Exploring the psychological effects of deceased organ donation on the families of the organ donors

Merchant, Shaila J.; Yoshida, Eric M.; Lee, Tim K.; Richardson, Penny; Karlsbjerg, Kari M; Cheung, Elsie

doi:10.1111/j.1399-0012.2008.00790.x

Cited by 101 publications

(77 citation statements)

References 11 publications

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“…Providing this option by expanding newborn DCDD may also have psychological benefits for the ARTICLE grieving family. 30 For the family of a pediatric donor, some of the benefit may derive from their altruistic desire to help another child. However, because DCDD grafts are primarily being currently used for adult recipients, this situation may affect the willingness of the family to consent to donation and their overall view of the experience.…”

Section: Discussionmentioning

confidence: 99%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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BACKGROUND: Over 96 000 patients await kidney transplantation in the United States, and 35 000 more are wait-listed annually. The demand for donor kidneys far outweighs supply, resulting in significant waiting list morbidity and mortality. We sought to identify potential kidney donors among newborns because en bloc kidney transplantation donation after circulatory determination of death (DCDD) may broaden the donor pool. METHODS: We reviewed discharges from our 84-bed NICU between November 2002 and October 2012 and identified all deaths. The mode of death among potential organ donors (weight ≥1.8 kg) was recorded. Patients undergoing withdrawal of life support were further evaluated for DCDD potential. After excluding patients with medical contraindications, those with warm ischemic time (WIT) less than 120 minutes were characterized as potential kidney donors. RESULTS: There were 11 201 discharges. Of 609 deaths, 359 patients weighed ≥1.8 kg and 159 died after planned withdrawal of life support. The exact time of withdrawal could not be determined for 2 patients, and 100 had at least 1 exclusion criterion. Of the remaining patients, 42 to 57 infants were potential en bloc kidney donors depending on acceptance threshold for WIT. Applying a 40% to 70% consent rate range would yield 1.7 to 4 newborn DCDD donors per year. CONCLUSIONS: A neonatal DCDD kidney program at our institution could provide 2 to 4 paired kidneys for en bloc transplantation each year. Implementing a DCDD kidney donation program in NICUs could add a new source of donors and increase the number of kidneys available for transplantation.

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Section: Discussionmentioning

confidence: 99%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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“…However, there are often reasons for organ acceptance/declination that are unrelated to donor management or graft quality, making it difficult to truly identify best practices by merely focusing on organ utilization/transplantation rates. Additionally, of recent, the psychological and social benefits of organ donation for families of organ donors are being increasingly recognized (6). While maintaining critical care practices in these patients through the use of catastrophic brain injury guidelines (CBIG's) is encouraged by the DTCP, the direct Malinoski et al effect that this donor hospital management has on organ donation outcomes is unknown.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Malinoski¹,

Patel

Ahmed

et al. 2013

American Journal of Transplantation

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Many organ procurement organizations (OPOs) utilize preset critical care endpoints as donor management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every donor after neurologic determination of death (DNDD). "DMGs met" was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect donor hospital ICU management, 12-18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p < 0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12-18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p = 0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The management of potential organ donors prior to consent affects outcomes and should remain a priority in the intensive care unit.

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“…These include but not limited to the number of hospitals carrying out transplants, the number of intensive-care beds available, relative refusing consent to donate, religious and cultural responses to cadavers, and public attitudes to and awareness of organ donation (Merchant et al, 2008;Mossialos et al, 2008;Shepherd et al, 2014); which should be factored into the implementation of legislation systems in order to evaluate the success of these systems. Error bars are at 95% CI.…”

Section: Resultsmentioning

confidence: 99%

Underlying wishes and nudged choices.

Lin

Osman

Harris

et al. 2018

Journal of Experimental Psychology: Applied

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Is the inferred preference from a choice to donate stronger when the choice was made under a mandated rather than the automatic default (nudged choice) legislative system?The answer to this is particularly important because families can, and do, veto the choices of their deceased relatives. In three studies, we asked American and European participants from countries that have either a default opt-in or default opt-out system to take on the role of a third party to judge the likelihood that an individual's "true wish" was to actually donate their organs, given that they were registered to donate on the organ donation register. In each study, participants were randomly assigned to one of the organ donation legislative systems (default opt-in, default opt-out, mandated choice or mandatory). Overall, regardless of which country participants came from, they perceived the donor's underlying preference to donate as stronger under the default optin and mandated choice systems as compared to the default opt-out and mandatory donor systems. We discuss the practical issues that result from using default systems in the domain of organ donation and propose potential ways to ameliorate the uncertainty around inferences of underlying preference from a nudged choice. Word count: 196

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Exploring the psychological effects of deceased organ donation on the families of the organ donors

Abstract: Our data suggest that donation has a beneficial effect on the bereavement process.

Cited by 101 publications

References 11 publications

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Underlying wishes and nudged choices.

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