Burnout and compassion fatigue among organ and tissue donation coordinators: a scoping review.

OBJECTIVES: To collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide? DESIGN: Scoping review using Joanna Briggs Institute methodology for scoping reviews. DATA SOURCES: Medline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020. STUDY SELECTION: Studies reporting aspects of burnout and CF among OTDCs, including risk and protective factors. DATA EXTRACTION: Two reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis. RESULTS: The searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence. CONCLUSION: We identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs.

Improving quality of withdrawal of life-sustaining measures in organ donation: a framework and implementation toolkit.

BACKGROUND: Donation after circulatory determination of death (DCD) is responsible for the largest increase in deceased donation over the past decade. When the Canadian DCD guideline was published in 2006, it included recommendations to create standard policies and procedures for withdrawal of life-sustaining measures (WLSM) as well as quality assurance frameworks for this practice. In 2016, the Canadian Critical Care Society produced a guideline for WLSM that requires modifications to facilitate implementation when DCD is part of the end-of-life care plan. METHODS: A pan-Canadian multidisciplinary collaborative was convened to examine the existing guideline framework and to create tools to put the existing guideline into practice in centres that practice DCD. RESULTS: A set of guiding principles for implementation of the guideline in DCD practice were produced using an iterative, consensus-based approach followed by development of four implementation tools and three quality assurance and audit tools. CONCLUSIONS: The tools developed will aid DCD centres in fulsomely adapting the Canadian Critical Care Society Withdrawal of Life-Sustaining Measures guideline.

RéSUMé: CONTEXTE : Au cours des dix dernières années, le don d'organe après un décès cardiocirculatoire (DDC) a été à l'origine de la plus importante augmentation de dons provenant d'individus décédés. Les lignes directrices canadiennes sur le DDC, publiées en 2006, recommandaient la création de politiques et de procédures standard pour l'interruption des traitements de maintien des fonctions vitales (TMFV) ainsi que celle de cadres d'assurance de la qualité pour cette pratique. En 2016, la Société canadienne de soins intensifs a publié des recommandations concernant les TMFV; ces recommandations nécessitent des modifications pour pouvoir être facilement mises en œuvre lorsque le DDC fait partie du plan de soins de fin de vie. MéTHODE : Un groupe collaboratif multidisciplinaire pancanadien s'est réuni afin d'examiner le cadre établi par les lignes directrices existantes et créer des outils pour mettre en œuvre ces recommandations dans les centres pratiquant le DDC. RéSULTATS : En utilisant une approche itérative et consensuelle, un ensemble de principes directeurs a été créé pour mettre en œuvre des directives concernant la pratique du DDC : quatre outils d'implantation et trois outils d'assurance de la qualité et d'audit ont été mis au point. CONCLUSION : Les outils créés aideront les centres de DDC à adapter de manière plus complète les Lignes directrices pour l'interruption des traitements de maintien des fonctions vitales de la Société canadienne de soins intensifs.

Burnout and compassion fatigue among organ donation coordinators: a scoping review protocol.

OBJECTIVE: The objective of this review is to develop a comprehensive description of burnout and compassion fatigue, including risk/protective factors, among organ and tissue donation coordinators worldwide. INTRODUCTION: Research on turnover rates among organ and tissue donation coordinators has shown that job tenure generally lasts less than three years, a possible consequence of burnout and compassion fatigue. Increased turnover rates of organ and tissue donation coordinators have significant impact on the ability of ODOs to optimize organ donation. This current scoping review will help inform understanding of the nature of burnout and compassion fatigue in this population as well as the available strategies for managing it. INCLUSION CRITERIA: Articles examining health care professionals working as organ and tissue donation coordinators, with the main concepts of interest being burnout and/or compassion fatigue, will be considered. Articles within the context of organ and tissue donation coordinators in acute care settings at any part of the organ donation process will also be considered for inclusion in this review. Quantitative and qualitative studies, text and opinion papers, unpublished material (eg, unpublished research data, reports, institutional protocols, government documents) provided by researchers in the organ donation field worldwide will also be examined for possible inclusion. METHODS: The scoping review will be performed in accordance with JBI methodology. Published and unpublished papers from 1980 to the present will be searched. Databases will include MEDLINE (Ovid), CINAHL, Embase, LILACS, PsycINFO, and PTSDpubs, while appropriate gray literature will be searched. Two reviewers will screen the papers according to predefined inclusion and exclusion criteria, extract data for specific variables, and perform descriptive examination.

Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives.

INTRODUCTION: In a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care into practice in deceased organ donation. METHODS AND ANALYSIS: This will be a national, qualitative study of family members of deceased organ donors in Canada. We will include family members who had been approached regarding an organ donation decision, including those who agreed and declined, at least 2 months and no later than 3 years after the patients' death. Data collection and analysis is ongoing and will continue until September 2020 to include approximately 250 participants. Family members will be identified and recruited from provincial organ donation organisation databases. Four experienced qualitative researchers will conduct telephone interviews in English or French with audio-recording for subsequent transcription. The research team will develop a codebook iteratively through this process using inductive methods, thus generating themes directly from the dataset. ETHICS AND DISSEMINATION: Local research ethics boards (REB) at all participating sites across Canada have approved this protocol. The main REB involved is the Ottawa Health Science Network REB. Data collection began in August 2018. Publication of results is anticipated in 2021. Study findings will help improve healthcare provider competency in caring for potential organ donors and their families and improve organ donation consent rates. Findings will also help with the development of educational materials for a competency-based curriculum for critical care residents.

Development of a national minimum data set to monitor deceased organ donation performance in Canada.

PURPOSE: Deceased donation data requires standardization to enable accurate interprovincial and international comparisons of deceased donation performance. In Canada, most provincial organ donation organizations (ODOs) have developed different processes and infrastructures for referring potential donors and subsequent data collection. This has led to differing definitions of the performance measures used for each step in the donation process, from potential donor identification to consent to transplantation. The Deceased Donation Data Working Group (DDDWG), comprised of representatives from ODOs across Canada, was therefore convened by Canadian Blood Services to develop a national, comprehensive, standardized deceased donation minimum data set. METHODS: The DDDWG's scope encompassed considering all potential deceased organ donation data elements, including operational and performance data collected along the deceased donor pathway from donation potential to donation and disposition of organs. An environmental scan was conducted of other existing deceased donation registries from the Canadian and the international community. The DDDWG then engaged in regular face-to-face meetings and teleconferences to develop recommendations for the minimum data set that would satisfy key considerations, including the impact on existing ODO data collection processes, financial impact on stakeholders, the clinical and operational needs of multiple healthcare professionals involved in the deceased donation pathway, and availability of other existing national data sets that could be leveraged to reduce data collection burden. RESULTS: The key deceased donation data elements identified by the DDDWG are contained in an inverted pyramid framework that was derived from similar work conducted in other countries. CONCLUSION: The DDDWG developed recommendations for proposed definitions and data sources that should be adopted nationally to guide the collection of deceased donation data. The ultimate purpose of the final minimum data set is to harmonize and standardize donation data definitions in Canada and align with international standards; inform the development of operational and clinical practice standards at the provincial and national levels; develop a framework for deceased donation performance measures; and advance the science of deceased donation.

RéSUMé: OBJECTIF: Les données concernant les dons d'organes de personnes décédées doivent être normalisées pour permettre des comparaisons précises de l'efficacité de ces dons entre provinces et entre pays. Au Canada, la majorité des organismes provinciaux de dons d'organes (ODO) ont élaboré divers processus et infrastructures pour l'orientation des donneurs potentiels et la collecte subséquente des données. Cela a abouti à des définitions différentes des mesures de performances utilisées pour chaque étape du processus de don, de l'identification du donneur potentiel au consentement à la transplantation. Le Groupe de travail sur les données de donneurs décédés (DDDWG), constitué de représentants des ODO de tout le Canada a donc été réuni par la Société canadienne du sang (SCS) pour élaborer un ensemble national et complet de données minimums standardisées de dons d'organes de personnes décédées. MéTHODES: Le DDDWG avait pour mission d'envisager tous les éléments de données de dons d'organes potentiels de personnes décédées, y compris les données opérationnelles et de performance collectées le long du parcours du donneur décédé, depuis le don potentiel jusqu'à l'utilisation des organes. Une analyse environnementale des autres registres existants (canadiens et internationaux) de dons d'organes de personnes décédées a été effectuée. Le DDDWG a alors entrepris des entretiens en face à face et des téléconférences pour élaborer ses recommandations pour un ensemble minimum de données qui répondraient aux problèmes clés, y compris : leur impact sur les processus de collecte de données des ODO existants, l'impact financier pour les différents acteurs, les besoins cliniques et opérationnels des multiples professionnels de santé impliqués tout au long du parcours de don de la personne décédée, et la disponibilité d'autres ensembles de données qui pourraient être utilisés pour réduire le fardeau de la collecte des données. RéSULTATS: Les principales données de don d'organes de donneur décédé, identifiées par le DDDWG, tiennent dans un cadre en pyramide inversée tiré d'un travail semblable mené dans d'autres pays. CONCLUSION: Le DDDWG a élaboré des recommandations pour les définitions proposées et les sources de données qui devraient être adoptées à l'échelon national pour guider la collecte des données de dons d'organes de personnes décédées. Le but ultime de l'ensemble minimum final de données est d'harmoniser et standardiser les définitions des données concernant les dons au Canada et de s'aligner sur les normes internationales; d'informer le développement de normes opérationnelles et de pratique clinique au niveau des provinces et au niveau national; de développer un cadre pour la mesure des performances concernant les dons de donneurs décédés; et de faire progresser les connaissances sur ce type de dons.

