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FAMILY INTERVIEW

FAMILY APPROACH 2nd part: REQUEST FOR ORGAN DONATION Danica Avsec, MD Key expert for Education and Communication. FAMILY INTERVIEW. How to break bad news Request for the donation. Request for the donation. Consent for the donation T o evaluate biological risk factors.

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FAMILY INTERVIEW

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  1. FAMILY APPROACH 2nd part: REQUEST FOR ORGAN DONATIONDanica Avsec, MDKey expert for Education and Communication Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  2. FAMILY INTERVIEW • How to break bad news • Request for the donation Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  3. Request for the donation Consent for the donation To evaluate biological risk factors Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  4. Opposition to Donation, ETPOD • Important number of lost Donors in many countries • Correctable cause • Less than 10% opposition can be achieved Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  5. OPT IN countries, 2011 Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013 Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  6. Correctable elements • Legislation (ETPOD) • Psycholgical aspect • AGREE model • Other socio cultural aspects • Religious statement • Public awareness • Educational level • Additional strategies Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  7. OPT IN countries, 2011 Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013 Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  8. OPT OUT countries , 2011Study on EU Action Plan on Organ Donation and Transplantation (2009-2015) by Nivel , published in June 2013 Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  9. Correctable elements • Legislation • Psychological frame • AGREE model -100% agreement • Other socio cultural aspects • Public awareness • Educational level • Religious statements Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  10. Psychological frame • Absolutely crucial • Way of communication • Emotional release • Empathy • Facilitating the proces of grieving • Is essential for developing the trust Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  11. Trust • Developing the trust starts at the time of admission the patients and when first time contacting the family Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  12. Effectiveness of communication Jones et al (2008). • “communication can only be effectively achieved where both parties have the same, or at least similar, recollection of what was communicated”. Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  13. Correctable elements • Legislation • Psychological aspect • AGREE model • Other socio cultural aspects • Religious statement • Public awarenes • Educational level Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  14. AGREE study • Family interview guide for requesting organ donation for transplantation and evaluation using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument • Organs Tissues & Cells. 2012, November, 15, 3: 163 • 100% (40 interviews and 4 interviewers) consent from Jan 2011 to Aug 2012 Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  15. Family interview guidelinesCabalero et all, ORGANS, TISSUES & CELLS, (15), 163-169, 2012 Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  16. Planning for the family interview Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  17. Planning for the family interview Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  18. Planning for the family interview Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  19. Monitoring and assesment of the procedure is important • Annual revision Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  20. Correctable elements • Legislation • Psychological aspect • AGREE model • Other socio cultural aspects • Public awarenes • Educational level • Religious statement Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  21. Public awareness • Starts with open discussion within family • The most important predictor of consent is whether a discussion about donation had been performedbefore donation • Families who know the donor's wishes, are more likely to donate organs Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  22. Solidarity as an argument for Donation, ETPOD Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  23. More arguments for Donation, ETPOD Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  24. Strategies to decrease family refusal rate, ETPOD • Deceased did not wish to donate • Try to find if it is true • Fear of the integrity and image of the corpse • Explain the process and assure respect and care of the corpse • Religious objections • Most main religious promote donation • Offer the opportunity to consult a RL • Dissatisfaction with the health care procedures • Accept complains • Separate it from the donation Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  25. WHEN 1. After medical and legal diagnosis of brain death 2. The physician in charge of the patient must report thedeath to the family. 3. Terminology use term ‘death’and not the term ‘brain death’ 3. Family needs to understand the patient’s death. 4. Before the interview it is important to confirm that immediaterelatives of the donor will attend. 5. It is advisable that the transplant coordinator is present Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  26. General recommendation 1 ONT Spain 1. Immediate relatives of the potential organdonor should be present at the interview. 2. The request for consent to donation must never berushed. We should wait for the right time to approach the family. 3. After the physician in charge communicates the patient’sdeath, it is advisable to wait for families’ prompts suchas: “What should we do now?” Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  27. General recommendations 2 4. At this moment, and not before, consent to organ donationfor transplantation should be introduced to relativesby a professional from TCT. It should be explained thattheir deceased relative – naming him/her by their name –“can help others”. 5. An emphasis on the social and healthbenefits for patients on the waiting list for organ transplantationis recommended. 6. Death is hard, not donation. Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

  28. To conclude • Be aware : Giving bad news about dead is more difficult than asking for donation Technical Assistance for Alignment in Organ Donation project, 1st International Symposium 2014

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