Implementation of clinical guidelines for requesting family informed consent to deceased organ donation for transplantation: positive effect on consent rates (original) (raw)
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Organ donation procedures: an epidemiological study
Progress in transplantation (Aliso Viejo, Calif.), 2010
To evaluate the impact of organ and tissue donation processes on family members of deceased donors and the probability that they would be an organ or tissue donor in the future. Cross-sectional survey of 69 families of deceased donors of the organ procurement organizations of the Federal University of São Paulo. Donors were predominantly men (57% vs 43%) with a median age of 35.9 years. The primary causes of death were classified as natural (65%), traumatic injury (33%), and other (1%). Of the family members surveyed, 40% had an elementary school education and 59% were unemployed. Family members expressed an understanding of the brain death diagnosis (67%). Among them, 74% had no doubt about brain death and had time to ask questions. The diagnosis was provided by the doctor responsible for the patient (89%). Family members also used funeral aid benefit (63%), perceived organ donation positively (97%), and indicated that they would donate again (79%). A significant relationship was f...
Brain-dead donors (BDD) are the single largest source of transplantable organs. Families’ informed consent to donate family members’ organs is always requested and is a determining factor in the success of organ transplantation. The interview between the transplant coordinator (TC) and the family of possible organ donors requires specific planning and methodology. The transplant coordination department at the Hospital de la Santa Creu i Sant Pau (HSCSP) of Barcelona (Spain) has developed a Family Interview Guide (FIG) for requesting informed consent to organ donation for transplantation from BDD. For the internal evaluation of the guidelines presented in this paper, the AGREE II (Appraisal of Guidelines Research & Evaluation) instrument was used. We present our FIG to request organ donation and its assessment with the AGREE II instrument by four medical specialists. The FIG describes the process and content of the conversations surrounding the donation request. FIG was implemented in 2011 and consists of the following 13 sections: planning, recommendations, professionals conducting the interview, requestor’s attitude towards families, interview setting, timing of the interview, duration of the interview, requesting informed consent, details of the donation process to the donor’s family, formalizing the agreement, donor documentation, funeral arrangements administration procedures and psychological support for donor families. The main purpose of this guide is to increase organ donation rates. From January 2011 to August 2012, 40 consecutive family interviews from 40 BDD were conducted using FIG. For the evaluation of this FIG the AGREE II instrument was used. This is a generic tool designed primarily to assist designers and users of clinical guidelines in the assessment of their methodological quality. The rate of family consent to organ donation for transplantation in the HSCSP after implementation of this FIG in 40 consecutive family interviews was 100%. The assessment of this clinical guideline with the AGREE II instrument scored 71%. The application of our guideline in face-to-face interviews with the families of potential brain-dead organ donors was a success. The evaluation of our guide with the AGREE II instrument recommended its use in general clinical practice.
OVERVIEW OF ORGAN DONATION IN BRAZIL - A BIBLIOGRAPHIC REVIEW (Atena Editora)
OVERVIEW OF ORGAN DONATION IN BRAZIL - A BIBLIOGRAPHIC REVIEW (Atena Editora), 2022
Given the importance of transplants for the treatment of various diseases and the unfavorable relationship between demand and supply of organs, it is necessary to understand the details of the donation process. This bibliographic review aims to discuss the current situation of organ donation in Brazil and in the world, focusing on national guidelines for determining brain death and the challenges faced in obtaining family consent for donation. Foreign strategies to reduce transplant waiting lists were also reviewed, in order to raise the reflection on the possibilities of confronting the issue on a national level. The methodology was based on the search for references using the following keywords: Organ Donation; Organ transplantation; guidelines; Brain Death; Consent. The current scenario of organ donation, although far from ideal, has the possibility of improvement, once efforts are implemented to understand and mitigate the reasons for refusing consent to donation.
Organ donation and family decision-making within the Spanish donation system
Social Science & Medicine, 2001
This study analyses the variables associated with the decisions made by families of potential organ donors to give or deny consent for the extraction of organs. Different indicators were recorded in 68 cases of family interview for petition of consent carried out in 13 Spanish hospitals. Those variables showing the strongest relation with family decision (donation/refusal of consent) are knowledge shown by the family about the deceased's wishes with regard to donation (p50:001), family relationship climate (p50:01), expression of family's satisfaction level with medical attention received (p50:01) and number of relatives present at the consent request interview (p50.01). Logistic regression on family decision with considered variables correctly predicted relatives' final choice in 98.4% of cases. In turn, multivariate exploratory analysis highlights a potential association between the expression of the deceased's wishes and several concurrent variables in the process (satisfaction with personal treatment and medical attention received, emotional reactions in the interviews of notification of death and consent request). It also shows that patterns of reaction and family participation in this process may vary according to the sex of the deceased relative. Results suggest that both educational efforts devoted to promoting a positive attitude toward donation in the general population and the training of health professionals involved in the generation of organs may be key factors in reducing organ shortage. #
Organ Donation: Acceptance and Refusal Among Users of the Public Health System From Brazil
Transplantation Proceedings, 2008
The present study sought to identify the perception of a given group of users of the Brazilian Public Health System (Sistema Único de Saúde) regarding organ donation and to implement an educational policy. Structured interviews were conducted with the aim of describing the profile of donor and nondonor subjects, the importance of organ donation, and the knowledge regarding donation and brain death. One hundred subjects were interviewed: 33% of them considered themselves potential donors; 40% were donors; 13% were nondonors; and 14% were ill-informed potential donors. However, only 40% of users have already officially expressed to their families a willingness to donate. Regarding their knowledge about the propitious moment for organ donation, only 64% of them associated the donation act with brain death. Although the present results revealed that users of the Brazilian Public Health System are prone to organ donation, there actually was a high amount of refusals, which may be due to lack of information and knowledge regarding the donation-transplantation process.
