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Current challenges in approaching relatives of potential organ donors following brain death

Current challenges in approaching relatives of potential organ donors following brain death. 05 October 2014 Professor Magi Sque. The University of Opportunity. Aims. Introduce a set of priorities for the care of the dying and their relatives of which the donation approach is a part.

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Current challenges in approaching relatives of potential organ donors following brain death

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  1. Current challenges in approaching relatives of potential organ donors following brain death 05 October 2014 Professor Magi Sque The University of Opportunity

  2. Aims • Introduce a set of priorities for the care of the dying and their relatives of which the donation approach is a part. • Discuss the tripartite, temporal relationship that generates challenges in the donation approach. • Clarify the challenges for bereaved relatives and health professionals posed by grief, the imagery of BD, care and communication, knowledge issues and the manner in which donation is conceptualised. • Identify what information matters to bereaved relatives and how it is best communicated.

  3. Priorities • The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly. • Sensitive communication takes place between staff and the dying person and those identified as important to them. • The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants. • The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible. • An individual plan of care is agreed, coordinated and delivered with compassion.

  4. Tripartite relationship Potential Donor Health professionals Relatives

  5. Temporal framework

  6. Rapport with health professionals

  7. Complementary information about the nature of the critical injury • Talking - responsive • CT Scans - confirmatory • X-rays - illustrative • Anatomical models - explanatory • Attending brainstem testing - confirmatory • Information leaflets - informative

  8. Correct, timely, responsive information sharing • Increased understanding of the nature of the brain injury • Increased feelings of confidence in any decision that was made in response to brainstem testing • Reduced post death ‘fantasizing’ about the nature of coma

  9. Conclusions We are reminded that: • The nature of the donation approach and discussion is multifaceted, multidimensional and often fragile. • The circumstances of loss and bereavement associated with DBD are culturally challenging. • The Temporal Framework offers a person-centred focus for individual assessment that keeps bereaved relatives at the centre of the donation experience. • Relatives of potential DBD donors faced with the challenging situation of a donation approach and discussion should expect: CARE TO THE LEVEL OF THE BEST – NOTHING LESS WILL DO

  10. References JansenN.E. McDonald M. Haase-Kromwijk BJJM. Sque M. and Long-Sutehall T. When are bereaved family members approached for consent to organ donation? Commentary from 10 European member states. Organs, Tissues & Cells. 17: 2, 2014, 101-113. Leadership alliance for the care of dying people. One chance to get it right: Improving dying people’s experience of care in the last few days and hours of life. London: Gateway.. SqueM. and Long T. Bereavement, decision-making and the family in organ donation. In Farrell AM. Price D. and Quigley M. (eds) Organ shortage: Ethics, law and pragmatism. Cambridge: Cambridge University Press, 2011, 67-85. SqueM. Long T. and Payne S. Organ donation: Key factors influencing families’ decision-making. Transplantation Proceedings, , 37: 2, 2005, 543-546 SqueM. Long T. and Payne S. and Allardyce D. Why relatives do not donate organs for transplants: 'sacrifice' or 'gift of life'? Journal of Advanced Nursing, 61: 2, 2008, 134-144. SqueM. and Payne S. Dissonant Loss: the experiences of donor relatives. Social Science & Medicine, 43: 9, 1996, 1359-1370. SqueM. Walker W. Long-Sutehall. T. Morgan M. Randhawa G. and Warrens A. Bereaved families' experiences of organ and tissue donation, and perceived influences on their decision making. Final report of a study funded by the Department of Health, University of Wolverhampton, UK, 2013. Walker W. Broderick A. and Sque M. Factors influencing bereaved families' decisions about organ donation: An integrative review of the literature. Western Journal of Nursing Research, 35: 10, 2013,1339-1359.

  11. Acknowledgements Thank you to our study participants and research funders The Community Fund Department of Health UK Transplant The University of Opportunity

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