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| Organ and tissue
transplantation is one of the major medical success stories of our time.
Well over a million people worldwide have had their lives saved or their
quality of life improved by an organ transplant. One of the most important
links in the process of getting organs for transplantation is obtaining
consent for organ donation from the family. No matter how successful we
are in identifying and maintaining donors, organs will be obtained for
use only if the family agrees to organ donation. It is therefore necessary
to plan this approach so that it proceeds with quality and consistency
resulting in higher rates of consent. |
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| UNDERSTANDING
FEELINGS OF THE DONOR FAMILY |
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| Take into consideration
the needs of the donor family. Initially they are tense about the outcome
of the patient when he is in the ICU. Then they will experience extreme
grief when they lose their loved one. When faced with the option of organ
donation they have some doubts and concerns about the same. Recognising
these different needs and responding appropriately is the challenge for
the transplant coordinator. The short term as well as long-term success
of this programme relies on this ‘family management’. |
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| A trained transplant
coordinator who may be a doctor, nurse or medical social worker must receive
an early reference for all potential donors. This, provides suf?cient
time, to build a rapport with thefamily and evaluate who in the family
is the decision maker. It is important to continually provide the family
with information on the condition of the patient so that they are better
prepared for the death when it occurs. Finally when request for organ
donation is made, whatever their decision regarding organ donation, this
decision must be respected. |
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| DECLARING
BRAIN DEATH |
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When brain death
is con?rmed it is mandatory that the treating physician tells the family
about it. Ensure that the person who has to give consent is there along
with the person who is identi?ed as the ‘decision maker.’
Death must be conveyed unequivocally leaving no doubts or hopes in the
family’s mind. Statements like - ‘He is almost dead.’
‘his brain is dead but his heart is still beating.’ can be
very confusing. Avoid words such as ‘life’ support. Refer
to the patient in the past tense. Request for organ donation must never
be made at this time. Give them time to come to terms with what has happened.
It is necessary to understand the stages of the grieving process that
the family will go through. These are as follows - |
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Anger
- they may be angry about delays in admission or treatment. |
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Denial - they
may not believe that their loved one is no more. |
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Depression
and |
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Acceptance. |
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| One
must never make the approach for organ donation when the family
is in anger or denial stage. After sometime when the family has
come toterms with the death the transplant coordinator can approach
the family for organ donation. |
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| COUNSELING
SKILLS |
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| Whilst
talking to the family the following points can be kept in mind.
Be empathetic. Tell them that you understand how they feel. Be a
good listener and listen to all that they have to say, even if they
are complaining. Understand that this is normal and do not justify
or be defensive, just listen. Boost donor image by saying that the
person must have been very helpful by nature, one who thought of
others ?rst. Talk about those who can be helped (recipients) if
they donate and if they had been in a similar situation, you would
have helped them too. Tell them that this is an opportunity few
people get - to be able to give life after death. Make them realise
that others who have donated have found it gratifying. It gave some
meaning to their own loss and so were able to overcome some of their
grief. |
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Allow
time for them to consider organ donation. Help them to overcome
whatever doubts they may have. They may doubt that a certain religion
does not support organ donation. Explain that every religion encourages
giving and helping others, and organ donation is exactly that. Reassure
them that the organ retrieval will be done with full respect to
the body and there will be no pain involved. If they agree to donate,
keep them informed aboutthe organs that will be taken and the time
it will take. Inform them about delays, if any. Make sure they are
comfortable and help them until the time of discharge. However,
if they do not wish to donate, gently ask them their reasons. Appeal
one more time but then accept their decision. Respect their decision
and help them until they are discharged.
It is important that they leave on a positive note. Though they
may not decide favourably this time,
next time they may do so. |
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| DONOR
FAMILY FOLLOW-UP |
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| Keep
in touch with donor families and inform them about those who bene?ted
because of them. Give general information like age and sex of the
person, not specific information like name and address of the patients.
This is meant to be confidential. If they wish to contact each other
i.e. donor family and recipient it must be done through the transplant
coordinator. Call them occasionally and check how they are doing.
Offer grief counseling whenever they wish. Send them a death anniversary
card to show that you remember and care. Honour the donor families
on donor’s day which is celebrated each year on 30th November.
They are the true heroes of this programme. |
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| Organ
and tissue donation is entirely dependent on the altruism of ordinary
members of the public. Their generosity must be welcomed and appreciated
if we are to save lives and if we are to develop a world class service.
We must build public confidence that the service is based on ethical
principles and that their life saving gift is respected and received
with gratitude. |
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MORPHINE
IMPROVES INTRACTABLE DYSPNOEA
Abernethy and colleagues showed that 20 mg of sustained release
morphine daily improved dyspnoea scores by 7-10%, without respiratory
depression or serious side effects. The authors state that the use
of opioids in the management of intractable breathlessness has been
controversial.
BMJ, 2003; 327 : 523. |
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