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Volume: 17 Issue: 1 January 2019 - Supplement - 1

FULL TEXT

Consequences of More Coordinator Engagement to Take Consent for Organ Donation: Comparisons of New Versus Experienced Staff

Objectives: The method of obtaining family consent for organ donation after occurrence of brain death in Iran is an opt-in process. Because of complicated cultural, legal, religious, and familial structures in Iran, it is not simple to take consent for organ donation in brain death situations. The process needs the professional staff to be experienced and have an appropriate personality to obtain consent.

Materials and Methods: We previous used a limited number of experienced coordinators to take consent. We revised our decision 2 years ago because of lack of trained personnel. From the beginning of 2017, we have started training courses regarding approaching families for donations for all interested coordinators. After participants finished the theoretical and practical training, we allowed them to interview themselves to practice a first evaluation for a suitable potential donor. We have continued this strategy and have gathered feedback from participating coordinators.

Results: At the beginning of 2017, 9 coordinators who were previously qualified for handling other steps of organ donation were put into a compact training program to train for family interviews. In 2016, the experienced interviewers had a 88% success rate compared with a success rate of 83% in 2017 for inexperienced interviewers (P = .1). No significant differences were shown. Despite younger ages of donors obtained in 2017, median donated organs per donor decreased from 2.81 to 2.66. The average time interval between first contact with families and establishment of family consent was not significantly different between experienced and inexperienced coordinators (9.2 vs 8.7 h).

Conclusions: Although with the new strategy we experiensed a decrease in the consent rate, we believe this strategy will have long-term beneficial effects for our organization and the decreased rate will be a temporary decline. Interviews showed that this strategy made our coordinators more motivated and responsible for their job. As a result, both volume and quality of organ procurement activities will be increased.


Key words : Brain death, Deceased donors, Family consent, Transplant coordinators

Introduction

Family consent for organ donation is no longer a nightmare for many Organ Procurement Units (OPU). After a decade of huge cultural and educational activities, staff members in our OPU are more comfortable in obtaining family consent. The Shahid Beheshti University of Medical Sciences OPU has been active from 2004, so far interacting with families of 1863 deceased potential donors, resulting in 1795 organ retrieval operations and 5003 donated organs as of the end of 2017. The organ donation rate per million population has risen to 30. With the consideration of our process being an opt-in one and the ethnic diversity of our population,1 this number compares well with other OPUs in the country and in the whole continent. Table 1 summarizes the hospitals and beds that are covered by our center.

Recruitment of new coordinators is a vital step in further development of any OPU.2 In many settings, a lack of knowledge exists regarding organ donation and transplant medicine among physicians, including specialists.3,4 Therefore, in addition to careful selection of coordinators with certain personality and com-munication skills and proper training, allowing advancement into new levels of coordination is helpful for building and maintaining the future labor force.

Materials and Methods

With the purpose of increasing involvement of more coordinators in the family interview process, we began a strategy of engaging inexperienced coor-dinators in 2017. The family consent rates before and after initiation of this strategy were compared. Monthly statistics were also considered.

Results

At the beginning of 2017, 9 coordinators who were previously qualified for handling other steps of organ donation were put into a compact training program and entered into the family interview process. Among this group, 2 coordinators had to leave the interview team because of a more than two-thirds failure rate to obtain consent. In 2017, 3 experienced coordinators who formed the interview team in 2016 had 88% success rate compared with a rate of 83% for the new inexperienced interviewers, with no significant differences (P = .1).

Figure 1 shows the consent rates in 2016 and 2017, which are clustered by month. The mean age of donors had reduced significantly from 36.2 ± 16.4 years to 31.1 ± 15.8 years (P = .04), which may have been due to differences in type of hospital, which included trauma and nontrauma centers.

Despite the younger age of donors in 2017, the median number of donated organs per donor decreased from 2.81 to 2.66. The average time interval between first contact with families and establishment of family consent was not significantly different between experienced and inexperienced coordinators (9.2 vs 8.7 hours).

Discussion

We found that organ donation directors can ap-probate use of younger or less experienced coor-dinators as family interviewers after completion of a proper training program. Albeit flawless family consent can only be achieved after exact assessment of the family’s and the donor’s situation, the interviewer’s character and abilities also play important roles. In other words, every case is a unique one that involves certain compatibility criteria from the coordinator. There have been certain donor/donor family characteristics in the literature that are accompanied with variable consent rates. These include donor age,5 number of family members,1,6 language and ethnicity of donor and coordinator,7,8 religious adherence,9 positive perception of the coordinator from the family at first contact,10 and educational and socioeconomic levels.11,12

The above facts should be kept in mind when we can train coordinators for family interviews. Our training strategy allows trainees to gradually earn more experience and to then work under super-vision; once trained, they will be ready for challenging cases regarding the above-mentioned characteristics for more difficult consent situations. With proper coordinator-donor/donor family case selection, we can develop new OPUs and also amplify our work force to extend organ donation.13,14

Conclusions

Although our new strategy resulted in a nonsignificant decrease in consent rate, we believe this strategy will have long-term benefits for our organization, allowing it to be stronger despite this temporary decline in rate. This strategy made our coordinators more motivated and responsible for their job according to our interviews. As a result, both volume and quality of organ procurement activities will be increased.


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Volume : 17
Issue : 1
Pages : 110 - 112
DOI : 10.6002/ect.MESOT2018.O50


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From the Organ Procurement Unit (OPU), Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Darabad, Niavaran, Tehran 19569-44413, Iran
Acknowledgements: The authors declare that they have no sources of funding for this study, and they have no conflicts of interest to declare.
Corresponding author: Masoud Mazaheri, Organ Procurement Unit (OPU), Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Darabad, Niavaran, Tehran 19569-44413, Iran
Phone: +98 9359427171
E-mail: Kolbehban@yahoo.com