Persuading a Person to Donate an Organ of a Recently Deceased Family Member
J Public Health Res. 2012 Jun xv; 1(2): 130–136.
Prior Family unit Communication and Consent to Organ Donation: Using Intensive Care Physicians' Perception to Model Decision Processes
Peter J. Schulz
1Institute of Communication & Wellness, Faculty of Advice Sciences, Academy of Lugano, Switzerland
Ann van Ackere
2HEC, Université de Lausanne, Switzerland
Uwe Hartung
1Institute of Communication & Health, Faculty of Communication Sciences, University of Lugano, Switzerland
Anke Dunkel
aneInstitute of Advice & Wellness, Kinesthesia of Communication Sciences, University of Lugano, Switzerland
Received 2012 Jan thirty; Accustomed 2012 Mar xv.
Abstract
Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no bill of fare is institute on a potential donor, families have to exist approached most donation. The aim of this paper is to model the role that some family advice factors play in the family decision to consent or not to organ donation by a encephalon dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open up answers and comments. 8 heads of intensive care units (ICU) of Swiss hospitals and one representative from Swisstransplant were interviewed. Questions asked respondents to estimate the prevalence and effect of advice factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family unit of the deceased person is near always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives' predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians' approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about information technology, make people think about organ donation and endeavour to change unfavourable predispositions.
Acknowledgement
the authors wish to give thanks the interviewees whose collaboration has provided them an overview of today's state of affairs in Switzerland.
Key words: organ donation, family consent, organ donor menu
Significance for public health
Knowing the reasons why potential organ donors do not become actual donors provides leverage for increasing the willingness of relatives of potential donors to requite their consent. Public campaigns should focus on communicating 1's willingness to donate one'southward organs or non to relatives or to a person of trust, by and large to prevent the relatives' scepticism from overturning a expressionless person's own wishes. 2nd, the importance of the donor carte du jour every bit an occasion for discussing the subject in families and as an aid to communication processes between doctors and relatives should not be underestimated. Thirdly it seems appropriate to induce people to recollect well-nigh the issue, and to promote generally supportive attitudes. And finally information campaigns should inform people about the circumstances of real situations in which they might take to make a difficult decision, fifty-fifty at the run a risk of lowering support for organ donation in full general.
Introduction
Progress in transplantation medicine has been very successful in recent years, creating a situation in which the number of patients on waiting lists increases, while the number of dead organ donors is not increasing proportionally. This results in a permanent shortage of donor organs and longer waiting periods for patients. To increment the number of dead donors, one can either improve detection of potential organ donors or effort to increase the donation rate of detected donors. This report is exclusively concerned with the latter.
Inquiry pertaining to the donation rate has focused strongly on the donor carte and the influences on the decision to sign and carry such a card.one-three The problem with the donor card is that, as in other countries,four most of the people in Switzerland5 are generally in favour of organ donation, only simply very few of them carry a donor menu or discuss the topic within their families. Aside from the donor card, the communication between intensive intendance medical personnel and family has received considerable attending,half-dozen-12 and recently researchers have focussed on the role of family advice in the decision to consent to donation.ane,2,six-8,13,xiv Other studies seek to discover to what extent psychological or attitudinal factors influence the willingness to donate one'south own organs.15-17 Horton and Horton18 plant evidence that the strongest predictors of willingness to donate organs are noesis and attitudes. Especially knowledge about organ donation seems to be a potent predictor of willingness to sign a donor carte du jour.6, xix Recent research shows that socio-demographic characteristics of a population such as gender or culture as well seem to play an important office,5,15,17,twenty-23 as will ane's personal experiences, education, the social norms an individual adheres to, religious beliefs, and other forces.
Other studies tried to estimate the number of potential organ donors by reviewing infirmary records to effigy out whether all potential donors had been identified as such, and if and then, whether family unit members had been approached about organ donation and whether they eventually agreed or not.24 Politoski et al. 25 studied the advice between professionals and donor families and stressed the need for standardization of exercise guidelines in hospitals.
Haddow26 and Willams et al. 27 studied the physician's role in discussing organ donation with the families. Williams et al. focused on the fact that knowledge, skills, and attitudes necessary for physicians to promote a decision in favour of organ donation are widely variable from ane infirmary to another.27 Other studies address the perceived support of medical staff equally a pivotal factor in consent decisions.vi The study of Siminoff et al. indicates the importance of the md's attitude.28 The findings on family unit attitudes and their perception by doctors has incited us to attempt to estimate the relevant factors past inquiring near the intensive care physicians' perception of the relatives' knowledge of the deceased person's wishes, the intensity of relatives' prior thinking about organ donation and their attitudes to it in general.
