Family Approach

- retroscective analysis of over 5.000 family approaches -

Franz Schaub; Carl-Ludwig Fischer-Fröhlich; Günter Kirste

Deutsche Stiftung Organtransplantation (DSO)

Attitudes toward organ donation

agreed not agreed / do not know

All

Men

women

Decision to donate organs (curent survey)

Umfrage der BZgA 10-2010Current survey (October 2010)

In total 54 Parameter for the family approach

Detailed documentation of the family approaches in

Methods

All donation requests from January 2009 to March 2010 (n = 2766; study group) are included in the study group.

Significances were validated by the Chi²-test (p<0,05).

The results of the analysis were checked by a validation group (n = 2366) of all documented donation requests of the period April 2010 to April 2011.

16,3%

12,4%

71,3%

Who conducts the interviews with the relatives?

physician

both

coordinator

Interviews in the period from January 2009 to April 2011 (n = 5132)

Results of family approach

42,328,3

71,757,7

0

20

40

60

80

100

Arzt Koordinator am Gesprächbeteiligt

Zustimmung Ablehnung

%

Interviews in the period from January 2009 to April 2011 (n = 5.132)

n = 1.931 n = 835

44,8

21,7

78,3

55,2

0

20

40

60

80

100

Arzt Koordinator am Gesprächbeteiligt

Zustimmung Ablehnung

%

Study group n = 2.766 Validation group n = 2.366

n = 1.709 n = 856

p < 0,001Consent RefusalConsent Refusal

Time of the interviews with relatives

44,125,8

38,6

61,455,974,2

0

20

40

60

80

100

vor HTD während HTD nach HTD

Zustimmung Ablehnung

% n = 683 n = 414 n = 1.669

p < 0,001

48,5

26,836,9

63,151,5

73,2

0

20

40

60

80

100

vor HTD während HTD nach HTD

Zustimmung Ablehnung

% n = 625 n = 370 n = 1.370

Study group n = 2.766 Validation group n = 2.366

Interviews in the period from January 2009 to April 2011 (n = 5.132)

Consent Refusal Consent Refusal

prior BDD during BDD after BDD

Results

The participation of a specifically trained coordinator in the family approach has a positive effect on the consent rate

Early, situationadjusted family approaches – eg. accompanying the brain death diagnosis – have a positive effect on the consent

Discussion (I)Why does the participation of a specifically trained coordinator have a

positive effect on the consent rate?

The particular conversational skills are trained and constantly improved in video trainings with professional actors.

The coordinators have been trained for the difficult situation during family approaches

Discussion (I)

Our coordinators are competent professionals with knowledge about organ donation and transplantation and they are contact persons with time and sentiment for the relatives.

DSO offers individual care for the family during and after Organ donation in order to assure a informed decisions about donation.

Discussion (II)

When is the „right“ moment for the family approach?

Nowadays the relatives expect a comprehensive information about the medical procedures and wish to be involved in the decisions that are taken.

A transparent explanation about all steps regarding the brain death diagnosis builds confidence and gives the family enough time in order to find a „stable decision“

Discussion (III)

What are the factors that eventually lead to a family refusal?

Relatives do not know the will of the deceased Family members are discordant on the issue of organ donation Fear of organ trafficking Lack of trust in brain death diagnosis Organ donation is considered to disrupt the integrity of the death body

An increased information and education of the public about organ donation could reduce existing fears and concerns. And it would promote the discussion of organ donation during lifetime.

Thank you very much!