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Organ recovery coordinators can help family work through the grieving process
DECEMBER 1988, VOL. 48,NO 6
AORN JOURNAL
Opinion Organ recovery coordinators can help family work through the grieving process
M
ost OR nurses do not have an opportunity to talk with a potential donor family during an organ request conversation, and therefore, do not see the process the family goes through in agreeing to donate organs. An organ donor coordinator has that opportunity, and I believe, he or she can help the family work through the grieving process. Two objectives can be achieved through a request for an organ donation: (1) it would fulfill the need for organs because the demand is higher than the supply, and (2) it would initiate a counseling session and give the donor family the opportunity to work through the grieving process. The organ recovery coordinator must ensure that the second objective is not overlooked in accomplishing the first objective. Because organ recovery coordinators are involved in the identification and surgical preparation of a transplant case, they are better able to counsel families about what will occur.
about the death at a later time. When the family is ready to face such a discussion, they will most likely initiate it. A discussion will not occur if only an outside party is ready to talk. The organ recovery coordinator is introduced to the family as they are going through the denial process. He or she helps the family understand the concept of brain death. They must believe that their loved one has died, even though cardiac and respiratory function are being maintained artificially. The attending physician should inform the family that brain death has occurred, but the organ recovery coordinator should be available to help answer any questions.
Grieving Process
T
he grieving process that the potential donor family experiences differs from the typical grieving process because they usually have guilt feelings that relate to the death of their loved one. Denial and isolation. The family usually goes through a period of denial when a family member dies or when told the death is imminent. Denial acts as a buffer to allow the family time to collect themselves and move out of the denial and isolation stages. This does not mean, however, that the family will not want to talk with someone
Bonnie Harris Sammons, RN,BS, CCRN, CPC, is a professional education specialistlorgan donation, Sandoz Pharmaceuticals Cop, East Hanover, NJ. She has an associate degree in nursingfrom North Hennepin Community College, Minneapolis, and a bachelor of science degree in education from the University of Kansas, Lawrence. 1181
DECEMBER 1988, VOL. 48, NO 6
AORN J O U R N A L
If the family does not move through the denial stage, more than likely they will not discuss organ donation. After the physician informs the family, they will either begin to accept the death or deny it. If the family does not move through the denial stage, more than likely they will not discuss organ donation. They may not be opposed to donation per se, but rather they view the act of donation instead of the death as the terminus. If the family wishes to donate, the coordinator begins to counsel the family about their decision. Anger. This stage is very difficult for nurses and organ recovery coordinators. The anger the family members feel is displaced randomly in all directions. During this stage, the coordinator must allow the family to vent their feelings and not become defensive. The displacement of anger often leads many health care providers to erroneously conclude that the family is opposed to donation, and therefore, should not be approached. There is no basis for that conclusion. The family needs to be allowed to express their anger; they have lost complete control of the situation. Offering the family the option to donate gives them some control. Bargaining. Most bargains are made with God and are usually kept a secret or mentioned “between the lines.” The donor family may view the act of donation as the ultimate bargaining power. In their minds, their loved one does not die but lives on in the transplant recipient(s). It is at this point in the grieving process that the family may want desperately to donate, and thus, the family members may be very vulnerable. They may make specific requests of the organ recovery coordinator. For example, the parents of a child may request that the organs and tissue be donated to a child the same age and sex as their own. Or, they may ask to meet the recipient(s) of the transplants. It is not possible to guarantee these requests, and the organ recovery coordinator should not make them. It is best to give the family this information and any other facts to allow them to make an I182
informed decision. Often, it means giving them information that may cause them to change their minds regarding the donation. Depression. The organ recovery coordinator will most likely observe the family’s preparatory depression about their impending loss. The initial reaction to depressed people is to cheer them up, to tell them not to look at things so grimly or hopelessly. Depression can be used as a tool to prepare a person for an impending loss to facilitate acceptance of the death. It would be contraindicated to tell them not to be depressed because that would be the natural state to be in when somebody close dies. In my experience, if the family is allowed to express their sorrow, they will find acceptance much easier and they will be grateful to those who are with them. During this stage, the organ recovery coordinator does not always need to speak. Sitting quietly with the family and comforting them may be all that is necessary. Empathy means that the organ recovery coordinator not only draws upon past personal experiences, but also acts to absorb some of the pain that the family is feeling. The coordinator must not become so absorbed, though, that he or she becomes ineffective, and thus, can no longer provide comfort to the family. Acceptance. When the family has had enough time and has been given enough support in working through these stages, they may reach a point of no longer being angry about the fate of their loved one and begin to accept it. This acceptance is not to be mistaken for a happy stage and is not treated as such. It is a stage almost void of feelings because the family is no longer struggling with the pain. This is when the decision to donate is usually made. BONNIEHARRISSAMMONS,RN Suggested reading
Kubler-Ross, E. On Death and Dying. New York City: Macmillan, 1969.
