Survey of Canadian intensivists on physician non-referral and family override of deceased organ donation

Abstract

Purpose Intensive care physicians play an important role in the identification and referral of potential organ donors in Canada. Nevertheless, little is known about intensivists' attitudes or behaviours in situations where families override previously expressed consent to donate; nor why physicians elect not to refer patients who are potential donors to provincial organ donation organizations (physician non-referral). Methods We integrated questions regarding family override and physician non-referral into an online, self-administered survey of Canadian intensivists. We report results descriptively. Results Fifty percent of targeted respondents (n = 550) participated. Fifty-five percent reported having witnessed family override situations and 44% reported having personally not referred patients who were potential donors. Fifty-six percent of respondents stated they would not pursue donation in the face of family override; 2% stated they would continue with the donation process. Fear of loss of trust in the donation system (81%) and obligation to respect the grief and desires of surrogate decision makers (71%) were frequently reported reasons to respect family override requests. Respondents who chose not to refer patients often did so based on organ dysfunction they assumed would preclude donation (59%), or a perception that the family was too distressed to consider donation This article is accompanied by an editorial. Please see Can J Anesth 2020; 67: this issue.

Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

“…Reasons for this include the belief that initiating organ donation on a registered donor without explicit authorization may increase family distress. [10][11][12] Seeking family authorization, however, permits SDMs to veto the deceased donor's registered wish to donate, a decision known as ''family veto''. 6 Family veto represents a legal and ethical conflict between respect for the deceased donor's wishes and those of the SDM.…”

Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives

“…Positive and negative psychological effects of donation are reported by families and it is critical to understand better how to navigate the diversity of family experience in multicultural societies to capture the psychological benefits for families and avoid the factors that may result in harm. [8][9][10][11] We believe that this study will comprehensively identify situations in which families are most vulnerable, enabling healthcare providers to introduce specific interventions to alleviate their suffering. Furthermore, this study will help identify the particular needs of provinces and regions (with different policies and resources) and populations (eg, families who have agreed to donation, agreed to donation but donation was not possible, or refused donation).…”

Family override for organ donation

“…Dans ce numéro du Journal, Weiss et coll. 3 présentent les résultats du premier sondage national canadien réalisé depuis plus d'une décennie sur les points de vue des intensivistes au sujet de la pratique du don d'organes. Les auteurs ont réalisé un sondage rigoureux en se concentrant sur deux pratiques controversées : la préséance de la volonté de la famille sur le don, et la non-référence médicale pour don d'organes d'un patient potentiellement éligible.…”

“…In this issue of Journal, Weiss et al 3 present the results of the first Canada-wide survey in over a decade of intensive care physicians' perspectives on the practice of organ donation. Their rigorously conducted survey focused on two controversial practices: family override of donation, and physician non-referral for organ donation of a potentially eligible patient.…”

“…Weiss et al 3 describe family override as ''emotionally charged and ethically ambiguous.'' We wholeheartedly agree that these situations are ''emotionally charged'', but emotions should not drive practice.…”