The importance of knowing the deceased person's wish was also confirmed in Smith et al. 29 Interestingly, they also found out that at the aforementioned time family unit discussion did not necessarily pb to getting the carte du jour witnessed by a family fellow member.29, 30
Additionally there are studies analyzing the trouble of the family being in a situation of shock when asked to assent to organ donation. Siminoff et al. for case say that it is not reasonable to expect that family unit determination makers can or fifty-fifty should relinquish strongly held beliefs almost organ donation when experiencing the severe stress of a loved one'due south decease (p. 76). 28 Also, Sque et al. draw the decision that there is a need to stimulate family discussion nigh organ donation before they are involved in the situation all of a sudden decease (p. 545).31
The purpose of this paper is to provide first hints on the role some factors of family communication and attitudes play in the conclusion to allow transplantation of a deceased relative's organs in Switzerland. It is therefore an exploratory written report into an area that has non been researched in Switzerland so far. Three methods offer themselves for such a study: document assay of medical records, interviews with families who had to make a decision on whether a dead relative should become an organ donor, and interviews with intensive care personnel involved in or observant to family decision making. Every bit medical records will non contain much information on earlier family unit communication, if any at all, and as interviews with families raise a number of organizational, legal and ethical issues, we decided to rely on expert interviews with heads of intensive intendance units (ICUs).
We refer to potential organ donors as persons who are brain-dead and do non show whatever medical contraindications to condign an organ donor. We exercise not accost the medical question of which contraindications in the potential donor may forbid organ transplantation. Neither do nosotros address problems of detection.
Potential factors affecting family consent
The starting time factor we wait at is the function of the donor carte du jour, which by law (commodity 8.5 of the Swiss National Transplantation law effective since July 1, 2007) is legally equivalent to a testament/last will, implying that the will of the deceased person prevails over the wish of the family.
Secondly, we selected three family advice factors for closer scrutiny: intensity of prior thinking on organ donation, family predispositions toward organ donation in full general, and knowing the deceased person's wishes.
The level of prior thought was found to be a pregnant factor in organ donation decisions.32 Besides, it is the latent assumption behind sensation campaigns that the more intensely a person has idea about organ donation the more willing he or she will be to donate organs or consent to a relative's altruistic.
Favourable family predisposition to organ donation tin be considered an important factor in reaching a positive decision about organ donation in a particular case.28, 33
Knowing the deceased person'south wishes tin too be considered intuitively every bit affecting consent to donation. The importance of this factor was already confirmed by Smith et al. 29 Iii categories of this knowledge have to be considered: knowing that the relative wished to donate, knowledge that he or she preferred not to donate, and lack of knowledge. Cognition is related to mental attitude toward donation too as to proxy measures for intention to donate such as having signed a donor carte du jour.2,6,15,18,nineteen,34-36 Having a donor card is correlated with values, factual knowledge, attitudes and willingness to donate,18 as well equally with attitude towards decease, prior claret donation, and age of the participant.19 Radecki and Jaccard came to the conclusion that overall, studies show homogeneously that consent decisions are primarily influenced past prior cognition of the deceased individual'southward wishes.6
All 3 family advice factors cover events that took place long before a relative died and became a potential organ donor. The analysis of these factors therefore links weather that developed before the death of a relative with a decision the family has to make after i of them died.
Design and Methods
Procedure
Our enquiry relies on expert face-to-face interviews. Interview partners were chosen according to their positions. We conducted 8 interviews with doctors working in intensive intendance units, ii from Ticino hospitals, iv from the German-speaking part and two from the French-speaking part of Switzerland. The report thus comprised all but two of the transplantation centers of the country. Interviewees were heads of ICUs in seven of the eight cases because we expected them to be the person with the greatest experience and best overview of relevant aspects. Additionally we interviewed a sometime high official from Swisstransplant, the central organization responsible for the organization and coordination of transplantations in Switzerland. This person did non answer the questions used to compute the case numbers and conditions, as this might have led to double counting of the same cases. In total, our analysis is thus based on nine expert interviews. While basing conclusions on simply nine interviews may seem ambitious, ane should proceed in mind the express number of big hospitals and transplantation centers in Switzerland. External upstanding approval of the interviews was non necessary.
Answers were noted on the questionnaire. Excel files were afterwards assembled for documentation. Every bit there were but nine cases, analyses were washed by simply counting cases and computing percentages and averages with a desk calculator.
