Family Approach

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FAMILY APPROACH 2nd part:
REQUEST FOR
ORGAN DONATION
Danica Avsec, MD
Key expert for Education and Communication
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014
FAMILY INTERVIEW
 How to break bad news
 Request for the donation
Technical Assistance for Alignment in Organ Donation project,
1st International Symposium 2014
Request for the donation
Consent for the donation
To evaluate biological risk factors
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014
Opposition to Donation,
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
OPT IN countries, 2011
Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
80
70
60
50
40
30
RR
20
DDR
10
0
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014
Correctable elements
•
•
•
•
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
OPT IN countries, 2011
Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013
80
70
60
50
40
30
RR
20
DDR
10
0
Technical Assistance for Alignment in Organ Donation project, 1st
International Symposium 2014
OPT OUT countries , 2011
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
Correctable elements
•
•
•
•
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
Psychological frame
•
•
•
•
•
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
Trust
• 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
Effectiveness of communication
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
Correctable elements
•
•
•
•
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
AGREE study
• 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
Planning for the family interview
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
Planning for the family interview
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
Planning for the family interview
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
Correctable elements
•
•
•
•
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
Public awareness
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
Strategies to decrease family refusal
rate,
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
WHEN
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
General recommendation 1
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
General recommendations 2
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
To conclude
• 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
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