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Minerva Anestesiologica 2018 September;84(9):1044-52

DOI: 10.23736/S0375-9393.18.12658-7


language: English

Factors influencing consent to organ donation after brain death certification: a survey of 29 Intensive Care Units

Guya PIEMONTE 1 , Maria L. MIGLIACCIO 2, Stefano BAMBI 3, Marco BOMBARDI 4, Lorenzo D'ANTONIO 4, Andrea GUAZZINI 5, Caterina DI PASQUALE 6, Laura TADINI-BUONINSEGNI 3, Cristiana GUETTI 3, Manuela BONIZZOLI 3, Sara BAGATTI 2, Paolo LOPANE 2, Anna NATIVI 2, Laura RASERO 1, Adriano PERIS 2

1 Department of Health Science, University of Florence, Florence, Italy; 2 Tuscany Transplant Authority, Tuscany Region, Florence, Italy; 3 Intensive Care Unit and Regional ECMO Referral Center, Neuromusculosketal and Sensory Organs Department, University Hospital of Careggi, Florence, Italy; 4 Regional Center for Organ and Tissue Allocation, Hospital Health Direction Department, University Hospital of Careggi, Florence, Italy; 5 Department of Education and Psychology (Psychology Section), Center for the Study of Complex Dynamics, University of Florence, Florence, Italy; 6 Department of Culture and Forms of Knowledge, University of Pisa, Pisa, Italy

BACKGROUND: Family refusal (FR) to heart beating donation (HBD) in Intensive Care Unit (ICU) is increasing in recent years with a significant impact on the number of transplantable organs. Fostering setting humanization, quality of relationships, respect for will and family reliance towards ICU could be relevant in containing FR to organ donation (OD) in ICU. Our aims were to highlight the effects of structural features of ICUs and humanization determinants on FR in HBD process, and to describe visiting policies, structure and modalities of support in ICUs.
METHODS: A survey was conducted among all the ICUs of the Tuscany Region included in the National Transplant System of the Ministry of Health in Italy. Data on ICUs’ general and architectural characteristics, visiting policies and support for families were collected. Baseline characteristics of brain dead certified patients (BDCPs) were retrieved from the Registry of the Regional Transplant Centre.
RESULTS: Twenty-nine (93.5%) ICUs out of 31 completed the survey. 330 BDCPs were managed during 2016 in the ICUs studied, with an opposition rate of 33.3%. The following independent factors for opposition emerged: BDCPs’ age (OR=1.025; 95% CI: 1.007-1.042; P=0.005), ICU length of stay (LOS) (OR=1.065; 95% CI: 1.005-1.128; P=0.034) and the availability of an ICU team trained in procurement (OR=0.472; 95% CI: 0.275-0.811; P=0.007).
CONCLUSIONS: Older age of BDCPs and a prolonged ICU LOS resulted in FR. ICU team specific education emerged as the only modifiable protective factor for oppositions, thus continuous and in-depth training programs for physicians and nurses could be of importance in preventing FR.

KEY WORDS: Third-party consent - Intensive Care Units - Tissue and organ procurement

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