Mr.A.R. Krishnaswamy,Transplant Coordinator,Madras Medical Mission, Chennai

The ultimate goal of any Organ Procurement Organization is assisting reffering Hospitals and Transplant Centers in potential donor situation. Formulation of  protocols for the identificaion and early referral of potential organ donors is a first step in a sucessful process. Formalising and organizing a consistent and sensitive consent process is the final step that must be achieved. All around the globe there is discrepancy between the supply and the demand for organs. Increasing the donor pool must be one of the successful objective of any Organ Procurement Organization (OPO).   

Steps to a positive outcome

Seeking a positive outcome in consent for organ donation is a process that should begin as soon as the patient is identified as a potential donor. This is not to imply that families of potential organ donors should be asked about organ donation too early in the process by the healthcare team. The healthcare team can facilities the outcome of the eventual consent discussion by constantly assessing the family’s needs and providing honest, understandable explanations about their loved one’s status, test results and prognosis.We can formalize the hospital protocol to safeguard the quality of the donation process from the moment the family arrives until they eventually leave the hospital. Only hospital staff can provide this care to the family. In formulating such prptocol, it is believed that the following are essential elements that healthcare team should follow whwn considering a patient as a potential donor candidate. Ideally, the approach to the family is an ongoing process with the participation of entire healthcare team.

Physicians: The physician will identify the patient as a potential donor and make the referral to the Organ Procurement Organization as soon as brain is suspected. Families of all potential donors should be given a clear, concise explanation of brain death. The physician should communicate openly and honestly with the family about the patient’s terminal status and explain brain death so that family understands death has occurred. Brain death is difficult concept, and even many healthcare professionals understand it poorly. The manner in which families are informed about the brain death diagnosis is often non-uniform and ambiguous. As a result, families often do not understand that death has occurred.

Nurses: Nurses involved in the patient’s care can reinforce the physician’s discussion by spending time with the family members and answering questions they may have regarding the patient’s condition. Information regarding patient’s condition and progress should be discussed with family on a continual basis in a sensitive and consistent manner. Above all, the communication between all members of the healthcare team and the family need to unwavering and consistent.

Decoupling: The families need some amount of time between being informed about their death of loved one and the discussion about organ donation – “decoupling.” More often than not, we tend to jump into the donation conversation before families have had an opportunity to comprehend that their loved one is dead. It is clearly the inappropriate time to discuss organ donation at the same as the family is informed that their loved one is dead. Families need some amount of time to begin to absorb the loss prior to discussion about organ donation.

Organ Recovery Personnel: when the transplant coordinator arrives at hospital, the patient’s record and medical status should be reviewed prior to any discussion regarding organ donation. Gathering information on a specific patient is essential in giving family detailed information pertinent to their loved one’s potential donation. It is suggested that key members of potential donor’s healthcare team spend a brief amount of time discussing the family’s needs, what they have been told, their reaction, family dynamics and timing for the approach.

Family Issue: Requesting organ donation with yes or no question or seeking an immediate response puts unnecessary pressure on family. Simply asking the question does not afford the family appropriate information to make their decision, and consequently, most families will give a negative response. Family should be given detailed information regarding all option of their particular situation in order to make as adequate decision regarding donation. This type of discussion with the family can take a substantial amount of time, but it is time well spent if the family feels that they have given ample information to make an informed decision. An informative and compassionate approach in offering the option of donation is, by its nature, very beneficial. The family may decline that option, but if they have been adequately informed, honestly apprised of their loved one’s condition, and given the opportunity to make choices based upon their own and their loved one’s wishes and values, then they have been afforded an excellent level of care.