International Journal of Healthcare Simulation

Background:

Conversations regarding deceased organ donation are complex and ideally are held with support from specialist nurses [1]. However, unplanned situations where this topic is raised are encountered in clinical practice. These discussions can involve unexpected elements and views, without immediate support available from specialist teams. Conditional or directed organ donation involves the caveat that an organ is or is not donated to a specific individual or demographic. In 1998 a deceased organ donation was accepted in Sheffield with the condition it only be transplanted into a white patient [2]. This sparked an ethical debate and government review. The subsequent report identified this practice as unacceptable and fundamentally against the altruistic nature of organ donation [3]. We aimed to increase candidate familiarity with the process of deceased organ donation, ensuring future discussions are held at an appropriate time involving essential members of the multidisciplinary team.

Methods:

We simulated a complex discussion regarding organ donation where conditional and directed viewpoints were addressed. This scenario also highlighted elements of inclusivity and discrimination that may be encountered in clinical practice. A scenario was designed following input from senior members of the emergency department, intensive care, and specialist nurses for organ donation. The simulation was discussed at a meeting of our Trust clinical Ethics Committee. Consent was electronically obtained prior to participation, and data regarding candidate familiarity with deceased organ donation was anonymously recorded utilising a Likert scale before and after completion of the simulation. These results were used to assess the effectiveness of the scenario against the desired aims utilising the Kirkpatrick model of learning.

Results:

Ten sessions were held recruiting 30 participants. Following completion of the simulation session, our results demonstrate junior clinicians in the emergency department developed increased familiarity regarding the process and timelines surrounding deceased organ donation, and improved confidence tackling complex conversations containing controversial viewpoints.

Conclusion:

We are intending to utilise data gathered from this scenario to assist in development of a toolkit for the emergency department regarding unanticipated organ donation discussions. We are also hoping to expand the simulation to cover other departments where similar conversations may be encountered.

References

1. Royal College of Emergency Medicine. The RCEM End of Life Care Toolkit: Royal College of Emergency Medicine. 2020. https://rcem.ac.uk/wp-content/uploads/2021/10/RCEM_End_of_Life_Care_Toolkit_December_2020_v2.pdf [Accessed on 19/06/2022]

2. BBC News. Racist organ donation condemned 2000. http://news.bbc.co.uk/1/hi/health/652132.stm [Accessed on 19/06/2022]

3. Department of Health and Social Care. An investigation into conditional organ donation: the report of the panel: Department of Health; 2000.