Bereavement Research Forum

Bereavement Research Forum

Some implications for policy and practice re organ and tissue donation drawn from research done with bereaved relatives and Registered nurses

17th October, 2007

(Sque & Payne 1996 Sque 2007)

1. The studies indicated that importance was attributed to bereaved relatives’ need to consider organ or/and tissue donation. This finding suggests that in situations of a donor’s clinical suitability organ donation and tissue donation should be discussed with relatives. Healthcare professionals need to be aware, and feel confident that relatives are most likely to be grateful that the option of donation was discussed with them. 2. Nurses and doctors own awareness and education about the donation of organs and tissues needs to be guided by the above ideal; also, hospital and local healthcare policies. Health professionals’ education about organ donation appears to be most effectively started during pre-registration training. Of particular importance appears to be the experience of caring for donors and their significant others. Issues regarding death, dying, bereavement and the management of the dead body in modern, Western society may usefully underpin organ donation education. The historical impact of traditional values regarding death is fundamental to these issues. Time needs to be allocated for health professionals to reflect upon their own feelings about donation and transplantation. Issues surrounding death certified by brainstem testing need to be explicated and debated. Where it is appropriate, healthcare staff need to be educated to recognise donors, and approach families about donation. Issues of importance appear to be the timing and nature of the donation discussion. This should always be carried out in a manner to facilitate a decision by relatives that will not be regretted. 3. Hospitals should have policies to identify potential donors and to inform families of their option to donate. Effective policies are needed to support staff so that donation discussions are not left to individual preferences. This would mean that hospitals need to consider systems for documenting that donation was discussed with the next-of-kin; have a duty to educate staff about donation; and, monitor the impact of donation discussions on the overall availability of organs and tissues for transplantation. 4. Appropriate explanations of how clinical neurological tests confirm death appear to be important to bereaved relatives, as well as the opportunity to attend brainstem testing. It was shown that the lack of knowledge and explanation about these events can cause relatives considerable distress, while attending brainstem testing and receiving information in caring, timely and complementary ways may be helpful. 5. There needs to be recognition of relatives’ distress when interacting with ventilated, potential donors, therefore, the need not to delay the medical confirmation of death.   6. The discourse of ‘sacrifice’ may assume a greater significance for the family at the bedside faced with a donation decision than giving the ‘gift of life’ as promoted by transplant propaganda. The perceived ‘sacrifice’ may become a barrier to actualising donation, even if the family and the potential donor, in life, had positive views about donation, and may help to explain why in populations where the benefits of organ transplantation are well understood donation rates remain low.