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A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation

  • Simon J. W. OczkowskiEmail author
  • Emmy Arnold
  • John Centofanti
  • Pamela Durepos
  • Aimee Sarti
  • Erika Arseneau
  • Sonny Dhanani
  • Deborah J. Cook
  • Maureen O. Meade
Reports of Original Investigations

Abstract

Purpose

Rates of organ donation vary between otherwise comparable intensive care units (ICUs) suggesting that the process of donation must vary between ICUs. The purpose of this study was to describe the process of organ donation from the perspective of ICU staff, identify important drivers of successful donation, and develop strategies to improve the process of donation.

Methods

We conducted qualitative interviews with 32 ICU staff, including physicians, nurses, and respiratory therapists, using an interview guide developed from previous studies on organ donation. Using a qualitative descriptive approach, we coded interviews using qualitative content analysis. We integrated findings from the interviews in a mixed-methods analysis with previously published data from a document analysis and cross-sectional survey to identify practices that may enhance organ donation in the ICU.

Results

Five major themes important to the organ donation process emerged from the interviews: i) staff relationship with organ donation coordinators; ii) standardized processes; iii) ICU staff beliefs; iv) integration of donation and high quality end-of-life care; v) feedback and staff support. In the mixed-methods analysis, we identified 22 actionable practices to enhance the process of organ donation in the ICU.

Conclusion

Incorporating the perspectives of ICU staff, we were able to identify 22 practice changes that may have a significant cumulative impact on donation outcomes. Future research is required to evaluate whether these findings account for the variability of donation rates between otherwise comparable ICUs.

Une étude par méthodes mixtes du don d’organes à l’unité de soins intensifs : 22 gestes concrets pour améliorer le don d’organes

Résumé

Objectif

Les taux de dons d’organes varient entre des unités de soins intensifs (USI) qui seraient autrement comparables, ce qui suggère que le processus de don doit varier entre les USI. Les objectifs de cette étude étaient de décrire le processus de don d’organes de la perspective du personnel de l’USI, d’identifier les éléments majeurs favorisant un don réussi, et de mettre au point des stratégies afin d’améliorer le processus de don.

Méthode

Nous avons réalisé des entretiens qualitatifs avec 32 personnes travaillant dans des USI, y compris des médecins, des infirmières et des inhalothérapeutes, à l’aide d’un guide d’entrevues mis au point à partir d’études précédentes sur le don d’organes. À l’aide d’une approche descriptive qualitative, nous avons codé les entrevues en nous fondant sur une analyse qualitative du contenu. Nous avons intégré les résultats des entrevues dans une analyse de méthodes mixtes aux données publiées précédemment dans une analyse de documents et un sondage transversal afin d’identifier les pratiques qui pourraient améliorer le don d’organes à l’USI.

Résultats

Cinq thèmes principaux et importants pour le processus de don d’organes sont ressortis des entretiens : i) la relation du personnel avec les coordonnateurs des dons d’organes; ii) les processus standardisés; iii) les convictions du personnel de l’USI; iv) l’intégration du don avec des soins de fin de vie de qualité élevée; et v) les rétroactions et le soutien du personnel de l’USI. Dans l’analyse par méthodes mixtes, nous avons identifié 22 gestes concrets permettant d’améliorer le processus de don d’organes à l’USI.

Conclusion

En incorporant les perspectives du personnel de l’USI, nous avons pu identifier 22 changements de pratique qui pourraient avoir un impact cumulé significatif sur les issues des dons. Des recherches futures sont nécessaires afin d’évaluer si ces observations expliquent la variabilité des taux de dons entre des USI autrement comparables.

Notes

Competing interests

None declared.

Editorial responsibility

This submission was handled by Dr. Sangeeta Mehta, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Simon Oczkowski contributed to all aspects of this manuscript, including study conception and design, acquisition, analysis and interpretation of data, and drafting the article. John Centofanti, Pamela Durepos, Ericka Arseneau, Sonny DhananiDeborah J. Cook, and Maureen O. Meade contributed to study conception and design, data analysis, data interpretation, and drafting the article. Emmy Arnold and Aimee Sarti contributed to the acquisition, analysis and interpretation of data, and drafting the article.

Financial support

This work was supported by Hamilton Health Sciences’ Research Strategic Initiatives. Dr. Oczkowski is supported by a Canadian Critical Care Trials Group Research Fellowship Award and a career award from the McMaster Department of Internal Medicine. Dr. Cook is a Research Chair of the Canadian Institutes of Health Research.

Supplementary material

12630_2019_1332_MOESM1_ESM.pdf (97 kb)
Electronic supplementary material 1 (PDF 97 kb)
12630_2019_1332_MOESM2_ESM.pdf (111 kb)
Electronic supplementary material 2 (PDF 111 kb)
12630_2019_1332_MOESM3_ESM.pdf (75 kb)
Electronic supplementary material 3 (PDF 75 kb)
12630_2019_1332_MOESM4_ESM.pdf (137 kb)
Electronic supplementary material 4 (PDF 137 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Simon J. W. Oczkowski
    • 1
    • 2
    • 5
    • 8
    Email author
  • Emmy Arnold
    • 1
  • John Centofanti
    • 1
    • 2
  • Pamela Durepos
    • 2
    • 3
  • Aimee Sarti
    • 4
  • Erika Arseneau
    • 5
  • Sonny Dhanani
    • 6
  • Deborah J. Cook
    • 1
    • 5
    • 7
  • Maureen O. Meade
    • 1
    • 2
    • 5
  1. 1.Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonCanada
  2. 2.Hamilton Health SciencesHamiltonCanada
  3. 3.School of NursingMcMaster UniversityHamiltonCanada
  4. 4.Department of Critical CareThe Ottawa HospitalOttawaCanada
  5. 5.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  6. 6.Division of Critical CareChildren’s Hospital of Eastern OntarioOttawaCanada
  7. 7.St Joseph’s Healthcare HamiltonHamiltonCanada
  8. 8.Juravinski HospitalHamiltonCanada

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