Improving organ donation in ICU: What can make a difference?
Organ donation, with its ability to improve quality of live and potentially save lives, has become a priority in many countries, and intensive care units are often play a central role in proposing potential donors. In spite of the different efforts focused on increasing donation, the growing demand for organs amongst potential recipients still far exceeds that of potential donors; this process raises many challenges and questions, including the difficulties in identifying donors, the complex ethical and technical issues related to donation, as well as the need to provide appropriate quality of care for the patient and his or her family (1).
The Spanish experience (2), with 40 donors and more than 100 transplant procedures per million inhabitants in 2015, has demonstrated how public support can improve organ donation. Their success comes from a specific organisational approach, which includes promoting the identification and early referral of possible organ donors before they even enter the intensive care unit; considering elective non-therapeutic intensive care and incorporating the routine option of organ donation into end-of-life care. Each of the three strategies in this approach require ICU teams to question their habits and to integrate organ donation into all stages of their practice.
The rigorous, in-depth study proposed by Oczkowski and his team (3), focuses on identifying the key steps in the organ donation process, describes the documentary help provided by their institution, and the evolution of organ donation policies over time. The hospital in which the research took place is considered a centre of excellence in Canada, although comparative data with regard other centres or countries were not provided. Authors identified 15 documents from which 12 recent and active related to organ donation in the ICU, including 6 protocols, two policies, two order sets and two unclassified documents. Four major themes emerged: 1) the organ donation process in ICU, 2) quality of care and collaboration, 3) patient and family-centred care, and 4) the role of the institution. There was no identified target for “success” in organ donation. Collaboration and quality of care, as well as patient and family supports and engagement, were particularly highlighted, revealing that the need to protect and offer support to potentially vulnerable families was seriously taken into account.
Progress in organ donation in ICU requires still much effort, but identifying the help that our own structures can provide and collaborating with them to adapt it to daily practice is one first important step. Further research is still needed to identify the relationship of institutional documents and support to actual donation practices, and how it can find its place in all high quality end-of-life projects.
Article review prepared and submitted by ESICM Journal Club member Silvia Calvino Günther on behalf of the N&AHP Section.
- Daly BJ. End-of-Life Decision Making, Organ Donation, and Critical Care Nurses. Crit Care Nurse 2006 Apr;26(2):78-86. PMID: 16565282.
- Matesanz R, Domínguez-Gil B, Coll E, Mahíllo B, Marazuela R. How Spain Reached 40 Deceased Organ Donors per Million Population. Am J Transplant. 2017 Jun;17(6):1447-1454. doi: 10.1111/ajt.14104. Epub 2017 Jan 9.
- Oczkowski SJW et al. Organ donation in the ICU: a documented analysis of institutional policies, protocols and order sets. Intensive and Critical Care Nursing doi: 10.1016/j.iccn.2017.12.005