García-Sánchez Rubén, Soria-Oliver María, López Jorge S, Martínez José M, Martín María J, Barceló-Soler Alberto, Coll Elisabeth, Roldán José, Uruñuela David, Fernández-Carmona Alberto
Departamento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain.
Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Campus de Arrosadia, Pamplona, Navarra, Spain.
Transplantation. 2025 May 1;109(5):e237-e247. doi: 10.1097/TP.0000000000005210. Epub 2024 Oct 8.
Intensive care to facilitate organ donation (ICOD) involves the initiation or continuation of intensive care for patients with devastating brain injury for donation purposes. In the Spanish system, relatives undergo an early interview to request consent for this procedure. If they consent, a waiting time is agreed upon in the expectation that death by neurological criteria occurs and donation after brain death takes place. Otherwise, relatives can decide on donation after circulatory determination of death or withdrawal of life support. This study analyzes how Spanish transplant coordinators interact with relatives in early interviews and follow-ups on potential donation pathways.
Semistructured interviews were conducted with a random stratified sample of 23 Spanish transplant coordination teams to explore strategies, practices, and perceptions of ICOD consent requests. The interviews were recorded, transcribed, and analyzed using content analysis.
Previous coordination with other units and information retrieval regarding patient and relatives' situations is crucial. The development of early interviews includes an introduction to the family, identification of decision makers, empathizing with relatives and offering condolences, reaffirming the fatal prognosis, explaining the possibility of donating based on the patient's will, confirming the family's understanding and resolving doubts, and ensuring comfort and assessing family needs.
Approaching families to obtain ICOD consent is a regular practice for Spanish coordination teams. It involves a highly professional and diversified set of strategies based on establishing a support relationship for relatives. Our study provides strategies that serve as a reference for obtaining ICOD consent from families in other settings.
促进器官捐献的重症监护（ICOD）涉及为脑损伤严重的患者启动或持续进行重症监护以实现器官捐献。在西班牙的体系中，亲属会接受早期访谈以请求其同意该程序。如果他们同意，会商定一个等待期，期望患者按照神经学标准死亡并在脑死亡后进行器官捐献。否则，亲属可以决定在循环判定死亡或撤除生命支持后进行捐献。本研究分析了西班牙的移植协调员在早期访谈以及对潜在捐献途径的后续跟进中如何与亲属互动。
对23个西班牙移植协调团队的随机分层样本进行了半结构化访谈，以探讨ICOD同意请求的策略、做法和看法。访谈进行了录音、转录，并采用内容分析法进行分析。
与其他单位的先前协调以及关于患者和亲属情况的信息检索至关重要。早期访谈的开展包括向家属介绍情况、确定决策者、同情亲属并表示哀悼、重申致命预后、解释基于患者意愿进行捐献的可能性、确认家属的理解并消除疑虑，以及确保家属舒适并评估其需求。
与家属接触以获得ICOD同意是西班牙协调团队的常规做法。这涉及一套高度专业且多样化的策略，其基础是为亲属建立支持关系。我们的研究提供了一些策略，可为其他环境下从家属处获得ICOD同意提供参考。