Measures
Most questions required the interviewees to gauge a case number or percentage based on their personal experience with potential organ donors and transplantation medicine, providing an assessment of the prevalence of the donor card and the three factors of family communication. Later the consent rate under different conditions had to be estimated. A special trouble was posed by the assumption that intensity of prior thinking is probable to be correlated with both predisposition and knowledge of the deceased person'south wishes. The start trouble was solved by a special estimation procedure in the questionnaire, the 2nd by ex post facto considerations. Details will be provided beneath. The relevant parts of the questionnaire are documented in the Appendix.
The interpretation of the scope of relatives' prior thinking and their predisposition to organ donation was asked using a modest matrix. This allowed determining the potential correlation between these 2 entities. Interviewees were offered a 2×2 cross-tabulation and asked, in two steps, to distribute 100% into the four cells (see Appendix with the questionnaire). For estimating the share of relatives allowing organ donation under different conditions, a 2nd matrix was employed. The conditions were offered in a 2×two×2 cross-tabulation, distinguishing among: i) relatives who know and those who do not know the deceased wished to donate; ii) who had thought or not virtually the issue before and iii) who were generally in favour or opposed to organ donation. For each of these eight cells, nosotros asked the doctors to assess the likelihood that the relatives would agree to organ donation. This means viii separate judgments had to be made, each about the likelihood of consenting to donation under a different status. The results are not concerned with comparing individual answers, merely with constructing a kind of collective perception of decision processes. We therefore summate averages of percentages and sums of case numbers, and utilise these for farther analyses. In documentation, ranges of the replies are usually also given. Using averages of expert perceptions of events they have non witnessed is certainly, nether usual circumstances, a dubious method to describe social reality. Given that ours is the first explorative venture into the area of Swiss family advice patterns on organ donation and their bear upon on existent decisions almost donation, this appears to us permissible. We concede that all results based on average calculations have to be interpreted with caution. Effigy ane visualizes and summarizes, iin the blueish bold-framed boxes and the blue arrows, our conception of the decision process that leads to a family unit's like-minded or objecting to organ donation in a detail instance. The greenish arrows show the anchor points of our data collection. Ane-sided arrows betoken pct or example number estimations we inquired virtually; two-sided arrows indicate the physicians' estimation of the likelihood of decisions in either management. The 3rd and final of these two-sided decision arrows pertain to the crucial issue, consent to donation. This conclusion was inquired near nether the conditions shown at the left side of the effigy. The dotted pointer offset at the last decision point shows that we did no further inquiries into the cases where the relatives are aware the deceased did not wish to donate his or her organs. All these cases were counted as lost for donation. No inquiries were made, for the sake of simplicity, into the cases where a donor card was institute. These cases were counted every bit donations.
Process model of determination making and questionnaire items.
Results
The part of the donor carte du jour
In answer to the question of how many detected potential donors deport a donor card, intensive care physicians' answers ranged from 0 to 5%, with one respondent estimating the share higher, at 20%. Almost all of them added that they usually do non observe the card but would not rate the share of cardholders at 0% flatly every bit there occasionally are patients with a donor carte. And according to their experience, if the patient does not carry the donor card with his/her personal property, the card is unlikely to surface. A 2004 representative phone survey conducted past the University of Lugano showed that approximately xv% of the Swiss population claimed to have a donor card.5 If both the estimation by intensive care physicians in this study and our 2004 survey are close to reality, this means that a sizeable proportion of donor cards filled in and signed do non surface when they are needed. The 2d qualification of the role of the donor carte is that doctors inquire relatives for their consent even in the presence of a donor menu, every bit already shown in the model in Figure 1. This is surprising because, as mentioned in a higher place, the donor card has the legal status of a attestation, potentially overruling the relatives' preferences.
Prior thinking and predispositions
As described, ICU heads were asked to gauge how many of all persons approached about organ donation past a deceased relative had e'er thought seriously well-nigh the consequence, and how many were favourable or unfavourable to organ donation in general. As mentioned, they had to fill in a 2×two matrix in a way that the four cells added upward to 100%. Unfortunately, only five of nine respondents did this in a coherent style. Thus, Table 1 gives the average and ranges of the estimates provided by v doctors.
Table 1.
