Abstract
In the UK, the majority of patients who donate organs for the purpose of transplantation are referred from Intensive Care Units (ICUs). A retrospective audit of deaths undertaken in ten Emergency Departments (EDs) in 2004-2005 (Aubrey, et al 2008) identified a significant missed potential of solid organ donors from EDs. Many Health Care Professionals (HCPs) said the main reason for not approaching suddenly bereaved families in the EDs was their lack of confidence in undertaking the approach, because they felt it was ‘too soon’ after bad news had been delivered to the family informing them about the inevitability of their relatives’ death. In order to address this assumption that it was ‘too soon to ask’, in-depth qualitative research was undertaken with donor family members. Fifty ED donor families were invited to participate in the study, from which 20 families agreed, comprising 28 participants (more than one family member participated in some interviews). Bereaved donor family interviews took place from 2008-2011 across four regions within the UK. Interviews were face-to-face and audio-taped. NHS Ethical Approval was obtained. Data from the 20 interviews were analysed using grounded theory (Strauss and Corbin, 1990). Key findings indicate that the experiences for donor families in EDs are significantly different from those of families in ICUs in relation to the organ donation trajectory of time, the relationship between the bereaved family and HCP and physical space. The most significant contrasting finding from this study is that it does not matter who makes the initial approach to request organ donation, but when it is done and how it is done are the critically important issues. This study has found that ED doctors are in a unique position in that the doctor caring for the patient (potential donor) and the bereaved family is best placed to make the initial approach. The Donor Transplant Coordinator plays a crucial later role in stage two of the consent approach process, in supporting the family through the organisational aspects of donation, the formal consent process, and beyond donation.