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Published on: August 15, 2022
Experience of Clinicians and Relatives with Donation after Controlled Circulatory Death: A Prospective Qualitative
Thomas Denise1, Mathilde Cœur2, Laurent Martin-Lefevre3
1Medical Intensive Care Unit and Famiréa Research Group, Saint-Louis University Hospital, AP-HP Nord, Paris, France.
Insights
Controlled donation after circulatory death (cDCD) involves three stages for healthcare teams and families: hope, acceptance of death, and donation. Understanding these stages improves support and communication during the cDCD process.
Area of Science:
- Medical Ethics
- Transplantation Medicine
- Intensive Care Medicine
Background:
- Controlled donation after circulatory death (cDCD) is a widely adopted organ donation strategy.
- Effective cDCD requires seamless collaboration between intensive care units (ICUs), organ procurement organizations (OPOs), and families.
- Limited data exists on the lived experiences of stakeholders involved in cDCD.
Purpose of the Study:
- To explore the experiences of ICU teams, organ procurement teams, and relatives during the cDCD process.
- To identify key challenges and facilitators in cDCD implementation from stakeholder perspectives.
Main Methods:
- Qualitative study employing focus groups with ICU and OPO professionals and semi-structured interviews with relatives of cDCD donors.
- Interpretative phenomenological analysis (IPA) applied to interview and focus group data.
- Study conducted within the framework of the PRODON randomized controlled trial in five French hospitals.
Main Results:
- The cDCD process unfolds in three distinct stages for both professionals and relatives: initial uncertainty and hope, transition to acceptance of inevitable death, and the end-of-life donation request.
- Healthcare professionals sometimes experienced a conflict between achieving a 'good death' and the technical success of cDCD.
- Relatives required adequate time to process the concept of cDCD and understand its procedural aspects.
Conclusions:
- Recognizing the three stages of the cDCD process can enhance support for relatives.
- Clearer definition of professional roles and improved inter-team communication are crucial for successful cDCD.
- This understanding can optimize collaboration between ICU and organ procurement teams.
Background:
Controlled donation after circulatory death (cDCD) has been encouraged in many countries for over ten years. This procedure requires close link between intensive care unit (ICU) and organ procurement teams, and relatives. Data on the experiences of these different stakeholders involved in cDCD are scarce.
Objective:
To gain insights into the experience of intensive-care teams, organ-procurement teams, and relatives during cDCD.
Methods:
For this qualitative study, physician and nurse members of ICU and organ-procurement teams participated in focus groups. Also, relatives of cDCD donors participated in semi-structured telephone interviews a few months after the death. All relatives were included in the ongoing PRODON randomised controlled trial of organ-procurement-team involvement in requesting cDCD from relatives. The staff members worked at hospitals involved in the trial. Interpretative phenomenological analysis was used to assess the focus-group and telephone-interview data. The study was guided by the Standards for Reporting Qualitative Research (SRQR).
Results:
We included 23 healthcare professionals and 10 relatives at five hospitals in France. The data show that the cDCD process evolves in three distinct stages in both the professionals and the relatives: uncertainty in the face of a life-threatening disease but persistent hope for survival, shift towards certainty that death is inevitable, and end of life with a request for donation. The professionals sometimes perceived a conflict between a good death and technically successful cDCD. The relatives needed time to come to terms with cDCD and to understand the procedure.
Conclusions:
The identification of three stages in the cDCD process can be expected to help intensive-care and organ-procurement teams provide effective support to relatives, define the role of each professional, and strengthen cooperation and communication between the two teams of professionals.
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