Korean J Transplant.  2022 Nov;36(Supple 1):S224. 10.4285/ATW2022.F-3603.

The three-step method to break death news to family of the brain-dead case: a successful experience

• Mirbahaeddin SK
• Aarabi A
• Haghshenas M
• Eslami F
• Katani SM
• Kia L
• Bahrampour N
• Ghorbani F
• Dezfoli MM

• KMID: 2535373
• DOI: http://doi.org/10.4285/ATW2022.F-3603

Abstract

Organ transplantation is one of the most important and challenging fields of medicine. In Iran, brain death cases are the most frequent source of transplanted organs. Donated organs are only available after successful consent seeking from the family of the brain dead case. The consent seeking is assigned to donor coordinator according to the Iranian protocols. A serous pitfall during the consent process is any discussion about organ donation with family members before they reach the internal acceptance of death. This mistake can dramatically reduce the chance of success in consent seeking and can stem from an insufficient time between the announcement of a death and the discussion about organ donation. The three-step method for breaking the death news is based on systematic desensitization. It breaks the death news to three sub-news. This advances the beginning of exposure of the family to the bad news facilitating the acceptance process. Three sub-news are as follows: sub-news 1 “severe brain injury”, a severe brain damage is explained to be the reason of the decreased level of consciousness. The pathogenesis of this process is described for the family; sub-news 2 "vegetative state or worse", the family realizes how serious their loved one's condition is (it is further revealed that their loved one "will never get up from the bed."); sub-news 3 “death”; the family is informed of the death. Breaking the death news in three steps brings forward the exposure of family mem-bers to the bad news and provides ample time for them to accept the death of their loved one before any discussion about organ donation. A further benefit of this method is that the extended time affords the coordinator to build a robust trust with the family members, and to identify the anatomy of the family and its influential members.