matching systems, further hinder the availability of organs. Public misconceptions and cultural and religious beliefs also negatively impact donor willingness. Moreover, potential donors and their families face ethical, psychological, and procedural concerns. Ethical dilemmas revolve around issues of autonomy and informed consent, while psychological concerns include fear and anxiety about the donation process and its impact on families. Procedural issues, such as transparency, legal hurdles, and post-donation follow-up, add to the complexities of organ donation. This review explores potential solutions to address these challenges, such as enhancing public education campaigns to dispel myths, and providing incentives for proactive registration. It also recommends improving the performance of organ procurement organizations, optimizing logistics for organ transport, and developing advanced matching algorithms to ensure equitable organ allocation. Addressing donor concerns through robust ethical standards, comprehensive psychological support, and clear communication strategies is essential. By adopting these multifaceted strategies, the organ transplantation system can be made more efficient and supportive, increasing the availability of organs and ultimately saving more lives. This review underscores the need for integrated and targeted approaches to overcome the existing barriers in organ transplantation.

Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study

Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.

A mixed-methods study of emotional support for families of organ donors in Hunan Province, China

Background

Family consent is a prerequisite for the organ donation of the deceased in China. However, a large number of donors are individuals who died due to accidental injuries or unanticipated diseases, which means that most of the families of such donors have just experienced the sudden death of their loved one and have to make a donation decision in a short time. This decision may cause psychological stress and some psychological damage to the minds of relatives of the donors. In addition, cultural sensitivity also has largely caused the relatives of donors inner conflicts and contradictions. And sometimes organ donation may still be stigmatized. However, have they received any emotional support and what is their emotional support needs are some questions that need to be answered. Therefore, this study aims to investigate the emotional support, influencing factors, and needs of the family members of organ donors in Hunan Province, China.

Materials and methods

This is mixed-methods research that combines quantitative and qualitative research methods. A cross-sectional survey was conducted among 102 donor families using a questionnaire to investigate their emotional support status. To further understand their emotional support needs, 12 donor families participated in the semi-structured interview.

Results

The results confirmed that: (1) A total of 67.7% of the 102 respondents received emotional support or psychological comfort. Thus, only a small number of respondents (31.4%) felt respected by the public. (2) Emotional support came mainly from immediate family members (73.91%), and official organizations such as the Red Cross (43.48%). (3) Marital status, health status, occupation, and coping style can affect the emotional support of the donor families (p < 0.05). (4) Interview showed that the families of donors need emotional support and psychological aid from psychological professionals mostly. And they also wish to receive the understanding and respect of the public.

Conclusion

Most families of organ donors received emotional support from family, Red Cross, and friends, but only a minority of families of donors reported receiving respect from the public after the donation. And families of donor showed a strong need for emotional support and professional psychological aid from institutions.

A Systematic Review on Improving the Family Experience After Consent for Deceased Organ Donation

Introduction

The demand for transplanted organs outweighs the supply and intensifies the need to improve care for donor families. Studies have shown inadequate care by hospital staff can increase posttraumatic stress disorder and complicated grief in these families but putting solutions into practice remains slow.

Objective

This systematic review identified factors that relieve or contribute to distress for deceased organ donor families in the time since the decision to donate. Additionally, it provides insights into potential improvements at public health, educational, and health system levels to address these deficiencies.

Methods

Search terms included organ don*, famil* or relati*, family-centered, grief, and experience*. The search covered original research articles, published in English, from 2014 to July 2021.

Results

Four key themes emerged among the studies. (a) Understanding factors that affect the emotional aftermath can help staff prevent posttraumatic stress disorder and complicated grief. (b) Improving communication by hospital staff includes: avoiding medical jargon, providing adequate audio and visual explanations, and understanding that the next of kin is struggling to comprehend the tragedy and the information they are being told. (c) End-of-life care such as memory making, bringing in palliative care resources, and parting ceremonies can assist with familial coping as well as staff interactions. (d) Families want more support in the months and years after the donation decision.

Discussion

Changes at multiple levels can improve the quality of care for families whose relative gave the gift of life, but more research and translation into practice are needed.