COMmunication with Families regarding ORgan and Tissue Donation after Death in Intensive Care
- Publication Type:
- Thesis
- Issue Date:
- 2021
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𝗜𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝘁𝗶𝗼𝗻: Demand for organs for transplantation exceeds supply; family consent rates for deceased organ donation could increase with improving communication skills of the healthcare professionals responsible for the family donation conversation.
𝗔𝗶𝗺: To implement and trial a ‘best practice’ approach for offering deceased organ donation, to test whether the intervention increases the proportion of families providing consent; to examine families’ decision-making experiences and rates of decisional regret three months later.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀: A multicentre mixed methods study with a pre-post intervention component was performed in nine NSW intensive care units. Compared with pre-intervention controls, a prospective cohort of families of potential deceased organ donors were assigned to the “COMFORT” intervention. Families were offered bereavement aftercare and an interview 90 days later to provide their experiences.
The primary end point was the proportion of families consenting to organ donation in patients without registered donation preferences. Secondary end points were healthcare professionals’ adherence rates to the intervention, identification of predictors of the donation decision, and the proportion of families regretting their donation decision at 90 days. Descriptive statistics and logistic regression modelling were used to examine outcome data, with content analysis for free text responses.
𝗥𝗲𝘀𝘂𝗹𝘁𝘀: In total 417 patients were enrolled in the study. For patients without registered donation preferences consent was obtained in 87 of 164 (53%) cases during the intervention period compared to 14 of 25 (56%) cases pre-intervention (p = .83). The odds of obtaining consent during the intervention period relative to the pre-intervention period were 1.13, (95% CI, 0.48-2.63); p = .78.
Characteristics independently associated with family consent were identified: when families first mentioned organ donation (OR 4.34; 95% CI, 1.79-10.52; p = .001), presence of an independent designated requester (OR 3.84; 95% CI, 1.35-10.98; p = .012), the number of donation conversations per case (OR 3.35; 95% CI, 1.93-5.81; p < .001), and patients of non-Christian religion (OR 0.18; 95% CI, 0.04-0.91; p = .038). Interviewees overwhelmingly (n = 127, 97%) agreed their decision had endured at three months after enrolment.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻(𝘀): Uptake of some components of the COMFORT intervention was incomplete, and while the intervention as a whole did not significantly increase the organ donation consent rate, some elements exerted significant effect. Further work is required to identify those best practice elements that are most important and supportive for families making donation decisions; to determine strategies that might improve uptake and adherence by managing teams.
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