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
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.