From Hesitation to Appreciation: the transformation of a single, local donation‐nurse project into an established organ‐donation service

Abstract

This study evaluates the transition from a local project to promote organ donation to a permanent county-based donation service inspired by the Spanish model. To address the problem of declining donation rates, a project with one donation-specialized nurse (DOSS) was initiated at a single neuro-intensive care unit. This project was later expanded into a permanent on-call service consisting of seven DOSSes, covering a large urban county. During the different periods (before, during project and during permanent service), the DOSS function's effect on donation rates was significant, and the number of eligible donors that became actual donors increased from 37% to 73% and 74%, respectively. The effect on family vetoes was as prominent with a decrease from 34% to 8% and 14%. The staff appreciation of the DOSS function was also evident during the periods; all areas included in the questionnaire (family care, donor care and staff support) have improved greatly owing to the DOSS. The transition from a single, local donation-nurse project, to an on-call service with several DOSSes covering a large urban county was a success considering the donation rates as well as the staff's appreciation. Hence, organizational models from abroad can be adjusted and successfully adopted.

Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review

“…The CaD-TAP intervention allows the requester to get general practical advice on effective communication from a CaD-trained psychologist shortly before the actual donation request.RequestersXYesJansen et al [21]Training of nursesNurses completed the training ‘Communication about donation’. The trained donation practitioners are always available, 24 h a day, and guide the relatives through the donation decision process.NursesXYesKrekula et al [22]Training of nursesThe donation specialist nurse (DOSS) on call supports the local team with the medical care of the donors and with the actual donation request, primarily together with the local physician. The DOSSes also promote adherence to standard routines concerning organ donation and take responsibility for the follow-up with DR at their local hospitals.NursesXYesLenzi et al [23]Donation request by trained professionalPerformances in obtaining informed consent from potential donors’ families were compared according to the type of healthcare professional conducting the interviews: OPO, In-hospital coordinator or ICU physician (not trained).OPO, in-hospital coordinators, ICU physiciansXNR (yes a )Linyear et al [24]Family communication protocolA standard family communication protocol was developed to ensure consistent identification of all patients with devastating neurological insults who might progress to brain death, optimal family communication and support, and a request for organ donation in accordance with best-demonstrated practices.Nurses and physicians from the ICUs, as well as hospital administrators, chaplains, and LifeNet representativesXXNR (no a )Manyalich et al [25]Training of healthcare professionalsThree educational initiatives were designed and implemented: 1) essentials in organ donation 2) professional training for junior transplant coordinators and 3) organ donation quality management.…”

“…Seven studies focused on additional support of relatives [12, 18, 21, 22, 24, 31, 32]. Six out of seven studies showed a statistically significant increase in the main outcome measure after the intervention.…”

“…The mean age of the potential donors in the intervention group was 63 years. The study by Krekula et al [22] also showed an increase in donation rate when working with trained nurses (called “donation specialist nurse” (DOSS)), first in a DOSS local project and later in a DOSS county-based service (Table 1 shows the outcomes of the DOSS service). In the ACRE trial [32], it was shown that collaborative requesting by a clinician and donor transplant coordinator did not increase the consent rate when compared to requesting by the clinical team alone (57% vs. 62%, p = 0.53).…”