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Survey of Canadian intensivists on physician non-referral and family override of deceased organ donation

  • Matthew J. WeissEmail author
  • Shane W. English
  • Frederick D’Aragon
  • François Lauzier
  • Alexis F. Turgeon
  • Sonny Dhanani
  • Lauralyn McIntyre
  • Sam D. Shemie
  • Gregory Knoll
  • Dean A. Fergusson
  • Samantha J. Anthony
  • Adnan Haj-Moustafa
  • David Hartell
  • Jim Mohr
  • Michaël Chassé
  • for the Canadian Critical Care Trials Group
Reports of Original Investigations

Abstract

Purpose

Intensive care physicians play an important role in the identification and referral of potential organ donors in Canada. Nevertheless, little is known about intensivists’ attitudes or behaviours in situations where families override previously expressed consent to donate; nor why physicians elect not to refer patients who are potential donors to provincial organ donation organizations (physician non-referral).

Methods

We integrated questions regarding family override and physician non-referral into an online, self-administered survey of Canadian intensivists. We report results descriptively.

Results

Fifty percent of targeted respondents (n = 550) participated. Fifty-five percent reported having witnessed family override situations and 44% reported having personally not referred patients who were potential donors. Fifty-six percent of respondents stated they would not pursue donation in the face of family override; 2% stated they would continue with the donation process. Fear of loss of trust in the donation system (81%) and obligation to respect the grief and desires of surrogate decision makers (71%) were frequently reported reasons to respect family override requests. Respondents who chose not to refer patients often did so based on organ dysfunction they assumed would preclude donation (59%), or a perception that the family was too distressed to consider donation (42%). No respondents reported that personally held beliefs against organ donation influenced their decision.

Conclusion

Physicians caring for patients who are potential organ donors commonly encounter both family override and physician non-referral situations. Knowledge translation of optimal practices in identification and referral could help ensure that physician practices align with legal requirements and practice recommendations.

Sondage auprès des intensivistes Canadiens concernant la non-référence médicale et le refus par la famille malgré l’accord du donneur du don d’organes après un décès

Résumé

Objectif

Les intensivistes jouent un rôle important dans l’identification et la référence des donneurs potentiels d’organes au Canada. Toutefois, nous ne connaissons que très peu de choses concernant les attitudes et comportements des intensivistes dans les situations dans lesquelles les familles vont à l’encontre d’un consentement de don exprimé au préalable; nous ne savons pas non plus pourquoi certains médecins décident de ne pas référer des patients qui seraient de potentiels donneurs aux organismes de dons d’organes provinciaux (non-référence médicale).

Méthode

Nous avons intégré des questions concernant la décision de la famille de ne pas respecter une décision de don d’organes et la non-référence médicale dans un sondage auto-administré en ligne envoyé aux intensivistes canadiens. Nous rapportons les résultats du sondage de façon descriptive.

Résultats

Cinquante pourcent des répondants ciblés (n = 550) ont participé. Cinquante-cinq pourcent ont rapporté avoir été témoins de situations dans lesquelles la décision de la famille allait à l’encontre des souhaits de la personne décédée et 44 % ont rapporté avoir personnellement décidé de ne pas référer certains patients alors qu’ils étaient des donneurs potentiels. Cinquante-six pourcent des répondants ont déclaré qu’ils ne chercheraient pas à encourager un don d’organes si la famille y était opposée; 2 % ont déclaré qu’ils poursuivraient le processus de don. La peur d’une perte de confiance dans le système de don (81 %) et l’obligation de respecter le deuil et les souhaits des mandataires (71 %) comptaient parmi les raisons fréquemment citées de respecter les demandes de la famille plutôt que celles de la personne décédée. Les répondants ayant choisi de ne pas référer leurs patients ont souvent pris cette décision en raison d’une atteinte des organes qui, selon eux, aurait exclu le don (59 %), ou d’une perception selon laquelle la famille était trop bouleversée pour envisager le don (42 %). Aucun répondant n’a rapporté que ses convictions personnelles contre le don d’organes auraient influencé sa décision.

Conclusion

Les médecins qui s’occupent de patients qui sont des donneurs potentiels se retrouvent souvent dans des situations où la volonté de la famille l’emporte ou dans des situations de non-référence médicale. La transmission des connaissances concernant les meilleures pratiques dans l’identification et la référence des patients pourrait aider à garantir que les pratiques médicales soient en accord avec les exigences légales et les recommandations de pratique.

