TY - JOUR
T1 - Communication with Families Regarding Organ and Tissue Donation after Death in Intensive Care (COMFORT)
T2 - a multicentre before-and-after study
AU - Potter, Julie E.
AU - Perry, Lin
AU - Elliott, Rosalind M.
AU - Aneman, Anders
AU - Brieva, Jorge L.
AU - Cavazzoni, Elena
AU - Cheng, Andrew T. H.
AU - O’Leary, Michael J.
AU - Seppelt, Ian M.
AU - Herkes, Robert G.
AU - COMFORT study investigators
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Objective: To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates. Design: A multicentre before-and-after study of a prospective cohort compared with pre-intervention controls. Setting: Nine Australian intensive care units. Participants: Families and health care professionals caring for donor-eligible patients without registered donation preferences or aged ≤ 16 years. Intervention: A multicomponent intervention including offers of deceased organ donation from specially trained designated requesters using a structured conversation separate to end-of-life discussions. Main outcome measure: Proportion of families consenting to organ donation. Results: Consent was obtained in 87/164 cases (53%) during the intervention period compared with 14/25 cases (56%) pre-intervention (P = 0.83). The odds ratio (OR) of obtaining consent during the intervention period relative to pre-intervention was 1.13 (95% CI, 0.48–2.63; P = 0.78). During the intervention period, designated requesters obtained consent in 55/98 cases (56%), compared with 32/66 cases (48%) in which the medical team managing patient care raised donation (P = 0.34). Factors independently associated with increased consent were: family-raised organ donation (OR, 4.34; 95% CI, 1.79–10.52; P = 0.001), presence of an independent designated requester (OR, 3.84; 95% CI, 1.35– 10.98; P = 0.012), and multiple donation conversations per case (OR, 3.35; 95% CI, 1.93–5.81; P < 0.001). Consent decreased when patients were of non-Christian religion (OR, 0.18; 95% CI, 0.04–0.91; P = 0.038) and end-of-life and donation meetings were separate (OR, 0.38; 95% CI, 0.16–0.89; P = 0.026). Conclusion: Implementation of a multicomponent intervention did not increase consent rates for organ donation, although some components of the intervention exerted significant effect.
AB - Objective: To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates. Design: A multicentre before-and-after study of a prospective cohort compared with pre-intervention controls. Setting: Nine Australian intensive care units. Participants: Families and health care professionals caring for donor-eligible patients without registered donation preferences or aged ≤ 16 years. Intervention: A multicomponent intervention including offers of deceased organ donation from specially trained designated requesters using a structured conversation separate to end-of-life discussions. Main outcome measure: Proportion of families consenting to organ donation. Results: Consent was obtained in 87/164 cases (53%) during the intervention period compared with 14/25 cases (56%) pre-intervention (P = 0.83). The odds ratio (OR) of obtaining consent during the intervention period relative to pre-intervention was 1.13 (95% CI, 0.48–2.63; P = 0.78). During the intervention period, designated requesters obtained consent in 55/98 cases (56%), compared with 32/66 cases (48%) in which the medical team managing patient care raised donation (P = 0.34). Factors independently associated with increased consent were: family-raised organ donation (OR, 4.34; 95% CI, 1.79–10.52; P = 0.001), presence of an independent designated requester (OR, 3.84; 95% CI, 1.35– 10.98; P = 0.012), and multiple donation conversations per case (OR, 3.35; 95% CI, 1.93–5.81; P < 0.001). Consent decreased when patients were of non-Christian religion (OR, 0.18; 95% CI, 0.04–0.91; P = 0.038) and end-of-life and donation meetings were separate (OR, 0.38; 95% CI, 0.16–0.89; P = 0.026). Conclusion: Implementation of a multicomponent intervention did not increase consent rates for organ donation, although some components of the intervention exerted significant effect.
UR - http://www.scopus.com/inward/record.url?scp=85057276618&partnerID=8YFLogxK
M3 - Article
C2 - 30482134
AN - SCOPUS:85057276618
SN - 1441-2772
VL - 20
SP - 268
EP - 276
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 4
ER -