Organ donation in the ICU – a survey on next of kin response in two Swiss academic centres

Abstract

AIM OF THE STUDY: In the Swiss population, attitudes to organ donation are mostly positive. However, a high refusal rate by the next of kin may be observed. We aimed to investigate potential underlying reasons. METHODS: In two independent Swiss tertiary care academic centres 167 next of kin were confronted with potential organ donation, over a period of 18 to 24 months. Of these, 147 could be contacted and were asked ≥6 months later to participate in a post-hoc survey (72-item questionnaire). Aspects related to conversations, time and care in the intensive care unit (ICU), underlying concepts for organ donation, impact on mourning, and other potential influencing factors were addressed. RESULTS: The overall return rate was 66%. Seventy four of 77 (96%) next of kin stated that the request for organ donation was appropriate and they agreed to address the issue. Personal attitudes of next of kin regarding organ donation correlated with the decision for or against organ donation (p <0.0001). Thirteen percent (8/62) reported that conversations with ICU physicians changed their decision. In 56% (18/32) of reports when organ donation was refused, the next of kin stated that presence of a documented will might have changed their decisions. Mourning was reported to be impaired by the request for organ donation in 8% (6/71), facilitated in 14% (10/71) and not affected in 77% (55/71) of cases. Twenty-seven percent (16/59) indicated that an opt-out policy for organ donation would subjectively have facilitated their decision and 81% (34/42) of consenting next of kin stated that an objection law should be put into place (p <0.0001).CONCLUSIONS: In this observational study, the majority of the next of kin stated that addressing organ donation did not affect mourning. Presence of a presumed will could likely facilitate grief and provide comfort for affected families.

How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia

“…First, in this cohort, it was mainly family members who had to make the decision, and their consent rate was significantly lower. Lower rates of consent by family members when the donor’s will is unclear were also found previously by others [ 5 , 28 , 29 ]. It is obviously different to decide for oneself in a survey rather than for someone else, especially in the stressful situation where family members are asked to make a decision in an end-of-live setting, but only the presumed will or one’s own values can serve as the basis for this decision [ 30 , 31 ].…”

“…The reasons for the discrepancy between the positive attitude and the low level of refused consent on the one hand, and the low rate of utilized donations on the other, remain unclear. This has been described in other countries with few organ donors, such as Switzerland [1,5]. The country-specific legislation is one factor, that is repeatedly discussed [6][7][8].…”

“…Data from England and the USA have shown that knowledge about a person’s attitude to organ donation is one of the most important factors in consent by family members [ 28 , 32 ]. In Switzerland, in 56% of the cases rejected by family members, it was stated they might have consented if there had been a documented will to donate [ 5 ]. Moreover, surveys on such a sensitive topic as the willingness to donate organs could lead to a bias in response behavior in favor of a perceived social desirability [ 33 ].…”

Family bereavement and organ donation in Spain: a mixed method, prospective cohort study protocol

“…Similarly, Smudla et al 21 found that levels of grief and depression were not associated with the authorisation of organ recovery. More recently, in a study conducted in Switzerland,22 in which 147 relatives who had faced the donation process answered a post hoc questionnaire on issues including organ donation and its impact on grief, the majority of relatives denied that facing organ donation had played a role in their bereavement.…”