Brinda Ramachandran_A prospective study to report the impact of

Report
A prospective study to report the
impact of consent on Cornea
Retrieval
Brinda P Ramachandran1 Virender Sangwan2 Usha Gopinathan1
Ramayamma International Eye Bank
L V Prasad Eye Institute, Hyderabad
Conflict of Interest
Financial Disclosure
NONE
Introduction
M Muraine et al in their study noted that:
i.
Asking the family of a dead patient to consider eye
donation is one of the most difficult aspects of the
donation process.
ii.
Health care professionals lack confidence &
motivation to approach families to request for
donation.
Introduction
A study by Greg A Diamond concluded that
i.
there must be a system for ensuring that
families are asked for donation.
ii.
A designated person be notified at the time
of death to determine suitability for donation
and then contact the family for donation.
Objective
The purpose of this study was to
understand who among the family
members of a potential donor is ideal to
be approached for counseling for eye
donation
Methodology
i.
ii.
Study duration :
6 months
5 multispecialty Hospitals in which Hospital
Cornea Retrieval Programme is conducted
iii. A pre designed questionnaire to collect
demographic information of the donor & the next
of kin
iv. Questionnaire filled by Eye Donation Counselors
v. Questionnaire was filled for every approach
Methodology
Role of an Eye Donation Counselor
• Daily monitoring of the donation process
•
•
•
•
Counseling the donor families for eye donation
Providing frequent hospital staff education sessions
Providing family support
Maintaining close relationship with the Hospital
Administration
Counseling the Donor family
•
Methodology
Deciding to approach - Identifying the Decision
maker/Influencer
Timing of approach
Steps in counseling
• Introduction
• Facts about eye donation
• Objection handling
• Closing & Withdrawal
Data Analysis
SPSS ver 17.0 software for windows
- Univariable analysis – Chi Square test
- Multivariable logistic regression analysis
Results
-
415 NoK were approached
- 306 consented for eye donation
Consent rate of 73%
Results
Age of donor (yrs)
0 – 20
21 – 40
41 – 60
>60
Odds Ratio
0.54
0.52
0.42
1.00
P value
0.182
0.046
0.006
Age of Donor was significantly associated with consent
Results
Age of next of Kin (yrs)
0 – 20
21 – 40
41 – 60
>60
Odds Ratio
P value
3.08 (1.21,7.86)
3.03 (1.17,7.78)
1.00
0.019
0.022
Age of Nok was significantly associated with consent
Results
Gender (Next of Kin)
Odds Ratio
Male
Female
315
70
1.17(0.65,2.12)
1.00
P value
0.602
Gender of NoK – not significantly associated
Results
Consent by Relationship of NoK
Parents
Children
Siblings
Spouse
Others
success/request
(%)
49/65
139/184
40/61
43/64
35/42
75
75
65
67
83
The relationship of the donor has not played any role with regard to
consent for eye donation
Discussion
Our study shows an overall increasing trend towards consent with
an increase in the age of the deceased similar to that observed by
M Lawlor et al.
Our results also show that gender of NoK has no influence on the
consent as found in other studies.
A higher proportion (OR 3.08 95% CI) of consent was obtained from
NoK less than 60yrs of age
Discussion
• The relationship of the NoK to the deceased has no influence on
consent. Identifying the right family member to ask for donation
increases the consent rate.
•It appeared that a designated person with systematic training, & a
defined skill set including knowledge of eye donation and day to day
experience in performing requests increases the consent rate.
•RIEB consent rates are some of the best in the world, with top
performing eye banks across the world averaging around 73%.
Conclusion
•There is a greater need to educate younger generation
about eye donation so as to enable them to act as
motivators for enhancing eye donation rates.
•The presence of a trained Eye Donation Counselor
enhances the rate of consent thus increasing the donor
numbers.
Acknowledgement
- Donor Families
- Hyderabad Eye Institute (HEI)
Thank you!
L V Prasad Eye Institute
www.lvpei.org
Excellence
Equity
Efficiency

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