Communication with Families regarding Organ and Tissue Donation after Death in Intensive Care study

The intervention is a modification of current standard practice procedures for requesting consent for donation. Essential ‘best practice’ elements of the intervention are: *A designated requester has prime responsibility for discussions regarding organ and/or tissue donation with next of kin of a potential donor in the ICU. *Designated requesters may be intensivists; experienced critical care nurses such as donation specialist nurses, or social workers, who have completed advanced training in sensitive communication. *When next of kin raise the possibility of the patient donating organs or tissue after death, the managing ICU health professional will sensitively defer the requesting discussion to the designated requester. *Separation of the donation discussion from the conversation where next of kin are notified of the patient’s death, or the inevitability of death. *Donation conversations are conducted within a family meeting, structure based on evidence-based guidelines for high quality communication regarding end of life care. *A balanced approach is used when providing information regarding organ donation to next of kin. Evidence-based guidelines for communication with health care professionals and families regarding the patients’ values and preferences at the end of life include recommendations that meetings take place in a private room or special area for meetings, that multidisciplinary team planning has occurred, and everyday language is used with effective communication techniques. References: Australian and New Zealand Intensive Care Society (2013) "The ANZICS Statement on Death and Organ Donation." 2013. Billings, J. A. (2011). "The end-of-life family meeting in intensive care part I: Indications, outcomes, and family needs." J Pall Med 14(9): 1042-1050. Billings, J. A. (2011). "The end-of-life family meeting in intensive care part II: Family-centered decision making." J Pall Med 14(9): 1051-1057. Billings, J. A. and S. D. Block (2011). "The end-of-life family meeting in intensive care part III: A guide for structured discussions." J Pall Med 14(9): 1058-1064. Curtis, J. R. and D. B. White (2008). "Practical guidance for evidence-based ICU family conferences." Chest 134(4): 835-843. Lautrette, A., M. Ciroldi, et al. (2006). "End-of-life family conferences: rooted in the evidence." Critical Care Medicine 34(11 Suppl): S364-372. Lautrette, A., M. Darmon, et al. (2007). "A communication strategy and brochure for relatives of patients dying in the ICU." New England Journal of Medicine 356(5): 469-478. The staff education and training modules are voluntary workshops designed to provide staged training and sequential learning through theory and practical training, as described in the Professional Education Package (The Organ and Tissue Authority. "Professional Education Package: Family Donation Conversation." Retrieved 8 July, 2013, from http://www.donatelife.gov.au/the-authority/education/professional-education-package). Also, in NSW designated requesters will attend a simulation workshop. This is a half day workshop developed in partnership with the University of Technology, Sydney. The intervention period commences when the possibility of organ donation is first raised with the family, and includes the time for families to make a decision. This time may last up to 72 hours. Longer term bereavement support involves the provision of written literature and counselling by the Donor Family Support Coordinator in the first month following bereavement. Referral to local grief counsellors is arranged if required. If they wish, families receive ongoing support, as do families who agreed to donation.