Honoring Donor Designation in Brain Dead Organ Donors

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BackgroundState laws say an individual's documented decision to be a donor is authorization for organ, eye, and tissue donation and shall be honored. This is referred to as donor designation. LifeSource serves the states of MN, ND, and SD. Laws affirming donor designation were passed in SD in 2001 and MN in 2003. All three states re-affirmed donor designation in 2007 with the adoption of the Uniform Anatomical Gift Act which states “in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift." In rare situations, the family of the potential donor does not support their decision. An effective process, collaboration between the hospital and OPO, and family support is necessary to proceed with donation and fulfill the donor’s decision.MethodsA review of donor family conflict cases showed potential reasons for the conflict and the response in situations where donation proceeded.1 The OPO continuously monitors situations of family conflict and has found it occurs in a small number of potential donors.ResultsFrom 2003 to 2014 the OPO cared for 1748 organ donors. 1520 were 18 years and older and 739 had a documented donation decision. Donation moved forward in eleven of 17 cases in which the families expressed a conflict with their loved one’s decision. Reasons for the conflict included an influencer from outside the family, uncertainty or confusion with brain death, belief the family had a choice, donation mentioned by a non-trained hospital professional, questions about the donor’s intent, or traumatic cause of death.ResultsThe review showed that it is possible to honor donor designation. Key learnings include: family conflict events are rare, huddles with healthcare team and LifeSource facilitates a smooth process, engagement with hospital and LifeSource leadership is crucial, early connection between LifeSource and the donor family is key, consistent messaging mitigates misperceptions and confusion, the established conflict resolution process is effective, and honoring donor designation builds a culture of accountability for donation.ConclusionFulfilling donation when the donor has documented their decision is consistent with the legal and ethical framework of donation. This can be done effectively when the hospital and OPO are working collaboratively and families are provided clear communication along with compassionate and sensitive support.Reference:1. Paul A. Stahler, MD, Susan E. Weese, Rachel M. Nygaard, PhD, Mark J. Hill, MD, Chad J. Richardson, MD, Susan Mau Larson, MPA, Susan Gunderson, MHA, and Robert R. Quickel, MD Honoring patient’s organ donation decisions when family conflict is present: Experience from a single organ procurement organization. 2014; 77(4): 555–558.

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