URI receives $1.2 Million grant for program
to increase family consent for organ donation
KINGSTON, R.I. -- November 22, 1999 -- Nationally, while opinion polls
show widespread public support for organ and tissue donation (better than
80 percent), in fact, only about 50 percent of families actually agree to
donate their loved one's organs when they find themselves confronted with
the situation. Knowing when to ask and how to ask a grieving family member
to consider donating the organs and tissues of their loved one is a task
that takes a tremendous amount of skill, tact, and care.
While many factors can influence the family consent decision-making process,
initial research has shown that solicitations for consent that do not address
the family's readiness to donate increase the likelihood of refusal.
To improve the ability of health professionals to effectively handle
such end-of-life discussions and care, the U.S. Department of Health and
Human Services (HHS) recently awarded researchers at the University of Rhode
Island and their partner, South-Eastern Organ Procurement Foundation in
Richmond, Va., a $1.2 million grant for a novel approach to training. The
grant was the second-largest of 18 grants awarded by the federal agency
in late September.
The three-year grant, entitled "Stage-based curriculum-training
for procurement coordinators to increase family consent for organ and tissue
donation" will evaluate the impact of an innovative training curriculum
that is based on the internationally known Transtheoretical Model for behavior
change developed at URI. The focus of the training is to help health care
professionals be better-prepared to assess whether a family is open to considering
organ donation following the death of a loved one. The development of the
training will also advance understanding of the important components of
the donation consent process for both health professionals and family decision
makers by systematically evaluating the change processes that are involved.
"Health professionals who offer the option of donation are meeting
families at the worst point of their lives, at the death of a loved one.
It is essential for these professionals to be able to assess how ready grieving
family members are to consent to organ donation and to provide appropriate
interventions that will help families make an informed decision," said
the grant's principal investigator, Mark L. Robbins, assistant research
professor at the URI Cancer Prevention Research Center (CPRC). "This
curriculum will provide health professionals with a greater ability to assess
a person's level of readiness for consenting to organ donation, and then
help them to communicate with the individual based on that decision-making
According to Robbins, by enhancing this delicate communication process
the training program will help to increase the number of organs donated
each year. This year, of the 65,000 patients on the national organ transplant
waiting list, almost 5,000 will die while waiting for a donated organ. Less
than one-third -- about 20,000 -- can expect to receive transplants.
"Organ transplantation has developed from an experimental therapy
to a highly effective treatment for end-stage organ failure," Robbins
said. "Unfortunately, while demand for organ transplants has continued
to rise at a significant rate, the supply of available organ donors has
increased at only a fraction of that rate. One key barrier is that approximately
half of the families of potential donors refuse consent. This obstacle has
remained despite extensive efforts to inform and educate the public and
professionals about the need for organ donation."
"It is truly rewarding to see how the Transtheoretical Model of
behavior change can be applied to so many important issues in our lives,"
said URI Professor and CPRC Director James O. Prochaska who developed the
model with his colleagues. "It is gratifying that the model will be
used to make the process a bit easier for those dedicated to the difficult
task of gaining consent for organ donation.
Surely, we intended that the model would help people to live longer,
healthier lives, and that is consistent with the goal and outcome of successful
organ donation programs."
The randomized clinical trial to be conducted will involve organ donor
coordinators and staff of 16 organ procurement organizations affiliated
with the South-Eastern Organ Procurement Foundation. Intervention group
coordinators will participate in four stage-based curriculum-training sessions
across 18 months.
These interactive sessions are designed to train coordinators to match
their donation requests to the needs of each family and focus their efforts
on key decisional variables that have been found important in accelerating
behavior change in other Transtheoretical Model-based interventions. Coordinators
will also receive feedback reports that will be used to improve the coordinators'
abilities to match their donation approach to the needs of each family.
Telephone surveys will assess the impact of the coordinator intervention
on measures of motivational readiness for donation consent in family members
who consented or refused consent for donation. The impact of this training
method will be explored in analyses examining donation consent rates, the
model's use with this group, and with potential organ donor family members.
Other key decision-making variables, central to the Transtheoretical Model,
will also be examined.
The HHS grant awarded to URI is part of the Clinton Administration's
National Organ and Tissue Donation Initiative, a comprehensive plan targeting
the donor shortage. The program is administered by HHS' Health Resources
and Services Administration's Division of Transplantation in the Office
of Special Programs.
For More Information: Jhodi Redlich, 401-874-2116