Estimates of the frequency of intensive prior thinking about organ donation among relatives and the frequency of favourable and unfavourable attitudes. Averages of estimates by v intensive care physicians. Ranges are indicated in brackets.
| Intensity of thinking about organ donation prior to decease of relative | Sum | ||
|---|---|---|---|
| Had not given serious thought to organ donation | Had seriously idea near organ donation | ||
| More often than not in favour of organ donation | 23% (0-55) | 27% (10-52) | 50% (ten-lxx) |
| Generally opposed to organ donation | twoscore% (25-80) | 10% (5-16.5) | 50% (xxx-90) |
| Sum | 63% (38-fourscore) | 37% (20-62) | 100% |
Doctors saw the relatives split well-nigh the question of whether they favoured or opposed organ donation in general, and they indicated that a bulk of almost ii-thirds of the relatives had not given serious thought to organ donation before their personal, straight confrontation with the upshot. The predisposition is probably more positive than estimated past the physicians. Our survey in 2004 resulted in about 60% of respondents in Switzerland saying they would be willing to donate their organs, and somewhat less than 30% indicating they were probably willing to agree to this.five Surveys from other countries show big majorities existence favourably tending to organ donation in general,4 but disposition is something very different from making a real conclusion after a relative has merely died, or is about to dice. The physicians perceive intensity of prior thinking and predisposition as correlated. The boilerplate estimates indicate that most two-thirds of the relatives who had not thought seriously about organ donation beforehand are by and large opposed, while almost three-fourths of those who had idea about it are perceived every bit being mostly in favour of donation. The largest group, in the doctors' perception, is the relatives who had not seriously thought virtually organ donation and are predisposed against it in general.
The effect of family unit communication factors on consent to donation
Due to incomplete data in the estimations of consent rate under different conditions, the analysis tin can simply be based on the answers of 6 doctors, not all of whom, in addition, filled in every prison cell. Estimates were averaged across as many respondents as possible in each case. Table 2 indicates that, in the physicians' perception, knowing the deceased person'south willingness increases the probability that relatives will agree to altruistic, whatever their predisposition and previous thinking about the issue. When relatives are favourably predisposed, whether or not they take thought seriously nearly the result is secondary: the estimates are as well close to draw any meaningful decision. In other words, if relatives are favourably predisposed, the one matter which seems to matter is whether or not they know their relative's wish. The situation is quite unlike for relatives with a negative predisposition. In this case, having thought virtually the outcome increases the perceived probability of their like-minded to donation by an order of magnitude. Looking more closely at the spread of the data for the case where relatives do not know the wishes of the potential donors and are generally opposed to organ donation, it appears that iv of the 6 respondents gave similar estimates for the situations with and without prior thinking, while two consider that the prior thinking has a very significant positive touch. If we compare this to the case where relatives do not know the deceased wish to donate, all only 1 call up that prior thought has a significant impact on the decision.
Table 2.
Estimation of donation rate by three atmospheric condition: families' prior thinking, their predisposition and their awareness of the deceased person'southward wishes. Averages are shown of estimated donation rates under different conditions, given by five/six intensive care physicians, respectively, depending on the number of usable answers. Ranges are indicated in brackets.
| Had not given serious thought about organ donation | Had seriously thought virtually organ donation | ||
|---|---|---|---|
| Relatives practice not know | Generally in favour of organ donation | 53% (5-90) | 57% (x-100) |
| potential donors wishes | Generally opposed to organ donation | 13% (0-l)* | 31% (0-95)° |
| Relatives know the deceased | More often than not in favour of organ donation | 88% (45-100) | 78% (50-100) |
| wished to donate | More often than not opposed to organ donation | 21% (0-xc)# | 41% (5-ninety) |
Quantifying the flow of decisions leading to transplantation
The relative prevalence of family unit communication factors, the average estimated consent rate nether unlike advice conditions, and the sum of estimated detected potential donors per year allows the ciphering of a model that provides estimates of how many cases per year are lost to donation for the different family communication conditions. The model starts out with the total annual number of detected potential organ donors. Viii respondents related such numbers, ranging from 10 to fourscore, with nearly doctors mentioning figures not above 20. Some doctors gave ranges instead of precise numbers. If the figures are added up, the number of potential organ donors in the institutions covered ranges between 189 and 211. Conveniently, the middle of that range is 200, and this number will serve as the basis for everything that follows. The calculations are shown in Table iii. As doctors indicated that even when a donor bill of fare was found, they would however discuss the matter with the potential donor'southward relatives, we do not differentiate between cardholders and non-cardholders. Hospitals are legally required to mention the possibility of organ donation to relatives whenever this is a medical selection. In reality, however, this will non happen in each and every instance. On average (8 doctors again), the estimated share of cases where donation is indeed mentioned to relatives is 94%. This means 6% or 12 potential donors are lost considering medical staff does not see a risk to enhance the event with relatives. The adjacent steps distribute the remaining cases into the different family advice conditions. First is the relatives' cognition of the deceased person's preferences. On boilerplate, viii doctors estimated the share of relatives who knew these wishes at 49%. That is to say: of the remaining 188 potential donors, 92 autumn in the condition that the relatives know the dead person'southward preferences, and 96 in the condition that relatives do not. Adjacent, doctors were asked in how many cases (among the 92 with relatives knowing their family member'due south wishes) relatives idea the deceased had been in favour or confronting donating his organs. Estimates for this question again vary widely, but on average they came down to 70% in favour and thirty% opposed. This means that in that location are, in a given year, 64 possible donors whose relatives are certain the deceased wished to be a donor, and 28 for whom relatives say they know the deceased was opposed to donation. The latter are counted as lost for donation.
