Full Text View
The impact of organ donation specialists on consent rate in challenging organ donation conversations
Sam Radford, Rohit D'Costa, Helen Opdam, Mark McDonald, Daryl Jones, Michael Bailey, Rinaldo Bellomo
Crit Care Resusc 2020; 22 (4): 297-302
- Sam Radford 1, 2, 3
- Rohit D'Costa 1, 4
- Helen Opdam 2, 5
- Mark McDonald 5
- Daryl Jones 2, 6, 7
- Michael Bailey 6, 7
- Rinaldo Bellomo 2, 3, 4, 6, 7
BACKGROUND: Consent rates for organ donation conversations (ODCs) vary. We hypothesised that a simple grading system could identify challenging ODCs. We further hypothesised that challenging ODCs would have higher consent rates when conducted by ODC specialists.
OBJECTIVES: We aimed to study the utility of a grading system for ODCs and test the hypothesis that any training effect would be associated with improved consent rates in ODCs graded as most challenging. METHODS: We stratified 2017 Australian DonateLife Audit aggregate consent and donation discussion data into four ODC grades based on Australian Organ Donor Register (AODR) status and person first raising the topic of organ donation. Grade I: "yes" present on AODR and family-raised organ donation; Grade II: "yes" present on AODR, and clinician-raised organ donation; Grade III: no registration on AODR but family-raised organ donation; and Grade IV: no registration on AODR, and clinician-raised organ donation.
RESULTS: Grade I ODCs were uncommon 7.7% (109/1420), with a consent rate of 95.4% (104/109). Grade IV ODCs were frequent (60.4%, 857/1420), with a consent rate of 41.4% (355/857). However, in Grade IV ODCs, organ donation specialist consent rate was 53.5% (189/353), significantly greater than for other trained staff at 33.1% (88/266) (P < 0.005; odds ratio [OR], 2.33; 95% CI, 1.68– 3.24) or untrained requestors at 32.8% (78/238; P < 0.005; OR, 2.36; 95% CI. 1.68–3.33).
CONCLUSION: The likelihood of consent can be predicted using readily available variables. This allows prospective identification of Grade IV ODCs, which carry low but potentially modifiable likelihood of consent. Involving donation specialists was associated with more consents for organ donation when applied retrospectively to Australian audit data.
- Lewis VJ, White VM, Bell A, Mehakovic E. Towards a national model for organ donation requests in Australia: evaluation of a pilot model. Crit Care Resusc 2015; 17: 233-8.
- Marck CH, Neate SL, Skinner MR, et al. Factors relating to consent for organ donation: prospective data on potential organ donors. Intern Med J 2015; 45: 40-7.
- Vincent A, Logan L. Consent for organ donation. Br J Anaesth 2012; 108 (Suppl): i80-7.
- Rodrigue JR, Cornell DL, Howard RJ. The instability of organ donation decisions by next-of-kin and factors that predict it. Am J Transplant 2008; 8: 2661-7.
- Siminoff LA, Molisani AJ, Traino HM. A comparison of the request process and outcomes in adult and pediatric organ donation. Pediatrics 2015; 136: e108-14.
- Hulme W, Allen J, Manara AR, et al. Factors influencing the family consent rate for organ donation in the UK. Anaesthesia 2016; 71: 1053-63.
- Potter JE, Perry L, Elliott RM, et al. Communication with Families Regarding Organ and Tissue Donation after Death in Intensive Care (COMFORT): a multicentre before-and-after study. Crit Care Resusc 2018; 20: 268-76.
- Shemie SD, Robertson A, Beitel J, et al. End-of-life conversations with families of potential donors: leading practices in offering the opportunity for organ donation. Transplantation 2017; 101: S17-26.
- Rodrigue JR, Cornell DL, Krouse J, Howard RJ. Family initiated discussions about organ donation at the time of death: Family initiated donation discussions. Clin Transplant 2018; 24: 493-9.
- Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-11
- Hurd CJ, Curtis JR. The intensive care unit family conference. Teaching a critical intensive care unit procedure. Ann Am Thorac Soc 2015; 12: 469-71.
MethodsWe developed an ODC grading system using two readily identified variables (each with only binary answers) to stratify all ODCs prospectively into one of four grades as described below:
- Grade I ODCs included cases where the donor was known to be registered “yes” in the AODR and the family raised the topic of organ donation.
- Grade II ODCs were those where the AODR status was known to be “yes” and the topic of organ donation was raised by clinicians.
- Grade III ODCs were those where the family raised organ donation but the AODR status was either unknown or the potential donor was not registered.
- Grade IV ODCs were those in which the topic of organ donation was raised by clinicians and the AODR status was either unknown or not registered.
The limited dataset approved for release and analysis included the following fields:
- AODR status (yes/no/not checked);
- donation raised by (family/staff);
- consent outcome for organ and tissue donation (yes/no);
- level of training of the family donation conversation (FDC) requestor (FDC trained yes/no); and
- donation specialist position (yes/no).We defined the tier of training as one of three levels based on completion of FDC core training workshop and professional role (Table 1).