A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation

Abstract

BACKGROUND AND OBJECTIVES: Although existing studies suggest that factors affecting families' decisions regarding pediatric organ donation mirror those for adult patients, health professionals working in this area maintain that pediatric and adult decision-makers differ in significant ways. This study compared the request process, experiences, and authorization decisions between family decision-makers (FDMs) of adult and pediatric donors and nondonors.METHODS: Perceptions of the donation request were collected via telephone interviews with 1601 FDMs approached by staff from 9 US organ procurement organizations (OPOs). Authorization regarding donation (ie, authorized/refused) was obtained from FDM reports and verified by using OPO records. Tests of association were used to estimate differences between FDMs of adult and pediatric patients. A logistic regression analysis was conducted to identify variables predicting FDM authorization.RESULTS: FDMs of children were significantly more likely to authorize donation than were FDMs of adults (89.7% vs 83.2%; x 2 = 6.2, P = .01). Differences were found between pediatric and adult families' initial feelings toward donation, donation-related topics discussed, communication behaviors and techniques used, perceptions of the request, and receipt and preference of grief information. The likelihood of FDM authorization increased with the number of topics discussed and communication skills employed during requests. Authorization was not predicted by patient age (ie, adult versus pediatric).CONCLUSIONS: FDMs of children are willing to donate and experience no more psychological distress from the request for donation than do FDMs of adults. Communication emerged as a critical factor of family authorization, reinforcing its importance in requests for donation.

A Comparison of Request Process and Outcomes in Donation After Cardiac Death and Donation After Brain Death: Results From a National Study

“…To recruit family decision makers (FDMs), a validated contact and interview protocol was employed. (18–21) FDMs were mailed recruitment packets two months after the organ donation approach (3 months for families of pediatric patients). Of the 2,232 individuals contacted, 1,601 (71.7%) FDMs agreed to be interviewed; 1,254 (78.3%) were FDMs of DBD patients; and 347 (21.7%) were FDMs of potential DCD patients.…”

“…Semi-structured telephone interviews, which have been validated for use with this population in previous studies,(18–21) were conducted with participating families of donor-eligible patients. The interviews collected FDMs’ sociodemographic data, attitudes and knowledge about donation, assessment of the quality and content of the donation discussions held at the hospital, final donation decisions ( authorized/refused ), and reasons for that decision.…”

Challenges of paediatric organ donation

“…Consent for OD is almost exclusively provided by next of kin or appointed guardian. Decision makers for both adults and children consent relatively equally and the depth and detail of the donation discussion is associated with higher consent rates . Consent rates in Europe, North America, the UK and Australia for both adults and children range from 42 to 69% .…”

“…Decision makers for both adults and children consent relatively equally and the depth and detail of the donation discussion is associated with higher consent rates. 30 Consent rates in Europe, North America, the UK and Australia for both adults and children range from 42 to 69%. 7,29,[31][32][33][34][35] In Australia, the rate is similar for adult (52.8%) 33 and paediatric (50%) patients.…”

Regional Differences in Communication Process and Outcomes of Requests for Solid Organ Donation

“…A recent analysis of potential brain‐dead eligible donors found that family authorization rates for deceased organ donation following an eligible death varied significantly between DSAs, resulting in a loss of >5700 transplantable organs during a 5‐ear period . A large body of research demonstrates the critical importance of communication to family authorization of donation . This report examines the communication processes and outcomes in requests for solid organ donation made by OPO staff in 8 of the 11 OPTN regions.…”