Impact of a collaborative approach on family consent rate for paediatric organ donors: a population-based registry study

A collaborative model involving a specialist nurse for offering organ donation to families of adult potential organ donors is associated with a higher consent rate, however some paediatric intensivists consider themselves alone best placed to discuss donation given the special relationship they forge with families. The effect of a collaborative model on consent rate in paediatric potential donors has not been studied. We therefore report the consent rate when paediatric families were offered organ donation using a collaborative model compared to an intensivist-only model, with a focus on staff-raised conversations. We conducted a retrospective population-based cohort study using DonateLife Audit data for all donation conversations conducted in Australia with families of potential paediatric organ donors from 01/01/2016 to 31/12/2022. Demographics and details of the family donation conversations were analysed using 95% confidence intervals (CI) by the Clopper-Pearson method. Differences in consent rate between collaborative and intensivist-only models were assessed using Fisher’s Exact test. Clinical factors associated with consent in staff-raised conversations were assessed using a multivariate logistic regression model. The consent rate to paediatric organ donation was consistently 22% higher when staff-raised conversations were conducted using a collaborative model, compared to an intensivist-only model. For the staff-raised collaborative model, consent was 4.15 times greater than that of the intensivist-only model (OR 4.15, 95% CI 2.47–7.10). Involving an organ donation specialist in donation conversations with families of children at end-of-life results in an increase in the incidence of consent in a similar way to that described in adult patients.