Design and evaluation of a workplace intervention to promote organ donation

BACKGROUND: A number of efforts have been made to improve rates of deceased organ donation. However, few have been specifically designed for implementation in the workplace. OBJECTIVES: To design and evaluate a workplace intervention to increase documentation of intention to be posthumous organ donors, communication of donation intention to families, and family members' documentation of their donation intentions. METHODS: The study was a randomized controlled trial of corporate employees. Within each corporation, worksites were randomized to a control condition or 1 of 2 educational interventions. Measures included baseline and 1-month postintervention measures of stage of organ donation intention, stage of family notification, and family members' organ donation intention. RESULTS: Across 12 corporations, 40 worksites with a total of 754 participants were randomized. At 1-month follow-up, 495 participants (66%) completed a posttreatment questionnaire. The percentage of participants who signed organ donor cards increased in the 2 intervention groups (29%, P < .001, and 31%, P < .002) but not in the control group (17%, P = .454). The percentage who discussed their donation intentions with family members increased significantly across all 3 arms (39%-47%, P < .001). The mean percentage of participants' family members who signed organ donor cards increased by 14% in the control group (P = .016) and by 17% in the 2 intervention groups (P < .001). CONCLUSIONS: Educational interventions in the corporate workplace setting can be effective in increasing organ donation intention, family notification, and recruitment of family members as potential organ donors.     

Probing transplant and living donor candidates about their participation in organ vending

The selling of human organs for transplant is illegal in the United States and in most countries; however, such transactions still occur. Transplant hospitals and their personnel have multiple ethical duties, including (1) protecting the safety of their living donors and transplant recipients and (2) protecting the integrity of living donation and transplantation as clinical practices. To date, few psychosocial screening tools exist that pertain specifically to a person's risk or intent of pursuing organ vending (buying or selling). This article presents a series of transplant ethics case consultations that spawned the creation of a set of behavioral prompts for teams to probe with regard to organ vending when screening candidates about their suitability for participation as living donors or transplant recipients.     

Incentives to promote organ donation

The worldwide shortage of organs has led to the development of incentives to promote organ donation. These incentives vary widely in nature ranging from financial remuneration to preferential access to conditional donation. Such strategies to increase organ donation present a variety of ethical dilemmas challenging traditional concepts of justice and equity of access. In addition, there are legal and logistic considerations that must be discussed. The case is made that schemes using incentives to promote organ donation must meet the requirements of society for justice, equity of access, and avoidance of racial or other bias.     

心脏介入术患者实施家属参与式健康教育效果探讨

目的探讨家属参与式健康在心脏介入手术患者中的应用效果。方法将194例行心脏介入手术的患者随机分为实验组(98例)和对照组(96例)。对照组实施常规护理;实验组在常规护理的基础上实施以家属参与式的健康教育,即确定患者及家属的需求,共同制定目标,采取个体教育、集体教育及情景模拟等方法对患者及家属进行疾病相关知识教育。观察两组入院时,术前焦虑、心率、血压的变化,术后24h内并发症发生率。结果实验组术前焦虑评分、心率和血压显著低于对照组(P0.05,P0.01),术后24h并发症发生率显著低于对照组(均P0.05)。结论家属参与式健康教育应用于心脏介入患者可提高健康教育效果。     

A plea for uniform European definitions for organ donor potential and family refusal rates

Conversion of potential organ donors to actual donors is negatively influenced by family refusals. Refusal rates differ strongly among countries. Is it possible to compare refusal rates in order to be able to learn from countries with the best practices? We searched in the literature for reviews of donor potential and refusal rates for organ donation in intensive care units. We found 14 articles pertinent to this study. There is an enormous diversity among the performed studies. The definitions of potential organ donors and family refusal differed substantially. We tried to re‐calculate the refusal rates. This method failed because of the influence caused by the registered will on donation in the Donor Register. We therefore calculated the total refusal rate. This strategy was also less satisfactory considering possible influence of the legal consent system on the approach of family. Because of lack of uniform definitions, we can conclude that the refusal rates for organ donation can not be used for a sound comparison among countries. To be able to learn from well‐performing countries, it is necessary to establish uniform definitions regarding organ donation and registration of all intensive care deaths.     

Death and the potential organ donor

There is no statutory definition of death in the UK, but death is accepted as the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe. Brainstem death is considered equivalent to somatic death. Brainstem death testing is a formalized process divided into three stages: preconditions, exclusions and clinical testing. The confirmation of brainstem death allows for heart-beating organ donation to proceed. The increasing demand for transplantable organs has not been matched by available heart-beating organ donors, leading to renewed interest in non-heart-beating donation. Improved preservation techniques and better assessment of organ function have enabled transplant teams to procure kidneys, livers, lungs and other tissues from non-heart-beating donors. Results from transplanted kidneys show identical five-year survival for organs taken from heart-beating and non-heart-beating donors.     

The organ donor crisis: the missed organ donor potential from the accident and emergency departments

The critical shortage of cadaveric donor organs for transplant purposes is a worldwide concern. The disparity between the number of cadaveric organs donated for transplant purposes and those patients awaiting transplant operations continues to widen. This article reports on the findings of an audit of deaths undertaken in 10 accident and emergency (A&E) departments in North Thames region, UK. The audit itself was borne out of informal anecdotal accounts from colleagues working in the A&E department who suggested that there was a potential pool of organ and tissue donors that were not being realized. The article discusses how those audit findings helped shape the current A&E education strategy in the North Thames region. The result has been that the North Thames region has seen a dramatic increase in the number of referrals from the A&E departments, resulting in solid organ transplantation. Although the results are very encouraging, the program is still very much in its infancy and a long way from the desired 100% referral rate. In order to maximize the number of organs from the potential donor pool, the transplant community needs to focus more attention toward donation from the A&E departments.     

Assessment of costs to donor hospitals for organ transplantation

In 1987, die Department of Health in the UK set up a working party to identify reasons contributing to a shortfall in donor organs. One recommendation was reimbursement to the District Health Authorities for costs incurred in providing the donor organs. The figure chosen was not to be seen as an incentive to donate organs, merely as an appropriate compensation for the costs incurred. There would be no direct payment to doctors, trustees or relatives of the donor. With the development of the competitive health care environment in the United Kingdom, the reimbursement of donating hospital costs is being considered with these data.