Entrevista familiar para la donación de órganos y tejidos: supuestos de buenas prácticas

Knhis, Neide da Silva; Martins, Sabrina Regina; Magalhães, Aline Lima Pestana; Ramos, Saulo Fábio; Sell, Camila Telemberg; Koerich, Clarice; Brehmer, Laura Calvacanti de Farias

Neide da Silva Knhis

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0003-0639-2829

Sabrina Regina Martins

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0003-0846-5227

Aline Lima Pestana Magalhães

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0001-8564-7468

Saulo Fábio Ramos

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-4389-5452

Camila Telemberg Sell

Hospital Governador Celso Ramos. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0001-6991-348X

Clarice Koerich

Universidade Federal de Santa Catarina, Hospital Universitário Polyodoro Ernani de São Thiago. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-0977-928X

Laura Calvacanti de Farias Brehmer

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0001-9965-8811

Corresponding author: Sabrina Regina Martins E-mail: sabrinamartins0704@gmail.com

EDITOR IN CHIEF: Antonio José de Almeida Filho

ASSOCIATE EDITOR: Elucir Gir

Concept^* * Concepts according to Alicante Model.	Evidence Integrative Review - Level of Evidence I⁽²⁶26 Vane DW, Sartorelli KH, Reese J. Emotional considerations and attending involvement ameliorates organ donation in brain dead pediatric trauma victims. J Trauma [Internet]. 2001 [cited 2017 Sep 08];51(2):329-31. Available from: https://insights.ovid.com/pubmed?pmid=11493794 https://insights.ovid.com/pubmed?pmid=11... 27 Long T, Sque M, Payne S. Information sharing: its impact on donor and nondonor families' experiences in the hospital. Prog Transplant. 2006;16(2):1-5. https://doi.org/10.7182/prtr.16.2.l715846273q1h784 https://doi.org/10.7182/prtr.16.2.l71584... 28 Bocci MG, D'Alo C, Inguscio S. Taking care of relationships in the intensive care unit: positive impact on family consent for organ donation. Transplant. 2016;48(10):3245-50. https://doi.org/10.1016/j.transproceed.2016.09.042 https://doi.org/10.1016/j.transproceed.2... 29 Tawil I, Brown LH, Comfort D. Family presence during brain death evaluation: a randomized controlled trial. Crit Care Med. 2014;42(4):934-42. https://doi.org/10.1097/CCM.0000000000000102 https://doi.org/10.1097/CCM.000000000000... 30 Blok GA, Morton M, Morley M. Requesting organ donation: the case of self-efficacy effects of the European Donor Hospital Education Programme (EDHEP). Adv Health Sci Educ Theor Pract. 2004;9(4):261-82. https://doi.org/10.1007/s10459-004-9404-6 https://doi.org/10.1007/s10459-004-9404-... 31 Jacoby L, Jaccardi J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of skin. Am J Crit Care. 2010;19(5):52-61. https://doi.org/10.4037/ajcc2010396 https://doi.org/10.4037/ajcc2010396... 32 Davel AP, Silva DR. Bereavement in the API-ES Context: aproaching narratives. Pensando Fam [Internet]. 2014 [cited 2017 Nov 10];18(1):107-23. Available from: http://pepsic.bvsalud.org/pdf/penf/v18n1/v18n1a10.pdf http://pepsic.bvsalud.org/pdf/penf/v18n1... ^-³³33 Adanir T, Erdogan I, Hunerli G. The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate. Transplant Proc. 2014;46(10):3249- 52. https://doi.org/10.1016/j.transproceed.2014.05.086 https://doi.org/10.1016/j.transproceed.2... ⁾
Concept^* * Concepts according to Alicante Model.	Factors that promote understanding about BD	Suggestions
Represents a stage in which the professional communicates death to family members in a clear and simple way⁽²³23 Duran BM. Modelo Espanhol é referência no mundo. Extra Classe [Internet]. 2014 [cited 2017 Oct 10];19(187). Available from: https://www.extraclasse.org.br/edicoes/2014/09/modelo-espanhol-e-referencia-no-mundo/ https://www.extraclasse.org.br/edicoes/2... 24 Santiago C. Donación y trasplantes de órganos e tejidos: el modelo Alicante de entrevista familiar para la donación de órganos para trasplante. Alicante[Internet]. 2016 [cited 2017 Jul 06]. Available from: http://donacion.organos.ua.es/submenu2_2/modelo_alicante.asp http://donacion.organos.ua.es/submenu2_2... 25 Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011. 229p. 26 Vane DW, Sartorelli KH, Reese J. Emotional considerations and attending involvement ameliorates organ donation in brain dead pediatric trauma victims. J Trauma [Internet]. 2001 [cited 2017 Sep 08];51(2):329-31. Available from: https://insights.ovid.com/pubmed?pmid=11493794 https://insights.ovid.com/pubmed?pmid=11... 27 Long T, Sque M, Payne S. Information sharing: its impact on donor and nondonor families' experiences in the hospital. Prog Transplant. 2006;16(2):1-5. https://doi.org/10.7182/prtr.16.2.l715846273q1h784 https://doi.org/10.7182/prtr.16.2.l71584... 28 Bocci MG, D'Alo C, Inguscio S. Taking care of relationships in the intensive care unit: positive impact on family consent for organ donation. Transplant. 2016;48(10):3245-50. https://doi.org/10.1016/j.transproceed.2016.09.042 https://doi.org/10.1016/j.transproceed.2... ^-²⁹29 Tawil I, Brown LH, Comfort D. Family presence during brain death evaluation: a randomized controlled trial. Crit Care Med. 2014;42(4):934-42. https://doi.org/10.1097/CCM.0000000000000102 https://doi.org/10.1097/CCM.000000000000... ⁾	Presence of a physician qualified to inform about the extreme severity before starting the BD protocol; Use of exams (tomography, imaging and others) during explanations of the BD protocol; Unique, sequential communication use, with the same language (simple language, bedside speech showing equipment); Time dedication by professionals to family members, from the moment patients enter the hospital, especially in the Intensive Care Unit; Specific, clear and coherent communication of the facts; Attention to stress, anxiety and expressions that may aggravate the fear and uncertainties of families. Attention to nonverbal responses; Encourage the opening to family members for visits, in relation to the state to address doubts.	Do not talk about the BD protocol in the first contact with families; Promote the understanding of families about BD combined with verbal explanation with the tests performed; Make up a special team with skills to assist professionals in all stages; Carry out training actions for professionals involved in the communication of death, as well as for professionals working in a critically ill patient unit; Opportunistic the presence of a family member in BD diagnosis; Guide families before the visit in relation to patients' physical state.

