Abstract
BACKGROUND: Controlled donation after circulatory death (cDCD) has been encouraged in many countries for over ten years. This procedure requires close link between intensive care unit (ICU) and organ procurement teams, and relatives. Data on the experiences of these different stakeholders involved in cDCD are scarce. OBJECTIVE: To gain insights into the experience of intensive-care teams, organ-procurement teams, and relatives during cDCD. METHODS: For this qualitative study, physician and nurse members of ICU and organ-procurement teams participated in focus groups. Also, relatives of cDCD donors participated in semi-structured telephone interviews a few months after the death. All relatives were included in the ongoing PRODON randomised controlled trial of organ-procurement-team involvement in requesting cDCD from relatives. The staff members worked at hospitals involved in the trial. Interpretative phenomenological analysis was used to assess the focus-group and telephone-interview data. The study was guided by the Standards for Reporting Qualitative Research (SRQR). RESULTS: We included 23 healthcare professionals and 10 relatives at five hospitals in France. The data show that the cDCD process evolves in three distinct stages in both the professionals and the relatives: uncertainty in the face of a life-threatening disease but persistent hope for survival, shift towards certainty that death is inevitable, and end of life with a request for donation. The professionals sometimes perceived a conflict between a good death and technically successful cDCD. The relatives needed time to come to terms with cDCD and to understand the procedure. CONCLUSIONS: The identification of three stages in the cDCD process can be expected to help intensive-care and organ-procurement teams provide effective support to relatives, define the role of each professional, and strengthen cooperation and communication between the two teams of professionals.