Table 3.
Ciphering of number of cases lost for donation in different atmospheric condition.
| Number of cases* | Relatives' prior thinking and predisposition | Distribution in percentage° | Cases in status | Percent family unit consents to donation# | Number of donations | Number of cases lost for donation | |
|---|---|---|---|---|---|---|---|
| Relatives non approached about donation | 12 | All lost for donation | 12 | ||||
| Relatives know deceased did not want to donate | 28 | All lost for donation | 28 | ||||
| Relatives know deceased wished to donate | 64 | Have thought, favourable | 27 | 17 | 78% | 13 | 4 |
| Have thought, unfavourable | 10 | 6 | 41% | 2 | four | ||
| Have non thought, favourable | 23 | 15 | 88% | 13 | two | ||
| Take non thought, unfavourable | 40 | 26 | 21% | 5 | 21 | ||
| Sum | 100 | 64 | 33 | 31 | |||
| Relatives practice not know the deceased person's wishes | 96 | Have thought, favourable | 27 | 26 | 57% | 15 | xi |
| Have thought, unfavourable | 10 | 10 | 31% | 3 | seven | ||
| Take non thought, favourable | 23 | 22 | 53% | 12 | 10 | ||
| Take not idea, unfavourable | 40 | 38 | xiii% | 5 | 33 | ||
| Sum | 100 | 96 | 35 | 61 | |||
| Grand total | 200 | 68 | 132 |
The cases remaining in the model were so distributed across the prior thinking/predispositions groups (using the percentages shown in Table 1). This was first washed under the unrealistic assumption of no correlation between intensity of prior thinking and knowledge of the deceased person's wish. A more complicated model accounting for such a correlation was also computed, based on an earlier representative population survey.2 The computation produced rather similar figures. We therefore stick to the simpler model. In the final step, the estimated transplantation rates (shown in Table 2) were practical cell-wise, that is: for the different family communication weather condition.
Following this procedure, we can estimate (Tabular array 3) that among the 64 cases where relatives know the deceased had favoured organ donation for himself, only 33 will lead to transplantation, while 31 (or 48%) are lost as organ donors. Amidst these 31 lost cases, there are 21 instances where the relatives had non thought almost organ donation before, merely were predisposed against it nevertheless. Amidst the 96 cases where relatives had no noesis of the deceased person'south preferences, only 35 result in transplantation while 61 (or 64%) are lost. Of these, 33 autumn in the condition no prior thinking/predisposed against.
Incidentally, the number of 68 transplantations yielded by the model corresponds by and large to the real number of organ donors that Swisstransplant reports for 2007: 81 cases all in all (2006: 80 donors, 2005: 90 donors), of which virtually three fourths are performed in the transplantation centers of the big hospitals where our respondents come up from. This cannot exist overinterpreted, though, equally for example some information in our survey may be based on identical cases. But the closeness of the estimated number of organ donors in our model to the real figure suggests the model may have some bearing.
If we summarize, starting from 200 potential organ donors a year, about two thirds of the cases are lost for donation. The single largest group of losses consists of cases where the relatives are non aware of the deceased person's wishes, have not thought about donation and are unfavourably predisposed. This is the grouping with the everyman transplantation rate (xiii%, Tabular array 2); it makes up 25% (33 of 132) of the losses. This group unites all factors that impede a decision for donation and may therefore be hard to persuade; just still much can exist won here. Also almost anything that can be said in a entrada to accelerate organ donation addresses this group'south impediments. The 2nd largest grouping of losses (28 in 132 or 21%) are the families who say their deceased relative did not wish to donate his or her organs. Nothing much tin can be done about these cases, except to encourage persons who are willing to donate to share this wish with their families. The third largest grouping is the one where unfavourable predisposition among relatives and lack of thinking overrules the deceased person's readiness to donate organs. We find 21 amid 132 or 16% of the losses in this group. Here communication that aims at respecting one'southward relatives' preferences may be called for. And finally a grouping of as well 21 (10+11 among 132) creates a sizeable proportion of losses, consisting of people with favourable predispositions (irrespective of level of thinking) who object presumably considering they practise not know the deceased person's wishes. Hither once again, encouragement to share one'south preferences with one's family is called for.