Concept^* * Concepts according to Alicante Model.	Evidence Literature Review - Level of Evidence I⁽³¹31 Jacoby L, Jaccardi J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of skin. Am J Crit Care. 2010;19(5):52-61. https://doi.org/10.4037/ajcc2010396 https://doi.org/10.4037/ajcc2010396... 32 Davel AP, Silva DR. Bereavement in the API-ES Context: aproaching narratives. Pensando Fam [Internet]. 2014 [cited 2017 Nov 10];18(1):107-23. Available from: http://pepsic.bvsalud.org/pdf/penf/v18n1/v18n1a10.pdf http://pepsic.bvsalud.org/pdf/penf/v18n1... ^-³³33 Adanir T, Erdogan I, Hunerli G. The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate. Transplant Proc. 2014;46(10):3249- 52. https://doi.org/10.1016/j.transproceed.2014.05.086 https://doi.org/10.1016/j.transproceed.2... ⁾
Concept^* * Concepts according to Alicante Model.	Factors that promote effective support to families	Suggestions
Represents professional support relation together with family in the process of mourning⁽³¹31 Jacoby L, Jaccardi J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of skin. Am J Crit Care. 2010;19(5):52-61. https://doi.org/10.4037/ajcc2010396 https://doi.org/10.4037/ajcc2010396... 32 Davel AP, Silva DR. Bereavement in the API-ES Context: aproaching narratives. Pensando Fam [Internet]. 2014 [cited 2017 Nov 10];18(1):107-23. Available from: http://pepsic.bvsalud.org/pdf/penf/v18n1/v18n1a10.pdf http://pepsic.bvsalud.org/pdf/penf/v18n1... ^-³³33 Adanir T, Erdogan I, Hunerli G. The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate. Transplant Proc. 2014;46(10):3249- 52. https://doi.org/10.1016/j.transproceed.2014.05.086 https://doi.org/10.1016/j.transproceed.2... ⁾	Attentive follow-up of the health team to family members throughout the hospitalization process until the conduct of the interview; Do not leave families alone, except when they verbalize this need. In the absence of a qualified professional, families need other professionals who can support them; Welcoming and emotional care with family members throughout the process; Offer psychological support to family members during the period in which they await the interview stages.	Creative, proactive training and educational programs for professionals who conduct each stage of the interview with family members and other team professionals involved in the process; Structuring the psychological support service should be performed for all family members, seeking to better identify feelings and how to face them in the face of such a situation.