AORN JOURNAL
Opinion Organ recovery coordinators can help family work through the grieving process
M
ost OR nurses do not have an opportunity to talk with a potential donor family during an organ request conversation, and therefore, do not see the process the family goes through in agreeing to donate organs. An organ donor coordinator has that opportunity, and I believe, he or she can help the family work through the grieving process. Two objectives can be achieved through a request for an organ donation: (1) it would fulfill the need for organs because the demand is higher than the supply, and (2) it would initiate a counseling session and give the donor family the opportunity to work through the grieving process. The organ recovery coordinator must ensure that the second objective is not overlooked in accomplishing the first objective. Because organ recovery coordinators are involved in the identification and surgical preparation of a transplant case, they are better able to counsel families about what will occur.
about the death at a later time. When the family is ready to face such a discussion, they will most likely initiate it. A discussion will not occur if only an outside party is ready to talk. The organ recovery coordinator is introduced to the family as they are going through the denial process. He or she helps the family understand the concept of brain death. They must believe that their loved one has died, even though cardiac and respiratory function are being maintained artificially. The attending physician should inform the family that brain death has occurred, but the organ recovery coordinator should be available to help answer any questions.
Grieving Process
T
he grieving process that the potential donor family experiences differs from the typical grieving process because they usually have guilt feelings that relate to the death of their loved one. Denial and isolation. The family usually goes through a period of denial when a family member dies or when told the death is imminent. Denial acts as a buffer to allow the family time to collect themselves and move out of the denial and isolation stages. This does not mean, however, that the family will not want to talk with someone
Bonnie Harris Sammons, RN,BS, CCRN, CPC, is a professional education specialistlorgan donation, Sandoz Pharmaceuticals Cop, East Hanover, NJ. She has an associate degree in nursingfrom North Hennepin Community College, Minneapolis, and a bachelor of science degree in education from the University of Kansas, Lawrence. 1181
DECEMBER 1988, VOL. 48, NO 6
AORN J O U R N A L
If the family does not move through the denial stage, more than likely they will not discuss organ donation. After the physician informs the family, they will either begin to accept the death or deny it. If the family does not move through the denial stage, more than likely they will not discuss organ donation. They may not be opposed to donation per se, but rather they view the act of donation instead of the death as the terminus. If the family wishes to donate, the coordinator begins to counsel the family about their decision. Anger. This stage is very difficult for nurses and organ recovery coordinators. The anger the family members feel is displaced randomly in all directions. During this stage, the coordinator must allow the family to vent their feelings and not become defensive. The displacement of anger often leads many health care providers to erroneously conclude that the family is opposed to donation, and therefore, should not be approached. There is no basis for that conclusion. The family needs to be allowed to express their anger; they have lost complete control of the situation. Offering the family the option to donate gives them some control. Bargaining. Most bargains are made with God and are usually kept a secret or mentioned “between the lines.” The donor family may view the act of donation as the ultimate bargaining power. In their minds, their loved one does not die but lives on in the transplant recipient(s). It is at this point in the grieving process that the family may want desperately to donate, and thus, the family members may be very vulnerable. They may make specific requests of the organ recovery coordinator. For example, the parents of a child may request that the organs and tissue be donated to a child the same age and sex as their own. Or, they may ask to meet the recipient(s) of the transplants. It is not possible to guarantee these requests, and the organ recovery coordinator should not make them. It is best to give the family this information and any other facts to allow them to make an I182
informed decision. Often, it means giving them information that may cause them to change their minds regarding the donation. Depression. The organ recovery coordinator will most likely observe the family’s preparatory depression about their impending loss. The initial reaction to depressed people is to cheer them up, to tell them not to look at things so grimly or hopelessly. Depression can be used as a tool to prepare a person for an impending loss to facilitate acceptance of the death. It would be contraindicated to tell them not to be depressed because that would be the natural state to be in when somebody close dies. In my experience, if the family is allowed to express their sorrow, they will find acceptance much easier and they will be grateful to those who are with them. During this stage, the organ recovery coordinator does not always need to speak. Sitting quietly with the family and comforting them may be all that is necessary. Empathy means that the organ recovery coordinator not only draws upon past personal experiences, but also acts to absorb some of the pain that the family is feeling. The coordinator must not become so absorbed, though, that he or she becomes ineffective, and thus, can no longer provide comfort to the family. Acceptance. When the family has had enough time and has been given enough support in working through these stages, they may reach a point of no longer being angry about the fate of their loved one and begin to accept it. This acceptance is not to be mistaken for a happy stage and is not treated as such. It is a stage almost void of feelings because the family is no longer struggling with the pain. This is when the decision to donate is usually made. BONNIEHARRISSAMMONS,RN Suggested reading
Kubler-Ross, E. On Death and Dying. New York City: Macmillan, 1969.