Abstract

Purpose

Intensive care physicians play an important role in the identification and referral of potential organ donors in Canada. Nevertheless, little is known about intensivists’ attitudes or behaviours in situations where families override previously expressed consent to donate; nor why physicians elect not to refer patients who are potential donors to provincial organ donation organizations (physician non-referral).

Methods

We integrated questions regarding family override and physician non-referral into an online, self-administered survey of Canadian intensivists. We report results descriptively.

Results

Fifty percent of targeted respondents (n = 550) participated. Fifty-five percent reported having witnessed family override situations and 44% reported having personally not referred patients who were potential donors. Fifty-six percent of respondents stated they would not pursue donation in the face of family override; 2% stated they would continue with the donation process. Fear of loss of trust in the donation system (81%) and obligation to respect the grief and desires of surrogate decision makers (71%) were frequently reported reasons to respect family override requests. Respondents who chose not to refer patients often did so based on organ dysfunction they assumed would preclude donation (59%), or a perception that the family was too distressed to consider donation (42%). No respondents reported that personally held beliefs against organ donation influenced their decision.

Conclusion

Physicians caring for patients who are potential organ donors commonly encounter both family override and physician non-referral situations. Knowledge translation of optimal practices in identification and referral could help ensure that physician practices align with legal requirements and practice recommendations.

中文翻译：

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加拿大专科医生对死者器官捐赠的非转诊和家庭优先调查

摘要

目的

重症监护医师在加拿大潜在器官捐赠者的鉴定和转诊中起着重要作用。但是，在家庭超过先前表达的捐赠同意的情况下，对于强化主义者的态度或行为知之甚少。也不为何医生选择不将可能的捐献者转介至省级器官捐献组织（非转诊医师）。

方法

我们将有关家庭凌驾和不推荐医生的问题纳入了对加拿大加护病医生的在线自我管理调查中。我们以描述性方式报告结果。

结果

50％的目标受访者（n = 550）参加了。55％的人报告目睹了家庭凌驾情况，而44％的人报告没有亲自转诊为潜在捐助者的患者。56％的受访者表示，他们不会面对家庭过分追求捐款；2％的人表示将继续捐赠过程。人们经常报告担心对捐赠系统失去信任（81％）和尊重代孕决策者的悲痛和渴望的义务（71％）是尊重家庭优先要求的原因。选择不转诊患者的受访者通常会基于他们认为的器官功能障碍而这样做（59％），或者认为家庭过于苦恼而无法考虑捐赠（42％）。没有受访者报告个人反对器官捐赠的信念会影响他们的决定。

结论

照顾可能是潜在器官捐献者的医生通常会遇到家庭超支和医师未转诊的情况。识别和推荐最佳实践的知识翻译可以帮助确保医师实践符合法律要求和实践建议。