Bootcongres

Purpose The issue of ‘when’ family members should be asked about organ donation first appears in the literature in the late 80’s, with authors proposing that family members needed time to accept that death had occurred before they are presented with the option of donation. In those days mainly donation after brain death (DBD) was practiced. However, over the last 15 years the number of Donation after Circulatory Death (DCD) donors has been rising. In these cases discussion with family members regarding the potential for organ donation follows the discussion about the futility of on-going treatment and the intention of the ICU team to withdraw life sustaining treatment. In the Netherlands the practice of discussing donation with relatives prior to the certified death of the potential donor has become increasingly common also in the potential DBD situations. In light of these findings we tried to scope current practice about the moment of asking for DBD and DCD donation across European member states. Methods A factual questionnaire comprising of 15 questions was send to in-country contacts. Results Responses were collected from 10 member states (Croatia, Estonia, Germany, Norway, Poland, Spain, Sweden, Switzerland, the Netherlands and UK). In Croatia organ donation is only requested after death, in all other countries the first moment of discussing donation (not the final request) is moving more forward, before death is certified. The approach is made after the infaust prognosis, during discussions of whether or not to continue intensive care treatment as part of end of life care planning. This implicates that if family refuses DBD donation, the brain death testing will not proceed. In Spain, an earlier discussion about donation is suggested to be linked to factors as the use of marginal organs from elderly donors. These donors provide a lower number of organs for transplantation and because of the shortage of ICU beds, such potential donors are no longer admitted to intensive care units for diagnosis of brain death.

Conclusion Our small fact-finding questionnaire is informative and suggests that there may be a number of drivers supporting reported changes in the historical practice regarding the moment family members are first asked about organ donation. Early family approach may be linked to pragmatic decisions about end-of-life care and the use of increasingly limited resources. Further research is suggested to analyse the effect on family consent rates.