FAMILY INTERVIEW

FAMILY APPROACH 2nd part: REQUEST FOR ORGAN DONATION

Danica Avsec, MDKey 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 donationTechnical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


Request for the donation

Consent for the donation To evaluate biological risk factorsTechnical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


Opposition to Donation, ETPOD

Important number of lost Donors in many countries Correctable causeLess than 10% opposition can be achieved



OPT IN countries, 2011 Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013



Chart1

014.7

06.7

5213.2

283.6

3512.5

744.2

4317

RR

DDR

Sheet1

RRDDR

Germanynd14.7

Icelandnd6.7

Netherlands5213.2

Romania283.6

Switzerland3512.5

Turkey744.2

UK4317

Correctable elementsLegislation (ETPOD)Psycholgical aspect AGREE modelOther socio cultural aspectsReligious statementPublic awarenessEducational levelAdditional strategies



OPT IN countries, 2011 Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013



Chart1

014.7

06.7

5213.2

283.6

3512.5

744.2

4317

RR

DDR

Sheet1

RRDDR

Germanynd14.7

Icelandnd6.7

Netherlands5213.2

Romania283.6

Switzerland3512.5

Turkey744.2

UK4317

OPT OUT countries , 2011Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013



Chart1

024

030

300.5

2234

305.5

417.6

013

2516.9

017.2

025

014.7

513.1

2418.2

2220.7

2821.8

1130

2124.5

1114.4

028.4

1420

1012.5

1635.3

015.5

RR

DDR

Sheet1

RRDDR

AUTnd24

Belgnd30

Bulg300.5

Cro2234

Cy305.5

Czech417.6

Dennd13

Est2516.9

Finnd17.2

Frand25

Greend14.7

Hun513.1

Lat2418.2

Ir2220.7

IT2821.8

Mal1130

Nor2124.5

Pol1114.4

Portnd28.4

SLO1420

Slova1012.5

Spain1635.3

Swend15.5

Correctable elementsLegislationPsychological frameAGREE model -100% agreementOther socio cultural aspectsPublic awarenessEducational levelReligious statements



Psychological frameAbsolutely crucialWay of communicationEmotional releaseEmpathyFacilitating the proces of grievingIs essential for developing the trust



Trust

Developing the trust starts at the time of admission the patients and when first time contacting the familyTechnical 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

LegislationPsychological aspectAGREE modelOther socio cultural aspectsReligious statementPublic awarenesEducational level



AGREE studyFamily interview guide for requesting organ donation for transplantation and evaluation using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrumentOrgans Tissues & Cells. 2012, November, 15, 3: 163

100% (40 interviews and 4 interviewers) consent from Jan 2011 to Aug 2012Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


Family interview guidelinesCabalero et all, ORGANS, TISSUES & CELLS, (15), 163-169, 2012



Planning for the family interviewTechnical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


Monitoring and assesment of the procedure is importantAnnual revision



Correctable elementsLegislationPsychological aspectAGREE modelOther socio cultural aspectsPublic awarenesEducational levelReligious statement



Public awareness

Starts with open discussion within familyThe 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



Solidarity as an argument for Donation, ETPODTechnical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


More arguments for Donation, ETPODTechnical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


Strategies to decrease family refusal rate, ETPOD

Deceased did not wish to donateTry to find if it is true

Fear of the integrity and image of the corpseExplain the process and assure respect and care of the corpse

Religious objectionsMost main religious promote donationOffer the opportunity to consult a RL

Dissatisfaction with the health care proceduresAccept complainsSeparate it from the donation



WHEN1. 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 patients 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 presentTechnical 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 patients death, it is advisable to wait for families prompts such as: What should we do now?



General recommendations 24. 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.



To concludeBe aware : Giving bad news about dead is more difficult than asking for donation



Teekkr ederimTechnical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014


Documents

FAMILY INTERVIEW