Case Study: Family Presence in the OR for Donation After Cardiac Death

Abstract

Organ donation after cardiac death is an ethical and acceptable practice of providing organs for transplantation. Organ recovery, the removal of life support, and patient death occur in the OR, and, because family members are not present, some feel that they have abandoned their loved one. This article reports a case study of a young woman brought to a level I trauma center with nonsurvivable injuries from a motor vehicle accident. When clinical examinations revealed no hope of recovery, the family agreed to organ donation if the mother could be present in the OR when life support was terminated. Family member presence during organ donation may provide a sense that some good has come of a personal tragedy. Although family requests may be unsettling, advocating for the patient and family is part of the nurse's role.

Perioperative nurses’ experiences of caring for donation after cardiac death organ donors and their family within the operating room

“…These differences were noteworthy of where withdrawal of treatment occurred for the donor such as on the OR bed, the anaesthetic room or a room adjacent to the OR. Within the literature, these practices were endorsed and reported as routine (Joris et al 2011, Manara et al 2012, Reed et al 2012). However, given these scenarios often played out in plain view of scrubbed (nursing and medical) staff who were awaiting to commence the organ procurement procedure.…”

“…Withdrawal of supportive treatment for DCD donors may occur in various locations of the hospital dependent on where the patient is located within the hospital setting (ward/department), the specific needs of the donor’s family and the individual health care facilities own policy, practice and procedures in relation to facilitating DCD (Cowl et al 2012, Coulson et al 2012, Joris et al 2011). Hence, withdrawal of treatment may occur within the intensive care unit (ICU), a room close to the operating room (OR) or within the OR itself, with or without the family being present at the time of death (Coleman et al 2008, Cowl et al 2012, Joris et al 2011, Reed et al 2012). For DCD donors, death must occur prior to organ procurement via a controlled or uncontrolled pathway (Manara et al 2012).…”

“…DCD procedures undertaken on both paediatric and adult donors have been reported to challenge health professionals’ ethical and conventional views of death, appropriate end of life care and further their views of what constitutes a dignified death (Cowl et al 2012, Curley et al 2007, Hart et al 2012). Moreover, several studies have identified health care professionals’ lack of knowledge, understanding and misconceptions about the DCD process along with a variety of attitudes and beliefs (Cowl et al 2012, Curley et al 2007, D’Alessandro et al 2008, Hart et al 2012, Joris et al 2011, Reed et al 2012, Rodríguez-Arias et al 2013). A major issue raised within the literature was health professionals concerns about concomitantly caring for the donor and initiating discussions with families to advocate organ donation (D’Alessandro et al 2008, Hart et al 2012).…”

“…In the context of organ procurement surgery, there is a dearth of research exploring the experiences of perioperative nurses involved with DCD procedures and the impact of caring for these donors and their family within the OR context (Smith 2012). Previous research encompassing DCD donors or care of family within the OR (Flodén & Forsberg 2009, Manzari et al 2012, Regehr et al 2004, Smith 2012, Walker & Sque 2016) along with anecdotal accounts and case studies (Reed et al 2012) have provided a glimpse into the issues faced by perioperative nurses. Yet, recent research has shown that problems still persist in current daily practice, where lacking knowledge, education and support resources are absent or delivery is fragmented towards the specialty of perioperative nursing within rural, regional or metropolitan areas (Smith 2012).…”

New Decade, New Design for the AORN Journal

“…We have also taken some risks in soliciting and accepting manuscripts that address new ways to look at the nursing care provided in the perioperative setting. In this issue, Balogh‐Mitchell 2 writes about family presence during resuscitation in the OR, and Reed et al 3 discuss family presence during organ donation. These would be considered controversial topics by some health care providers, but, in my experience, they are being discussed by a growing number of clinicians.…”