Discussion
The added value of our study is to map the starting points for future campaigns encouraging organ donation. We identified crucial points in the conclusion procedure, that is to say: the points where many potential donors are lost in the process of becoming actual donors. These points are the obvious places where measures to improve advice and to heighten awareness should focus in an try to increase the number of organ donations in Switzerland. Details on this are already spelled out in the last paragraph of the Results department.
Specifically on the donor carte, the fact that so few are found on detected potential donors suggests that a sizeable proportion of donor cards filled in and signed practise non surface when they are needed. A tentative decision then would be that some encouragement is chosen for, directed at persons who have signed a card, to comport it around all the time. The fact that a donor menu is rarely found might atomic number 82 to the decision that campaigns promoting that people sign and carry such a card have niggling value. Nonetheless we would draw a dissimilar conclusion: the donor card is still worth beingness promoted. Firstly, by police force a carte weighs more than than the family'due south preference. Secondly, and probably more than chiefly, although doctors usually renounce to refer to the police force during the give-and-take with the family unit, the existence of a card helps them a lot when approaching relatives. Thirdly, it is a first step, encouraging people to remember about the issue, to face the thought of i's own death and tin thus be a useful stepping stone to convincing other people to starting time thinking and to accept discussing this delicate affair. And fourthly, an existing donor card might make information technology more than hard for relatives to misrepresent the deceased person'southward willingness to donate, should they be and so inclined. Interestingly, in a onetime written report almost the cognition and attitudes of the Swiss population towards organ donation, Schulz et al. 5 indicated that about people were sure their relatives would take the right decision for them, should the situation arise. At the same time, the majority of respondents admitted that they did not know their relatives' attitude. The difference between the answers of cardholders and not-cardholders in that report is noteworthy. Most fourscore% of cardholders answered that they were certain that their relatives would make the right decision (correct significant what they would have wanted themselves) and 43% of them knew well-nigh their relatives' wish to donate their organs or not. This share is well-nigh twice as large as the respective percentage for not-cardholders: only 25% of this group knew the preference of their relatives. These numbers illustrate not just that there is a discrepancy betwixt what people retrieve others know about them and what they really know. They besides indicate that cardholders are more likely to talk with their family about organ donation: only this can explain the fact that they seem to know much more almost their relatives' attitudes than the opponents to organ donation or the undecided fraction. This fits our assumption that beyond its function every bit a record of the person'due south wish, the carte is also, and possibly foremost, a vehicle to initiate communication with relatives. This is particularly of import equally in our culture death has get a taboo: while in the by people were confronted with death early in life (siblings or grandparents dying at abode), this happens much less frequently today. We need to find ways to pause the taboo on death and dying to make families talk about organ donation, and the donor card seems a promising approach.
Implications
A central implication of this study is that future communication campaigns for organ donation should focus on the decision of communicating one's willingness to donate 1'southward organs or not to relatives or to a person of trust (article viii.6 of the 2007 transplantation law), and so that, in instance of an accident, they tin can brand an informed decision. Relatives are put in an extremely stressful situation and their conclusion is biased by their own attitude, upwards to the signal where they might overrule what the deceased person would have decided. To foreclose the relatives' scepticism from overturning a expressionless person's own wishes, it appears to exist advisable to emphasize i'south determination to become an organ donor in case of decease in family discussions. Whatsoever entrada should emphasize the importance of communicating this decision within families.
Second, the importance of the donor card should not be underestimated. Filling in the donor card may too lead to discussions with friends and colleagues which may again be an incentive to mention the topic within the family as well. Additionally the advice process in the infirmary betwixt doctors and relatives is almost important although information technology seems that doctors are generally behaving in compliance with the constabulary. Finally, equally the fact of not having thought about organ donation and/or holding adverse general attitudes to it emerged equally major factors in generating the loss of potential donors to transplantation medicine, possibly overruling a sizeable number of cases in which relatives thought they knew their deceased family member was ready to donate organs, it seems advisable to induce people to think well-nigh the upshot, and to promote by and large supportive attitudes. Any entrada to urge people to tell their relatives what they wish seems to be to a big degree pointless when relatives are predisposed confronting organ donation. Awareness campaigns should rather (or at least also) address these agin predispositions. There is some tension betwixt a generally favourable mental attitude to organ donation that emerges in population surveys and the fact that doctors on average see relatives split at 50:50 in favour and against organ donation. If we accept that the doctors' observations are realistic, this raises the question: why does the favourable mental attitude in full general not translate, when a decision must exist made about the body of brain-dead relative, into a behaviour in which doctor recognize a person predisposed in favour of donation. This is a discipline for further research. A likely answer to this question is that the abstract favourable attitudes visible in surveys break down when relatives are confronted with the real decision in a existent situation. If that is true, information campaigns should inform people nearly the circumstances of real situations in which they might have to make a difficult decision. Even if such data campaigns were to lower support for organ donation in some sections of the population, this appears to exist an acceptable outcome, for in a physical situation, these people would be unlikely to demonstrate a favourable mental attitude anyway. On the other mitt, information on the conditions under which they would accept to decide whether a relative was to become a potential donor may prepare some favourably predisposed relatives for the toughness of the decision to make, and thus strengthen their resolve to consent to organ donation when a determination comes up.
