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FAMILY APPROACH FOR ORGAN DONATION

FAMILY APPROACH FOR ORGAN DONATION. Essentials in Organ Donation. Opposition to Donation. First cause of Loss of Donors in many countries First correctable cause Less than 10% opposition can be achieved Influenced by Legislation Education and Organization Social Aspects Family Interview.

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FAMILY APPROACH FOR ORGAN DONATION

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  1. FAMILY APPROACH FOR ORGAN DONATION Essentials in Organ Donation

  2. Opposition to Donation • First cause of Loss of Donors in many countries • First correctable cause • Less than 10% opposition can be achieved • Influenced by • Legislation • Education and Organization • Social Aspects • Family Interview

  3. Legislation • Opting-Out Policy or Presumed Consent: • a deceased individual is classified as a potential donor, in absence of explicit opposition to donation • Opting-In Policy or Required Consent: • a person expresses her/his will to donate • Donor Card • National Registries

  4. Legislation Presumed Consent: • Gives priority to the recipient • Basis of altruism • Positive-solidarity in front of silence of deceased • Efficient • Harms no one and benefits many

  5. Legislation • Informed/Required Consent: • Gives priority to the deceased will • Basis in personal autonomy • Presumed consent countries have higher donation rates than required consent countries

  6. Education and Organization Transplants require the involvement of the whole society • School Programs • Create and reinforce positive attitudes towards donation • Adults • Campaigns, Donor Cards, Driver License • “Share your life, share your decision” • Health Workers • Create positive attitude regarding donation • Understand the whole process • Understand brain death • Their opinion will be influential to general public • Mass Media • Positive news about donation • Benefits of transplantation • Improving understanding of medical, ethical and legal aspects of the process

  7. Social Aspects • Religion • Most major religions encourage donation • Other aspects • Age, educational level, economical status • BUT • the most important predictor of consent is whether a discussion about donation had taken place before • Families who know the patient's wishes, are more likely to donate organs

  8. Family Interview • Communicative complex task • It’s not a conversation • healthcare professionals not trained • must be done by an expert • Objectives • to help families to reduce stress • to know the deceased willingness • to evaluate biological risk factors

  9. Family Interview: Three steps • Giving bad news • Difficult – not trained • Death communication • Brain-Death explanation • Supportive relationship – Empathy • Time for grief • Donation request • As an opportunity

  10. WHY IS IT DIFFICULT? Breaking Bad News

  11. Fear of • getting blamed • unleashing a reaction • feeling incompetent • feeling embarrassed

  12. Key points • Prepare the interview • Get information from ICU doctors and nurses • Right environment • Privacy • Comfortable – Seatings for all participant • Avoid barriers and interruptions • Before you tell… ask • What did they know ? • Use open-ended questions • Correct misinformation

  13. Key points • Give Information • Be clear and concise • Use his/her own vocabulary • Verify the degree of comprehension • Follow their rhythm of comprehension • Address their emotions • Observe and try to identify the experienced emotion • Establish an empathic relationship • Offer the possibility of Donation • Donation as an opportunity

  14. Communication Skills • Verbal communication • Active listening • Summarizing techniques • Metaphors • Coherent, reasoned language • Open questions • Non-Verbal communication • Silences • Eye contact • Physical position • Physical contact • Pay heed, listening and use of gestures • Warm and low tone of voice

  15. Arguments pro Donation I • Solidarity • Social • We are all involved. Any of us or our loved ones might need a transplant. • Group • People on waiting lists • Parents waiting for an organ for their child • Individual • Someone known, family or friend on dialysis

  16. Arguments pro Donation II • 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 • Help with formalities (ICU visit, legal aspects, funeral home) • Provide privacy and intimacy

  17. Strategies to face family refusal • Deceased did not wish to donate • Try to find if it is true • Family not knowing deceased will to donate • Arguments of solidarity, utility, reciprocity • Not understanding brain death • Explain brain death • 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 religious leader • Dissatisfaction with the health assistance • Accept complains • Separate the unfavorable donation context: receptors are not guilty

  18. Don't take your organs to Heaven – Heaven knows we need them here! THANK YOU FOR YOUR ATTENTION!

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