A grounded theory study exploring critical care staff experiences of approaching relatives for organ donation

Aim of study: This grounded theory study explores critical care staff experiences of approaching relatives for organ donation following the death of a patient. Background: The research was influenced by a startling statistic that reported an average 1,000 patients die each year on the transplant waiting list because no suitable organ donor was identified. Additionally, transplant operations are impeded by a significant family refusal rate for organ donation. Some of the reasons are known why relatives / carers decline the option of organ donation. It is unclear how the experiences, perceptions and beliefs of critical care professionals influence organ donation decisions and outcomes. This study seeks to explore the professional experiences in greater detail, generating new knowledge and the development of a conceptual framework to support the practice of critical care staff during the organ donation process. Methods: A grounded theory methodology was used to help guide the research design and process. Specifically, constructivist grounded theory developed by Kathy Charmaz (2006) became the theoretical basis used to conduct the research. Ethical approval was granted by the University of Salford, NHS Blood and Transplant and the hospital trust where the study was conducted. Sampling was purposeful and data were extracted using a series of semi- structured in depth interviews with critical care professionals (6 registered nurses and 2 registered medical practitioners: N = 8). Interview data were transcribed line by line and analysed using grounded theory methods, with an iterative process encouraging the detection of links and themes in the data. Findings: Four theoretical categories were developed as a result of the data analysis process. The categories include ‘Secrecy’, relating to critical care staff concerns that the organ donation process is secretive, ‘Mutilation’, connected to the belief that the patient could be harmed following death, ‘Broaching’, concerned with critical care staff fear surrounding donation discussions and ‘Experiential Competence’ which encompasses critical care staff competence associated with organ donation. The core category entitled ‘Fear’ is presented, which leads to the development of a substantive theory. Additionally, a conceptual framework was developed, centred on the core category, which was constructed to increase the likelihood of positive donation outcomes. Conclusion: Having explored critical care staff experiences of organ donation following the death of a patient, the study concludes that ‘fear’ influences professional practice at each stage of the donation process. A number of recommendations for practice arise from the study findings. Equally, the study suggests areas for further research and post-doctoral inquiry