Potential organ donor identification and system accountability: expert guidance from a Canadian consensus conference.

PURPOSE: Deceased donation rates in Canada remain below the predicted potential and lag behind leading countries. Missing a potential donor leads to preventable death and disability of transplant candidates and increased healthcare costs. METHODS: Stakeholders were invited to a national consensus conference on improving deceased organ donor identification and referral (ID&R) and healthcare system accountability. In advance, participants received evidence-based, background documents addressing death audits, clinical triggers, required referral legislation, ethics, clinical pathways, and donation standards. At the conference, expert presentations and summaries of background information prepared by the Steering Committee informed group discussions of the preset questions. The conference's themes were: 1) expectations of potential donors, recipients and their families; 2) donor ID&R: clinical and legal perspectives; 3) enhancing accountability: gaps and solutions; and 4) enhancing accountability: quality/safety organizations. RESULTS: Thirty-seven consensus statements were generated. At the healthcare professional (HCP) level, key statements include: 1) donation be consistently addressed as part of end-of-life care but only after a decision to withdraw life-sustaining treatment; 2) HCP know how and when to identify and refer potential donors; and 3) transplant candidates be informed of local allocation guidelines and performance. At the healthcare system level, key statements include: 1) national adoption of clinical criteria to trigger ID&R; 2) dedicated resources to match donation activities, including transfer of a potential donor; 3) performance measurement through death audits; 4) reporting and investigation of missed donation opportunities (MDO); 5) recognition of top performers; and 6) missed donor ID&R be considered a preventable and critical safety incident. CONCLUSION: Our consensus statements establish HCP and healthcare system responsibilities regarding potential organ donor ID&R and include the tracking, reviewing and elimination of MDO through system-wide death audits. Once implemented, these consensus statements will help honour patients' wishes to donate, improve service to potential transplant recipients, and support HCPs in fulfilling their ethical and legal responsibilitites. Next steps include implementation, assessment of their impact on donation rates, and investigation of new evidence-based targets for system improvement.

