Korean J Transplant.  2023 Dec;37(4):241-249. 10.4285/kjt.23.0049.

Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study

• Nejatollahi SMR
• Abdolmohammadi Y
• Ahmadi S
• Hasanzade A
• Hosseini F
• Mohseni A
• Shafaghi S
• Dezfuli MM
• Ghorbani F

• KMID: 2550235
• DOI: http://doi.org/10.4285/kjt.23.0049

Abstract

Background
Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors.
Methods
In this cross-sectional study, we utilized a questionnaire containing 14 ques-tions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospi-tal performance and drew comparisons between the studied hospitals.
Results
A total of 60 participating ICU nurses provided mean scores for hospital per-formance in family interviews of 2.60±0.84 for type I hospitals (those providing neuro-surgery and trauma care) and 2.035±0.890 for type II hospitals (those without neuro-surgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families’ lack of awareness of patient prognosis emerged as a key barrier in private hospitals.
Conclusions
This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Keyword

Organ donation; Brain death; Organ procurement system; Organ donor

Reference

1. Greer DM. 2021; Determination of brain death. N Engl J Med. 385:2554–61. DOI: 10.1056/NEJMcp2025326. PMID: 34965339.

2. Arabi YM, Haddad S, Tamim HM, Al-Dawood A, Al-Qahtani S, Ferayan A, et al. 2010; Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury. J Crit Care. 25:190–5. DOI: 10.1016/j.jcrc.2009.05.004. PMID: 19592201.

3. Martin-Loeches I, Sandiumenge A, Charpentier J, Kellum JA, Gaffney AM, Procaccio F, et al. 2019; Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next? Intensive Care Med. 45:322–30. DOI: 10.1007/s00134-019-05574-5. PMID: 30820584.

4. Anwar AS, Lee JM. 2019; Medical management of brain-dead organ donors. Acute Crit Care. 34:14–29. DOI: 10.4266/acc.2019.00430. PMID: 31723901. PMCID: PMC6849043.

5. International Registry in Organ Donation and Transplantation (IRODaT). 2023. Database [Internet]. IRODaT;Available from: https://www.irodat.org/?p=database. cited 2023 Mar 26.

6. Doby BL, Hanner K, Johnson S, Purnell TS, Shah MB, Lynch RJ. 2021; Results of a data-driven performance improvement initiative in organ donation. Am J Transplant. 21:2555–62. DOI: 10.1111/ajt.16442. PMID: 33314706.

7. Mokhber Dezfuli M, Eslami F, Mostafavi K, Khoshkholgh R, Reza Nejatollahi SM, Montazeri S, et al. 2022; Organ procurement from donors after brain death during the COVID-19 pandemic: experience of a high prevalence country. Exp Clin Transplant. 20:420–4. DOI: 10.6002/ect.2021.0398. PMID: 35297335.

8. Mostafavi K, Mokhber Dezfuli M, Jarrah N, Montazeri S, Mirbahaeddin SK, Hazrati M, et al. 2023; Causes of family refusal for organ donation in brain-dead cases, a narrative review. Koomesh. 25:113–8.

9. Qu Z, Oedingen C, Bartling T, Beneke J, Zink M, Krauth C, et al. 2021; Systematic review on potential brain dead donor estimations and conversion rates to actually realized organ donations. Transplant Rev (Orlando). 35:100638. DOI: 10.1016/j.trre.2021.100638. PMID: 34246111.

10. Najafizadeh K, Abbasi A, Ghorbani F, Radpei B, Kashani BS, Ahmadi ZH, et al. 2009; Organ retrieval from brain-dead patients by a single organ procurement center in Iran. Transplant Proc. 41:2723–5. DOI: 10.1016/j.transproceed.2009.06.145. PMID: 19765417.

11. Ahmadian S, Khaghanizadeh M, Khaleghi E, Hossein Zarghami M, Ebadi A. 2020; Stressors experienced by the family members of brain-dead people during the process of organ donation: a qualitative study. Death Stud. 44:759–70. DOI: 10.1080/07481187.2019.1609137. PMID: 31058581.

12. Abdolmohammadi Y, Tabibi SJ, Riahi L. Facilitators and barriers to donor detection based on hospital staff opinions in different hospitals. Iran Red Crescent Med J. 2022; 24.

13. Fernández-Alonso V, Palacios-Ceña D, Silva-Martín C, García-Pozo A. 2020; Facilitators and barriers in the organ donation process: a qualitative study among nurse transplant coordinators. Int J Environ Res Public Health. 17:7996. DOI: 10.3390/ijerph17217996. PMID: 33143168. PMCID: PMC7662326.

14. Salim A, Berry C, Ley EJ, Schulman D, Bukur M, Margulies DR, et al. 2012; The effect of trauma center designation on organ donor outcomes in Southern California. Am Surg. 78:535–9. DOI: 10.1177/000313481207800533. PMID: 22546124.

15. Frezza EE, Krefski LR, Valenziano CP. 1999; Factors influencing the potential organ donation: a 6-yr experience of the New Jersey Organ and Tissue Sharing Network. Clin Transplant. 13:231–40. DOI: 10.1034/j.1399-0012.1999.130303.x. PMID: 10383103.

16. Ali JT, Ebadat A, Martins D, Ali S, Horton S, Coopwood TB, et al. 2017; Hospital characteristics affect consent and conversion rates for potential organ donors. Am Surg. 83:354–8. DOI: 10.1177/000313481708300421. PMID: 28424129.

17. Oczkowski SJ, Durepos P, Centofanti J, Arsenau E, Dhanani S, Cook DJ, et al. 2019; A multidisciplinary survey to assess facilitators and barriers to successful organ donation in the intensive care unit. Prog Transplant. 29:179–84. DOI: 10.1177/1526924819835826. PMID: 30895847.

18. Pilcher D, Gladkis L, Arcia B, Bailey M, Cook D, Cass Y, et al. 2015; Estimating the number of organ donors in Australian hospitals: implications for monitoring organ donation practices. Transplantation. 99:2203–9. DOI: 10.1097/TP.0000000000000716. PMID: 25919766. PMCID: PMC4617283.

19. Sutherland M, Moloney G, Norton M, Bowling A, Walker I. 2020; Utilizing a hospital-based setting to increase organ donor registrations. Transplantation. 104:1210–4. DOI: 10.1097/TP.0000000000002981. PMID: 31568273.

20. Castillo-Angeles M, Li G, Bain PA, Stinebring J, Salim A, Adler JT. 2021; Systematic review of hospital-level metrics and interventions to increase deceased organ donation. Transplant Rev (Orlando). 35:100613. DOI: 10.1016/j.trre.2021.100613. PMID: 33744820.

21. Rios-Diaz AJ, Olufajo OA, Stinebring J, Endicott S, McKown BT, Metcalfe D, et al. 2017; Hospital characteristics associated with increased conversion rates among organ donors in New England. Am J Surg. 214:757–61. DOI: 10.1016/j.amjsurg.2017.03.032. PMID: 28390648.

22. Manzari ZS, Mohammadi E, Heidari A. 2012; Factors influencing organ donation decisions by brain death patients' families: a qualitative study. Payesh. 11:913–25.