Asking the Difficult Questions: Message Strategies Used by Organ Procurement Coordinators in Requesting Familial Consent to Organ Donation

Abstract

The present study provides an in-depth examination of the messages used by organ procurement coordinators (OPCs) in shaping familial requests for organ donation. OPCs (N = 102), recruited from a national sample of 16 organ procurement organizations, participated in a structured interview designed to uncover the communication strategies used in obtaining familial consent for donation. Analysis of interviews indicates OPCs' messages cover 4 domain areas. Specifically, OPCs report use of messages intended to (a) provide education, (b) discuss the benefits to donation, (c) learn about potential donor families, and (d) persuade families to engage in donation. Within the 4 domain areas, OPCs report use of 15 specific messages (e.g., “positively framing the donor,” “social proof,” “discuss the benefit of donation to grieving”) in requesting consent. The present study provides a detailed examination of strategies and offers recommendations for using message strategies to explore the effectiveness of the consent process from the perspective of OPCs in approaching donor families.

Acknowledgments

The authors acknowledge the participation of Arkansas Regional Organ Recovery Agency, Center for Donation and Transplant, Finger Lakes Donor Recovery Network, Indiana Organ Procurement Organization, LifeCenter Organ Donor Network, LifeSharing, Louisiana Organ Procurement Agency, Mississippi Organ Recovery Agency, Translife, Upstate New York Transplant Services, Wisconsin Donor Network, and five other organ procurement organizations for contributing their experiences and knowledge to the present project. In addition, the authors acknowledge Carolyn A. Lagoe for her assistance in coding data for the project.

Notes

¹The term organ procurement coordinator is used to describe individuals whose primary role is requesting organ donation from potential donor families. Organizations involved in the present study used a number of terms (e.g., family advocate, requestor, family support services) to describe this role.

²As a result of policy changes, responsibility for donation requests was transferred from health care professionals to OPCs in the early to mid-1990s. Thus, early studies examining the perspective of requestor staff often report primarily on the experiences of health care providers in requesting donation, rather than exploring the experiences of OPCs who were involved in only a limited number of requests (see Siminoff, Arnold, & Hewlett, 2001; Siminoff, Gordon, Hewlett, & Arnold, 2001).

³An organization's conversion rate is a measure of the proportion of donors obtained from the eligible donor pool. For example, a conversion rate of 60% would indicate that 60 of every 100 eligible donors progress to donation.

⁴A proportion of interviews (n = 22) were conducted by telephone because of the geographic isolation of a coordinator and/or OPO. Because such interviews did not differ in length from those conducted face-to-face, results are combined across interview methods.

⁵We examined the minority donor population using data available from the Scientific Registry of Transplant Recipients (2009). In total, minority donors accounted for 28.89% (SD = 16.08) of the average donor population at participating OPOs. Among participating OPOs, minority donor population served ranged from 4.9% to 62.7%.

⁶Four OPOs failed to respond to the initial study recruitment e-mail, one OPO declined to participate because of ongoing involvement with an alternate research project, and an invitation to one OPO was retracted because the organization could only offer less than 10% of staff members to the project.

⁷We excluded 14 interviews from the present study. Excluded interviews examined the messages produced by tissue coordinators, who are responsible for procuring consent to tissue donation over the telephone, and by family support staff, who are responsible for supporting potential donor families, but do not request donation. As tissue coordinators and family support staff either do not request donation or do so over the phone in a limited time period, their experiences were considered to be decidedly different from that of OPCs and were excluded from the present work.

⁸The complete coding scheme documents OPCs' training, techniques for establishing credibility, barriers to donation, message strategies, timing/setting of requests, and changes to the request process on the basis of familial characteristics.

Note. Total n for each performance bracket represents the number of coordinators within each bracket.

⁹Coordinators also reported use of eight additional message strategies. Additional post-hoc analyses suggested these themes were not prominent in the data (i.e., endorsed by less than 15% of OPCs). Thus, results pertaining to such themes are not presented here, in the interest of space, but are available from the first author.