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The gift of life

A national approach is being taken to combat a significant shortfall in organ and tissue donations. Annie May reports.

At this moment, there are more than 1700 Australians on official waiting lists – people hoping and praying that someone has had a conversation about organ donation with their family.

However, even if this conversation has taken place, families must make decisions about organ and tissue donation for a loved one during intensely emotional circumstances, making support from others crucial to their coping.

Critical care nurses play a vital role in providing this support and in communicating about organ donation, however there is evidence that both nursing and medical staff often have insufficient knowledge and lack training in interacting with families about the donation option.

In recent years, the growing gap between supply and demand for organs has led to the implementation and evaluation of various community and in-hospital interventions designed to increase donation and consent rates.

The need to increase the rate of donations in Australia, which has remained static for the past 10 years, has resulted in the federal government adopting a national approach which includes having dedicated clinical staff on the ground in all major hospitals and raising community awareness.
Linda Thomas, DonateLife WA clinical nurse, is part of that team of staff.

Taking on the role of clinical nurse consultant organ and tissue donation at St John of God Health Care, Thomas will focus on awareness raising and education for caregivers based at the faculties’ Perth divisions.

“My goal is to ensure that staff working in intensive care units and emergency departments, as well as the general wards, can recognise a potential donor and have the knowledge, confidence and sensitivity to begin the necessary dialogue,” says Thomas.

“It is a very delicate subject, there is no denying that. Especially if the family have never thought about, or discussed, it before. However, with the correct knowledge nurses can play an important, and necessary, role in supporting families during this decision process.”

This has been backed up by research focusing on families’ experiences during the decision-making process regarding donating their loved ones’ organs, showing that quality of hospital care and receiving psychosocial support are important factors influencing their decision.

Thomas’s first task is to commence an ongoing audit of patient deaths to see where donor opportunities exist and use this information as part of her education program on organ and tissue donation which she – and invited guest speakers - will deliver to intensive care and emergency staff. Ward-based staff will also be included in the program with a focus on tissue donation, as this is the area they are most likely to encounter.

“My message to staff is not about going to patients or families with the idea of ‘I’m here to take all your organs’. It’s about giving families the opportunity to make an informed and correct decision – for them and the person who has died,” she says.

It’s also important for nurses to know when not to raise the issue.

“Organ and tissue donation is not a black and white issue. Governments and media often take the angle of donating saves lives, so do it. It is not that simple,” says Thomas.

“People have to die a certain way and sometimes it’s just not right for the family. If families don’t understand brain death, and believe that their loved one is still breathing and pink, so therefore alive, I would never approach them for organ donation. Carers need to make a judgement call.”

Nurses and medical staff also need to be aware of misconceptions, such as religious beliefs prevent them from consenting to donations.

“Most organised religions do not oppose donating or receiving organs. But the wishes of the family must always be respected.”

In order to spearhead the national reform process, the government established the Organ and Tissue Authority in January last year, and DonateLife agencies in each state and territory were formally established as a national network on 1 July last year.

State medical directors are overseeing the clinical network in each jurisdiction and are linked back to the Organ and Tissue Authority.

The DonateLife network now has over 150 people on the ground, including new medical and nursing staff devoted to organ donation working in 76 local hospitals across the country.

While Thomas believes her work with the health professionals was important, it was only one side of the story and an ongoing community awareness campaign titled Discover – Decide – Discuss is intended to encourage potential donors to discuss this difficult and sensitive subject with their families in advance and therefore ensure that their wishes are carried out if the situation arises.

Go to www.donatelife.gov.au

• Australia sits low in the international rankings with only 11.3 donors per million of population.
• About 80 per cent of Australians support organ and tissue donation.
• 30 per cent of Australians don’t discuss their donation wishes with their family.
• 40 per cent of Australians don’t realise their family makes the final decision about donation.
• The majority of Australians (93 per cent) say they would uphold their loved one’s donation wishes of family members if they were aware of their wishes.
• Australia’s family consent rate is low, with just 58 per cent of families giving consent for organ and tissue donation to proceed.
• To lift donation rates the federal government, with state and territory governments, is implementing a national reform package, ‘A World’s Best Practice Approach to Organ and Tissue Donation for Transplantation’.

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