Process of Organ Donation and Tissue in Hospital Units
International Archives of Medicine, 2016
Background: To describe the process of organ and tissue donation for transplantation in hospitals in the northeastern of Brazil. Methods: This is a quantitative, descriptive, prospective study with 65 potential donors, using a structured script of non-participant observation and institutional documents. Data were analyzed using descriptive statistics. Results: There were 65 potential of donors, 59 (90.7%) of them underwent laboratory tests to evaluate the functioning of the organs, 49 (75.4%) were evaluated regarding the diagnosis of Brain Death (BD), 37 (56.9%) families were interviewed, 20 (30.7%) of them authorized the donation and 18 (27.7%) had their organs donated. In the donation process, the steps of evaluation, maintenance and diagnosis of BD presented the biggest problems. Conclusions: It was identified that several procedures of the donation process were weak, contributing to low effectiveness. These data support the planning of actions related to organ donation, enabling reflexive action on the process.
Minerva anestesiologica, 2018
Family refusal (FR) to heart beating donation (HBD) in Intensive Care Unit (ICU) is increasing in recent years with a significant impact on the number of transplantable organs. Fostering setting humanization, quality of relationships, respect for will and family reliance towards ICU could be relevant in containing FR to organ donation (OD) in ICU. Our aims were to highlight the effects of structural features of ICUs and humanization determinants on FR in HBD process, and to describe visiting policies, structure and modalities of support in ICUs. A survey was conducted among all the ICUs of the Tuscany Region included in the National Transplant System of the Ministry of Health in Italy. Data on ICUs' general and architectural characteristics, visiting policies and support for families were collected. Baseline characteristics of brain dead certified patients (BDCPs) were retrieved from the Registry of the Regional Transplant Centre. 29 (93.5%) ICUs out of 31 completed the survey. ...
Dahili ve cerrahi bilimler yoğun bakım dergisi, 2019
Objective: The aim of this study was to investigate the attitudes of patient relatives about organ donation for patients with brain death diagnosis and to identify the cause of negative attitudes related to donation. Methods: A retrospective examination was made of the archived records of patients with brain death (BD) diagnosis from September 2007 to August 2018 in Anesthesia Reanimation Intensive Care Unit. Demographic factors of the cases with BD such as age, gender, and admission diagnosis were recorded. The patient families were then contacted by telephone and organ donation acceptance or rejection was assessed in terms of reasons. Results: A total of 86 cases with brain death diagnosis were identified. When cases were assessed in terms of admission diagnoses, post-CPR hypoxic brain was the most common diagnosis (30.2%). The organ donation rate was identified as 12.8% (n=11). The mean age of patients was 31.09±20.98 years in those who donated organs, and 35.62±21.45 years in those whose families rejected donation (p=0.614). When the factors causing brain death of patients with organ donation were assessed, 54.4% died due to traumatic reasons. The two most important factors identified in the study for families rejecting organ donation were religious beliefs (41.3%) and beliefs about not disrupting the integrity of the body after death (37.3%). The most important factor for acceptance was the wish to help other people (91%). Conclusion: In our study, religious beliefs were found as the main reason for rejection of organ donation. To be able to increase cadaver-sourced donation rates, there is a need for society to be informed by religious leaders, family interviews should be held with an experienced and trained organ donation coordinator and families should definitely be fully informed about the sensitivity shown to bodily integrity during the organ donation procedure and surgical procedures.
Influence of knowledge for organ and tissue donation for transplantation
International Journal of Advanced Engineering Research and Science, 2020
Objective: to investigate the opinion and intention of the adult population in the city of Belém, State of Pará, Brazil, regarding the donation of organs and tissues for transplantation. Method: a crosssectional, population-based, descriptive study with a quantitative approach, carried out in the city of Belém of Pará, Brazil, from July to August 2019. Results: 387 participants were interviewed, where 70.8% expressed a positive opinion regarding donation and intention to donate organs and tissues; and 50.9% had expressed their desire to be a donor to a family member. 88.6% of the interviewees would authorize the donation of organs and tissues after the death of a family member, provided that he previously expressed his willingness to be a donor. However, only 59.7% would authorize the donation of organs from a loved one diagnosed with brain death. There was a greater intention to donate, among female individuals, aged between 18 to 27 years, students, with family income between 3 to 5 minimum wages, who have children, Catholics and who live 3 to 4 hours a day with the family. Conclusion: this study allows us to conclude that older individuals with less education have less intention to donate their organs. The lack of information on organ donation and transplantation and all the consequences of not knowing the donation process is certainly a limiting factor for the increase in the number of donors.