Danica Avsec, MD
Key expert for Education and Communication
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

 How to break bad news
 Request for the donation
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

Consent for the donation
To evaluate biological risk factors
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

ETPOD
 Important number of lost Donors in many countries
 Correctable cause
 Less than 10% opposition can be achieved
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

80
70
60
50
40
30
20
10
0
Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
RR
DDR
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

• Legislation (ETPOD)
• Psycholgical aspect
• AGREE model
• Other socio cultural aspects
• Religious statement
• Public awareness
• Educational level
• Additional strategies
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

80
70
60
50
40
30
20
10
0
Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
RR
DDR
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

• Legislation
• Psychological frame
• AGREE model -100% agreement
• Other socio cultural aspects
• Public awareness
• Educational level
• Religious statements
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

• Absolutely crucial
• Way of communication
• Emotional release
• Empathy
• Facilitating the proces of grieving
• Is essential for developing the trust
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

• Developing the trust starts at the time of admission the patients and when first time contacting the family
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

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”.
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

• Legislation
• Psychological aspect
• AGREE model
• Other socio cultural aspects
• Religious statement
• Public awarenes
• Educational level
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

• 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
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

Family interview guidelines
Cabalero et all, ORGANS, TISSUES & CELLS, (15), 163-169, 2012
Prepare recommendations
Make a plan for the interview
Formalize the agreement
• A signature of relatives if needed
• Donor documentation
• About funeral timing etc
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

Professionals
• Attitude of the requester
• TCs
• In combination with ICU doctors
• Well trained and skilled in communicators
Timing, place
The content
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

Professionals
Timing, place
• The most optimal time for the family
• Duration of the interview, not too long
• Quiet, comfortable room
The content
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

Professionals
Timing, place
The content
• All organs
• The process of donation
• Explain final steps
• Dignity of the donor body
• Psychological support to the family
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

• Monitoring and assesment of the procedure is important
• Annual revision
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

• Legislation
• Psychological aspect
• AGREE model
• Other socio cultural aspects
• Public awarenes
• Educational level
• Religious statement
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

 Starts with open discussion within family
 The 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
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

Solidarity as an argument for Donation
, ETPOD
Social aspect: benefit in the society
Group : somebody on the waiting list etc
Individual: somebody from the broad family
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

More arguments for Donation,
ETPOD
Utility
• Death always seems like a waste but it could be useful to someone
• Death signifies rupture, it could be a form of continuity of life for other people
Reciprocity, Generosity
• Positive arguments which elevate the image of the deceased
• We would do the same if he/she would need it?
• Tomorrow it could be for us
Facilitation
• Invite them to visit the death person in the ICU to say good by
• Provide privacy and intimacy
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

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
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

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
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

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?”
Technical Assistance for Alignment in Organ Donation project, 1st International
Symposium 2014

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.
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014

• Be aware : Giving bad news about dead is more difficult than asking for donation
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014

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Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014