RéSUMé: OBJECTIF: Au Canada, les dons des personnes décédées restent inférieurs aux possibilités prédites et loin derrière les pays les plus performants. Le manque de donneurs potentiels aboutit à des décès évitables, à l'invalidité des candidats à la transplantation et à des coûts de soins de santé plus élevés. MéTHODES: Les principaux acteurs ont été invités à une conférence de consensus nationale sur l'amélioration de l'identification et de l'orientation des donneurs d'organes décédés (ID&R ­Identification and referral) et sur la responsabilité du système de santé. Les participants ont reçu à l'avance des documents basés sur des données probantes qui abordaient l'audit des décès, les facteurs cliniques identifiants, la législation requise pour l'orientation, l'éthique, les cheminements cliniques et les normes de dons. Au cours de la conférence, les présentations d'experts et des résumés de l'information de fond préparés par le Comité de pilotage ont alimenté les discussions de groupe sur les questions préparées. Les thèmes de la conférence étaient les suivants : 1) attentes des donneurs potentiels, des receveurs et de leurs familles; 2) identification et orientation des donneurs : points de vue cliniques et légaux; 3) amélioration de la responsabilité : lacunes et solutions; et 4) amélioration de la responsabilité : organisations de la qualité/sécurité. RéSULTATS: Trente-sept énoncés de consensus ont été générés. Au niveau des professionnels de santé, les principaux énoncés sont les suivants : 1) que le don soit constamment abordé dans le cadre des soins de fin de vie, mais seulement après avoir pris la décision d'arrêter les traitements de maintien de vie; 2) les professionnels de santé ont le savoir-faire pour identifier et orienter les donneurs potentiels; et 3) les candidats à la transplantation doivent être informés des lignes directrices locales sur les attributions et sa performance. Au niveau du système de soins de santé, les principaux énoncés sont les suivants : 1) l'adoption au niveau national de critères cliniques déclenchant l'identification et l'orientation des donneurs; 2) des ressources dédiées aux activités d'appariement des dons, y compris au transfert des donneurs potentiels; 3) des mesures de performance par des audits des décès; 4) la déclaration et des investigations sur les opportunités de dons manqués; 5) la reconnaissance des plus performants; et 6) l'identification et l'orientation manquées de donneurs doivent être considérées comme un incident évitable et critique. CONCLUSION: Nos énoncés de consensus établissent les responsabilités des professionnels de santé et du système de soins pour ce qui concerne l'identification et l'orientation des donneurs potentiels d'organes; ils incluent le suivi, l'analyse et l'élimination des dons manqués via une vérification des causes de décès dans tout le système. Une fois mis en œuvre, ces énoncés de consensus contribueront à honorer les souhaits des patients en matière de dons, améliorer les services apportés aux receveurs potentiels de greffes et soutenir les professionnels de santé dans l'accomplissement de leurs obligations éthiques et légales. Les étapes suivantes incluront la mise en œuvre, l'évaluation de leur impact sur les taux de dons et la recherche de nouvelles cibles basées sur des données probantes pour améliorer le système.

GRADEing the un-GRADE-able: a description of challenges in applying GRADE methods to the ethical and implementation questions of pediatric organ donation guidelines.

Good practice statements (GPSs) have been proposed by the GRADE working group as a way of avoiding the inappropriate characterization of evidence as low quality in support of strong recommendations justified by indirect evidence. This commentary examines how the GPS methodology was applied to the development of a recent guideline for pediatric deceased donation after circulatory determined death. This guideline was informed by a broad body of indirect literature and addressed a variety of social, legal, and ethical questions in addition to several implementation issues. While the resulting document contained a vast majority of GPS (63 as opposed to seven actionable GRADEd recommendations), we maintain that this application was appropriate to develop recommendations within the GRADE framework. This commentary explores how GPS may be applied in this context and explores whether a new classification of recommendations focused on these types of issues may be appropriate.

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.

OBJECTIVES: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. RESULTS: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. CONCLUSIONS: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.

Development of a Canadian deceased donation education program for health professionals: a needs assessment survey.

PURPOSE: The purpose of this survey was to determine how Canadian healthcare professionals perceive their deficiencies and educational requirements related to organ and tissue donation. METHODS: We surveyed 641 intensive care unit (ICU) physicians, 1,349 ICU nurses, 1,561 emergency room (ER) physicians, and 1,873 ER nurses. The survey was distributed by the national organization for each profession (the Canadian Association of Emergency Physicians, the Canadian Association of Critical Care Nurses, and the National Emergency Nurses Association). Canadian Blood Services developed the critical care physician list in collaboration with the Canadian Critical Care Society. Survey development included questions related to comfort with, and knowledge of, key competencies in organ and tissue donation. RESULTS: Eight hundred thirty-one (15.3%) of a possible 5,424 respondents participated in the survey. Over 50% of respondents rated the following topics as highly important: knowledge of general organ and tissue donation, neurological determination of death, donation after cardiac death, and medical-legal donation issues. High competency comfort levels ranged from 14.7-50.9% for ICU nurses and 8.0-34.6% for ER nurses. Competency comfort levels were higher for ICU physicians (67.5-85.6%) than for ER physicians who rated all competencies lower. Respondents identified a need for a curriculum on national organ donation and preferred e-learning as the method of education. CONCLUSIONS: Both ICU nurses and ER practitioners expressed low comfort levels with their competencies regarding organ donation. Intensive care unit physicians had a much higher level of comfort; however, the majority of these respondents were specialty trained and working in academic centres with active donation and transplant programs. A national organ donation curriculum is needed.