FAMILY APPROACH FOR ORGAN DONATION

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!