Limitations
The primary limitation of our study is that our data only consists of nine face-to-face interviews. Still we contacted the primary public hospitals in Switzerland that have transplantation centers on their premises, and managed to interview the head of intensive care units of at least 2 hospitals per language region. Moreover, our interview partners, who correspond the most of import hospitals of the country, are among the most experienced in this field in Switzerland. Another trouble is the possible bias of the doctors' retentivity of the situations they experienced throughout their career. One of the interview partners mentioned that he/she was more than likely to recall the dramatic cases than the ones who agreed to organ explantation without whatsoever trouble. Hence the results may be biased in a negative way. Finally, the report treats families as if they were in understanding on donation problems. Time to come studies should accost how alien views within families affect their consent to donation. A further limitation is that nosotros necessarily treated family advice virtually organ donation past a recently deceased shut relative as if information technology existed isolated from a larger social or cultural context. Not studying this context does non imply to deny its importance. To the contrary: every bit attitudes and the readiness to donate ane'due south organs differ betwixt countries or between the micro-cultural entities within countries such equally the language groups in Switzerland,5,15,17,20-23 so will family cohesion and communication blueprint, taboos on death, knowledge of one's families preferences exist strongly affected past cultural backgrounds. To receive a full picture of organ donation decision making, these factors will eventually besides take to exist considered.
References
one. Morgan SE, Miller JK.Across the organ donor menu: The effect of cognition, attitudes, and values on willingness to communicate about organ donation to family members. Wellness Commun 2001;xiv:121-34 [PubMed] [Google Scholar]
2. Morgan SE, Miller JK.Communicating about gifts of life: The outcome of knowledge, attitudes, and altruism on behavior and behavioral intentions regarding organ donation. J Appl Commun Res 2002;30:163-78 [Google Scholar]
three. Skumanich SA, Kintsfather DP.Promoting the organ donor carte du jour: A causal model of persuasion furnishings. Soc Sci Med 1996;43:401-8 [PubMed] [Google Scholar]
5. Schulz PJ, Nakamoto Thousand, Brinberg D, Haes J.More than than nation and knowledge: Cultural micro-diversity and organ donation in Switzerland. Patient Educ Couns 2006;64:294-302 [PubMed] [Google Scholar]
6. Radecki CM, Jaccard J.Psychological aspects of organ donation: a critical review and synthesis of individual and next-of-kin donation decisions. Health Psychol 1997;16:183-95 [PubMed] [Google Scholar]
seven. Frutos MA, Blanca MJ, Mansilla JJ, et al. Organ donation: a comparison of donating and nondonating families. Transplantation Proc. 2005;37:1557-9 [PubMed] [Google Scholar]
8. Frutos MA, Ruiz P, Requena MV, Daga D.Familiy refusal in organ donation: Analysis of iii patterns. Transplant P 2002;34:2513-4 [PubMed] [Google Scholar]
9. Loewy EH.Presuming consent, presuming refusal: Organ donation and communal construction. Health Care Anal 2000;eight:297-308 [PubMed] [Google Scholar]
ten. Gortmaker SL, Beasley CL, Brigham LE, et al. Organ donor potential and functioning: Size and nature of the organ donor shortfall. Crit Intendance Med 1996;24:432-9 [PubMed] [Google Scholar]
eleven. Guadagnoli E, McNamara P, Evanisko MJ, et al. The influence of race on approaching families for organ donation and their conclusion to donate. Am J Public Wellness 1999;89:244-7 [PMC free article] [PubMed] [Google Scholar]
12. Robbins ML, Levesque DA, Redding CA, et al. Assessing family unit member's motivational readiness and decision making for consenting to cadaveric organ donation. J Health Psychol 2001;6:523-35 [PubMed] [Google Scholar]
13. Martínez JM, López JS, Martín A, et al. Organ donation and family unit controlling within the Spanish donation organisation. Soc Sci Med 2001;53:405-21 [PubMed] [Google Scholar]
