Readiness of critical care physicians and nurses to handle requests for organ donation

Abstract

BACKGROUND: Critical care nurses and physicians usually care for those patients whose condition progresses to brain death and are also often responsible for requesting organ donation from the family of a brain-dead patient. We hypothesized that staff support, knowledge, and training levels would be significantly associated with organ donation rates. OBJECTIVE: To assess the readiness of critical care staff to successfully handle requests for organ donation. METHODS: A total of 1061 critical care staff from 28 hospitals in four separate regions of the United States completed a questionnaire that assessed (1) factual knowledge about organ donation, (2) understanding of brain death, (3) previous training in procedures for requesting donations, and (4) comfort levels with the donation process. RESULTS: Staff training in effective procedures for requesting organ donations was significantly correlated with hospitals' donation rates. Less than a third of respondents, however, had received training in explaining brain death to and requesting organ donation from a grieving family. In hospitals with high rates of organ donation, 52.9% of staff had received training; in hospitals with low rates of organ donation, 23.5% of staff had received training. Levels of factual knowledge about organ donation and brain death were unexpectedly low but were not significantly related to hospitals' rates of organ donation. CONCLUSIONS: Training of critical care nurses and physicians in effective procedures for requesting organ donation is significantly associated with higher rates of organ donation, yet two thirds of critical care staff report no relevant training. Consequently, critical care staff cannot be considered ready to effectively handle requests for organ donation.

Intensive care nurses’ perceptions of their professional competence in the organ donor process: a national survey

“…The results revealed that ICU nurses rated their perceptions of their theoretical knowledge about aspects of the donor process, such as death diagnostics, procedures and the donor operation as low. This is similar to findings in other studies (Evanisko et al 1998, Bøgh & Madsen 2005, Chernenko et al 2005. Relatives' fear of desecration of the body might be relevant to their decision about organ donation (Sanner 2007, Siminoff et al 2007, Sque et al 2008.…”

“…Educational input was seen as essential for approaching the family; however, only one-third of the respondents had any training in this difficult task (Evanisko et al 1998). In Evanisko et al's (1998) study the educational level of staff was higher at hospitals with higher donor rates. Chernenko et al (2005) found that lack of knowledge about transplantation, donor criteria and guidelines was an impediment to donor identification and organ preservation.…”

“…Half of the respondents in another study reported that donor protocols were time-consuming and not congruent with procedures (Chernenko et al 2005). Educational input was seen as essential for approaching the family; however, only one-third of the respondents had any training in this difficult task (Evanisko et al 1998). In Evanisko et al's (1998) study the educational level of staff was higher at hospitals with higher donor rates.…”

“…Occasions to practise these skills may be limited, and Morton et al (2000) found that they were not maintained after 6 months. Evanisko et al (1998) revealed that nurses with a low educational level were less comfortable with the manner in which organ donation was performed compared to those with a higher educational level. These findings indicate that nurses could benefit from repeated training through both educational seminars and hospital-based education to enhance their professional competence in the organ donor process.…”

“…Not all ICU nurses and physicians were comfortable with the concept of brain death, and many reported dissatisfaction with the manner in which donor acquisition took place and found donor protocols burdensome (Evanisko et al 1998). Half of the respondents in another study reported that donor protocols were time-consuming and not congruent with procedures (Chernenko et al 2005).…”