Organ Procurement Organization Approach of ICU Families in Person Versus by Phone for Donation Authorization

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OBJECTIVES: Due to hospital visitor restriction policies, the COVID-19 pandemic forced many conversations between ICU patients' families and organ procurement organizations (OPOs) to be conducted by phone, as opposed to in-person. We aimed to determine if OPO phone approaches are a negative predictor of authorization for donation. DESIGN: Retrospective observational study. SETTING: Hospitals partnering with New England Donor Services (NEDS) as their OPO. PATIENTS/SUBJECTS: Multicenter database study of all ICU patients from 2017 to 2021 whose families had been approached by NEDS. Of note, registered organ donors who were declared brain dead were excluded due to their prior first-person authorization. However, registered organ donors who were candidates for donation after circulatory death were included in the analysis because of the family's role in controlling the timing of ventilator withdrawal and, thus, their critical role in determining donation success. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In addition to whether OPO approaches occurred in person or by phone, we extracted covariate data on patient and surrogate demographics, OPO representative training, and extent of ICU-OPO collaboration. Univariate and multivariate analyses were conducted to determine predictors of successful authorization. Among 2240 approaches of potential organ donors, OPO donation discussions by phone constituted 221 of 1282 (17%) of authorizations, as opposed to 134 of 958 (14%) of failed attempts (p = 0.04). In a multivariate model, phone approach was no longer significantly negatively associated with authorization. However, patient race/ethnicity, registered status for donors after cardiac death, ICU-OPO collaboration, specialized OPO representative training, OPO representative being the sole participant in authorization discussions, and surrogate relationship were strong predictors. CONCLUSIONS: OPO approach by phone is not a barrier to organ donation. Strategies for successful donation discussions should focus on collaborative processes between ICU teams and OPOs and involvement of OPO representatives with special training for discussing authorization.

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