14. Bredehorn T, Langer C, Eichhorst A, et al. Questioning the relatives for organ and tissue donation. Transplant P 2002;34:2353-4 [PubMed] [Google Scholar]
15. Sanner MA.Attitudes toward organ donation and transplantation. A model for understanding reactions to medical procedures subsequently death. Soc Sci Med 1994;38:1141-52 [PubMed] [Google Scholar]
16. Stevens One thousand.Factors influencing decisions nigh donation of the encephalon for research purposes. Age Ageing 1998;27:623-9 [PubMed] [Google Scholar]
17. Davidson MN, Devney P.Attitudinal barriers to organ donation among black Americans. Transplant P 1991;23:2531-2 [PubMed] [Google Scholar]
18. Horton RL, Horton PJ.Knowledge regarding organ donation: identifying and overcoming barriers to organ donation. Soc Sci Med 1990;31:791-800 [PubMed] [Google Scholar]
19. Horton RL, Horton PJ.A model of willingness to become a potential organ donor. Soc Sci Med 1991;33:1037-51 [PubMed] [Google Scholar]
20. Lange SS.Psychosocial, legal, ethical and cultural aspects of organ donation and transplantation. Crit Intendance Nurs Clin North Am 1992; 4:25-42 [PubMed] [Google Scholar]
21. Lock Thousand.Cultural aspects of organ donation and transplantation. Transplant P 1999;31:1345-half-dozen [PubMed] [Google Scholar]
22. Lock M.Human torso parts every bit therapeutic tools: contradictory discourses and transformed subjectivities. Qual Health Res 2002;12:1406-eighteen [PubMed] [Google Scholar]
23. Sanner MA.Exchanging spare parts or condign a new person? People's attitudes toward receiving and donating organs. Soc Sci Med 2001;52:1491-9 [PubMed] [Google Scholar]
24. Sheehy East, Conrad SL, Brigham LE, et al. Estimating the number of potential organ donors in the United States. North Engl J Med 2003;349:667-74 [PubMed] [Google Scholar]
25. Politoski Chiliad, Coolican 1000, Casey K.Perspectives on communication issues amongst transplant and procurement professionals, transplant recipients, and donor families. J Transpl Coord 1996;six:78-83 [PubMed] [Google Scholar]
26. Haddow G.Donor and non donor families' accounts of advice and relations with healthcare professionals. Prog Transplant 2004;14:41-8 [PubMed] [Google Scholar]
27. Williams MA, Lipsett PA, Rushton CH, et al. The physician'south role in discussing organ donation with families. Crit Care Med 2003;31:1568-73 [PubMed] [Google Scholar]
28. Siminoff LA, Gordon Northward, Hewlett J, Arnold RM.Factors influencing families' consent for donation of solid organs for transplantation. J Am Med Ass 2001;286:71-7 [PubMed] [Google Scholar]
29. Smith SW, Massi Lindsey LL, Kopfman JE, et al. Predictors of engaging in family word virtually organ donation and getting organ donor cards witnessed. Health Commun 2008;23:142-52 [PubMed] [Google Scholar]
30. Smith SW, Kopfman JE, Massi Lindsey LL, et al. Encouraging family discussion on the decision to donate organs: the role of the willingness to communicate scale. Wellness Commun 2004;16:333-46 [PubMed] [Google Scholar]
31. Sque M, Long T, Payne S.Organ donation: key factors influencing families' determination-making. Transplant P 2005;37:543-half dozen [PubMed] [Google Scholar]
32. Kopfman J, Smith S, Yun J, Hodges A.Melancholia and cognitive reactions to narrative versus statistical evidence organ donation messages. J Appl Commun Res 1998;26:279-300 [Google Scholar]
33. den Hartogh G.The part of the relatives in opt-in systems of mail-mortal organ procurement. Med Health Care Philos 2012;15:195-205 [PMC free article] [PubMed] [Google Scholar]
34. DeJong W, Franz HG, Wolfe SM, et al. Requesting organ donation: an interview written report of donor and nondonor families. Am J Crit Care 1998;7:13-23 [PubMed] [Google Scholar]
35. Ford LA, Smith SW.Memorability and persuasiveness of organ donation message strategies. Am Behav Sci 1991;34:695-711 [Google Scholar]
36. Jacob Arriola KR, Robinson DH, Perryman JP, Thompson N.Understanding the relationship between knowledge and African Americans' donation conclusion-making. Pat Educ Counsel 2008;70: 242-50 [PMC free commodity] [PubMed] [Google Scholar]
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140364/
0 Response to "Persuading a Person to Donate an Organ of a Recently Deceased Family Member"
Post a Comment