Hornhautspende in der Palliativmedizin – Auswirkung eines standardisierten Vorgehens

Zusammenfassung

Hintergrund In Deutschland besteht ein erheblicher Mangel an transplantierbaren Hornhäuten. Eine Hürde kann das Gespräch zur Gewebespende (GS) sein. Ein standardisiertes Vorgehen und die Effekte auf Spendenzahlen und multiprofessionelle Teammitglieder (MPT) werden berichtet.

Methoden Als standard operating procedure führten wir ein Gespräch zur GS ein (SOP_GS).

Wir untersuchten a) quantitativ die SOP_GS-Durchführungen, Zustimmungen und GS und b) quantitativ auf Likert-Skalen und qualitativ in semistrukturierten Interviews die Haltung, Belastung und Bereitschaft zur Erfassung der Spendenbereitschaft der MPT.

Ergebnisse In 12 Monaten vor SOP_GS rekrutierten wir 2 Spender (bei 212 Patienten; 0,9 %); mit SOP_GS gewannen wir in 12 Monaten 13 Spender (202 Patienten; 6,4 %). SOP_GS wurde in 47 % der Aufnahmen durchgeführt. Gespräche zur GS waren weniger belastend (Median vor SOP_GS 4, mit SOP_GS 2; p < 0,05); die Bereitschaft dazu war gestiegen (vor 5.5; nach 1.5; p < 0,01). Ursachen für die emotionale Belastung waren die „Assoziation mit Sterben“, „fehlende Qualifikation“ und „unpassendes Thema“.

Diskussion SOP_GS war durchführbar, führte zu einer Zunahme an GS, einer Reduktion der Belastung des MPT und einer Zunahme der Bereitschaft, GS zu thematisieren.

Abstract

Background In Germany there is a continuing shortage of transplantable corneae. One of the obstacles may be the communication about donating tissue in the face of terminal illness. In our palliative care service, we introduced a structured approach on communication and report on the outcome in tissue donation and its effect on healthcare professionals (HPR).

Methods As part of our in-house standard operating procedures, we introduced a discussion about tissue donation (SOPtd) with the patient and/or next of kin on admission. The structured approach introduced this question along with the inquiry on advance directives (health care proxy, living will, organ donation). HPR were prepared to empathically react to patientsʼ and familiesʼ emotions and distress. We assessed the number of donations, the emotional strain and willingness to partake of HPR, both measured on a 6-point Likert scale before and after the implementation of SOPtd, and conducted semi-structured interviews.

Results In the 12 months prior to SOPtd, we recruited 2 donors out of 212 patients, and in the 12 months after implementation, 13 donors out 202 patients; this represents an increase in donations from 0.9 % to 6.4 % of all patients. The SOPtd was carried out in 47 % of all admissions. We interviewed 17 HPR. Strain on HPR was reduced significantly by SOPtd (median pre 4, post 2, p < 0.05) as willingness to partake increased (median pre 5.5, post 1.5, p < 0,01). Most common reasons for emotional strain were “association with death”, “lack of training”, and “being out of place”. Perceived benefits were “maintaining patient’s autonomy” and the possibility “to help” and “to inform”.

Discussion The SOPtd proved to be feasible and led to an obvious increase in cornea donations in our palliative care service. In addition, the structured approach helped HPR to decrease emotional strain and increase willingness to partake in tissue donation discussions.

Schlüsselwörter

Hornhaut - Hornhautspende - Gewebespende - Palliativmedizin - standard operating procedure

Keywords

cornea - cornea donation - tissue donation - palliative medicine - standard operating procedure

^* Diese Autoren beteiligten sich in gleichem Maße an der Publikation.

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