Notes

Author contributions

Matthew J. Weiss and Michaël Chassé contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Shane W. EnglishFrederick D’Aragon, François Lauzier, Alexis F. Turgeon, Sonny Dhanani, Lauralyn McIntyre, Sam D. Shemie, Gregory Knoll, Dean A. Fergusson, Samantha J. Anthony, David Hartell, and Jim Mohr contributed to the study conception and design. Adnan Haj-Moustafa contributed to the acquisition and analysis of data. Shane W. English, Frederick D’Aragon, François Lauzier, Alexis F. Turgeon, Sonny Dhanani, Lauralyn McIntyre, Sam D. Shemie, Gregory Knoll, Dean A. Fergusson, Samantha J. Anthony, and Adnan Haj-Moustafa contributed to the interpretation of data.

Acknowledgements

We thank all the respondents who offered their time to thoughtfully respond to this survey. Livia Carvalho assisted with preparation of the tables and editing of the final manuscript. We also would like to thank Drs. Kusum Menon and Bram Rochwerg from the Canadian Critical Care Trials Group for offering their insightful reviews of this manuscript prior to submission.

Conflicts of interest

None.

Funding statement

This survey was supported with funds from the Fondation du Centre Hospitalier de l’Université Montréal. The Canadian Critical Care Society and Canadian Blood Services provided in-kind support for development of the contact list. Drs. Lauzier, D’Aragon and Chassé are recipients of a research salary support Award from the Fonds de Recherche du Québec—Santé (FRQS). Dr. Turgeon is the Chairholder of the Canada Research Chair in Critical Care Neurology and Trauma. The Canadian Critical Care Trials Group receives funding from a Canadian Institute of Health Research grant.

Editorial responsibility

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

Supplementary material

12630_2019_1538_MOESM1_ESM.pdf (160 kb)
Supplementary material 1 (PDF 159 kb) eAPPENDIX 1 Survey of Canadian intensivists’ attitudes towards deceased organ donation
12630_2019_1538_MOESM2_ESM.xlsx (89 kb)
Supplementary material 2 (XLSX 88 kb) eAPPENDIX 2 Delphi results of index survey development

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Matthew J. Weiss
    • 1
    • 2
    • 3
    • 4
    Email author
  • Shane W. English
    • 5
    • 6
  • Frederick D’Aragon
    • 4
    • 7
  • François Lauzier
    • 1
    • 8
    • 9
  • Alexis F. Turgeon
    • 1
    • 8
  • Sonny Dhanani
    • 4
    • 10
  • Lauralyn McIntyre
    • 5
    • 6
  • Sam D. Shemie
    • 2
    • 11
    • 16
  • Gregory Knoll
    • 4
    • 5
    • 6
  • Dean A. Fergusson
    • 5
    • 6
  • Samantha J. Anthony
    • 4
    • 12
  • Adnan Haj-Moustafa
    • 13
  • David Hartell
    • 4
  • Jim Mohr
    • 2
  • Michaël Chassé
    • 4
    • 12
    • 13
    • 14
    • 15
  • for the Canadian Critical Care Trials Group
  1. 1.CHU de Québec – Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care MedicineUniversité LavalQuébecCanada
  2. 2.Donation and Transplantation, Canadian Blood ServicesOttawaCanada
  3. 3.Transplant QuébecMontréalCanada
  4. 4.Canadian Donation and Transplant Research ProgramOttawaCanada
  5. 5.Department of MedicineUniversity of OttawaOttawaCanada
  6. 6.Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
  7. 7.Department of AnesthesiologyUniversité de SherbrookeSherbrookeCanada
  8. 8.Division of Critical Care Medicine, Department of Anesthesiology and Critical Care MedicineUniversité LavalQuébecCanada
  9. 9.Department of MedicineUniversité LavalQuébecCanada
  10. 10.Division of Critical CareChildren’s Hospital of Eastern OntarioOttawaCanada
  11. 11.Division of Critical Care, Montréal Children’s HospitalMcGill University Health Centre and Research InstituteMontrealCanada
  12. 12.Transplant and Regenerative Medicine CentreThe Hospital for Sick ChildrenTorontoCanada
  13. 13.Carrefour de l’Innovation, Centre de Recherche du CHUMMontréalCanada
  14. 14.Division of Critical Care, Department of MedicineCentre Hospitalier de l’Université de MontréalMontréalCanada
  15. 15.Department of MedicineUniversity of MontréalMontréalCanada
  16. 16.McGill UniversityMontréalCanada

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