Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Hamilton Health Sciences, Hamilton, ON, Canada.
Can J Anaesth. 2019 Jun;66(6):686-695. doi: 10.1007/s12630-019-01332-9. Epub 2019 Feb 26.
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.
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.
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.
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.
在其他方面可比的重症监护病房（ICU）之间，器官捐献率存在差异，这表明捐献过程在 ICU 之间必然存在差异。本研究的目的是从 ICU 工作人员的角度描述器官捐献过程，确定成功捐献的重要驱动因素，并制定改善捐献过程的策略。
我们对 32 名 ICU 工作人员进行了定性访谈，包括医生、护士和呼吸治疗师，使用了从先前关于器官捐献的研究中开发的访谈指南。采用定性描述方法，我们使用定性内容分析对访谈进行编码。我们将访谈结果与先前发表的文献分析和横断面调查的数据进行了混合方法分析，以确定可能在 ICU 中促进器官捐献的实践。
访谈中出现了五个对器官捐献过程很重要的主题：i）工作人员与器官捐献协调员的关系；ii）标准化流程；iii）ICU 工作人员的信念；iv）捐赠与高质量临终关怀的整合；v）反馈和工作人员支持。在混合方法分析中，我们确定了 22 项可增强 ICU 器官捐献过程的可操作实践。
我们纳入了 ICU 工作人员的观点，确定了 22 项可能对捐献结果产生重大累积影响的实践改变。需要进一步研究这些发现是否能解释其他方面可比的 ICU 之间捐献率的差异。