Concept^* * Concepts according to Alicante Model.	Evidence Literature Review - Level of Evidence I and II⁽²⁶26 Vane DW, Sartorelli KH, Reese J. Emotional considerations and attending involvement ameliorates organ donation in brain dead pediatric trauma victims. J Trauma [Internet]. 2001 [cited 2017 Sep 08];51(2):329-31. Available from: https://insights.ovid.com/pubmed?pmid=11493794 https://insights.ovid.com/pubmed?pmid=11... ^,²⁸28 Bocci MG, D'Alo C, Inguscio S. Taking care of relationships in the intensive care unit: positive impact on family consent for organ donation. Transplant. 2016;48(10):3245-50. https://doi.org/10.1016/j.transproceed.2016.09.042 https://doi.org/10.1016/j.transproceed.2... ^,³⁰30 Blok GA, Morton M, Morley M. Requesting organ donation: the case of self-efficacy effects of the European Donor Hospital Education Programme (EDHEP). Adv Health Sci Educ Theor Pract. 2004;9(4):261-82. https://doi.org/10.1007/s10459-004-9404-6 https://doi.org/10.1007/s10459-004-9404-... ^,³³33 Adanir T, Erdogan I, Hunerli G. The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate. Transplant Proc. 2014;46(10):3249- 52. https://doi.org/10.1016/j.transproceed.2014.05.086 https://doi.org/10.1016/j.transproceed.2... ^-³⁴34 Bellali T, Papadatou D. The decision-making process of parents regarding organ donation of their brain dead child: a Greek study. Soc Sci Med. 2007;64(2):439-50. https://doi.org/10.1016/j.socscimed.2006.09.006 https://doi.org/10.1016/j.socscimed.2006... ⁾
Concept^* * Concepts according to Alicante Model.	Essential elements of family interview	Suggestions
Represents the phase in which the health professional conducts the donation theme of organs and tissues with families ⁽²³23 Duran BM. Modelo Espanhol é referência no mundo. Extra Classe [Internet]. 2014 [cited 2017 Oct 10];19(187). Available from: https://www.extraclasse.org.br/edicoes/2014/09/modelo-espanhol-e-referencia-no-mundo/ https://www.extraclasse.org.br/edicoes/2... ^,²⁵25 Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011. 229p.^,²⁷27 Long T, Sque M, Payne S. Information sharing: its impact on donor and nondonor families' experiences in the hospital. Prog Transplant. 2006;16(2):1-5. https://doi.org/10.7182/prtr.16.2.l715846273q1h784 https://doi.org/10.7182/prtr.16.2.l71584... ^,³⁰30 Blok GA, Morton M, Morley M. Requesting organ donation: the case of self-efficacy effects of the European Donor Hospital Education Programme (EDHEP). Adv Health Sci Educ Theor Pract. 2004;9(4):261-82. https://doi.org/10.1007/s10459-004-9404-6 https://doi.org/10.1007/s10459-004-9404-... ^-³¹31 Jacoby L, Jaccardi J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of skin. Am J Crit Care. 2010;19(5):52-61. https://doi.org/10.4037/ajcc2010396 https://doi.org/10.4037/ajcc2010396... ⁾	The subject of organ and tissue donation should only be inserted after understanding death; Pay attention to the fact that family members of children have greater difficulty assimilating death; Teams should consider the time between communication of death and development of donation information; The presence of the professional who conducted emotional support at the time of the speech about organ donation is important; Qualification of professionals conducting family interview is fundamental for the development of skills, competencies, and relational techniques capable of promoting self-perception and safety in the theme of BD diagnosis and organ and tissue donation.	Development of relational skills for professionals with enphase in perception, understanding and empathy in relation to families mourning process; Professional responsible for welcoming be present and/or conduct the speech about donation; Individual assessment, case by case of need of time between the communication of death and the talk about organ donation; Development and implementation of protocols of the stages of the process of reception, interview and donation of organs and tissues; Consolidation of an articulated and coherent communication approach among team professionals; Creation of training programs with approaches that move from the theoretical, technical and legal aspects of the organ and tissue donation process, mourning process and conducting family interview.

[1] Corresponding author: Sabrina Regina Martins E-mail: sabrinamartins0704@gmail.com

Brasil

Brasil

Entrevista familiar para la donación de órganos y tejidos: supuestos de buenas prácticas

RESUMEN

Objetivos:

Métodos:

Resultados:

Consideraciones Finales: