Perceptions of organ donation after circulatory determination of death among critical care physicians and nurses: A national survey*.
Hart JL, Kohn R, et al.Critical Care Medicine 2012; 40(9): 2595-2600.
Aims
This national survey aimed to identify factors related to critical care physicians’ and nurses’ willingness to help manage potential donors after circulatory determination of death (DCDD), to elicit opinions on the presence of role conflict in DCDD and its impact on end-of-life care.
Interventions
Two elements of the vignette with describing a potential DCDD were randomly assigned among participants: ‘whether the potential donor had or had not previously signed a donor card’ versus ‘whether discussions regarding donation were initiated by a family member or by a representative of the organ procurement organization’.
Participants
2206 academic intensive care unit physicians and 988 intensive care unit nurses.
Outcomes
Three outcome measures were: 1) whether ICU clinicians should help manage DCDD; 2) whether doing so creates role conflict for ICU providers; 3) whether doing so would improve the quality of end-of-life care. Variables included in final multivariate models were presence or absence of a donor card signed by the patient and whether the family initiated donation discussions. Two clinician’s characteristics (clinicians’ duration of ICU practice and past experiences managing DCDD) were analyzed as integer variables.
Follow-up
2 weeks after the last reminder
CET Conclusions
2206 intensive care unit physicians and 988 intensive care unit nurses received a questionnaire about one of four vignettes of patients with circulatory death. The response rate to the questionnaires was around 40% and the analysis of the answers suggest that critical care physicians and nurses are generally supportive of managing donors after the circulatory determination of death, especially when patients were registered organ donors. However a significant minority of physicians did harbour concerns about conflicts of interest and were concerned also about the impact of this practice on end of life care.
Quality notes
Quality assessment does not apply
Trial registration
Not reported