Role of Specialist Nurse

Role of Specialist Nurse

Specialist Nurses-Organ Donation (SN-OD’s) support potential donor families and the operational processes of organ donation. The specialist nurse receives detailed training in communication and family support, especially in the end of life wishes conversations. This training enables the specialist nurse to explore the individual’s decision or the families wishes, providing specific donation information tailored to the individual case.  Involving the specialist nurse from the initial end of life care discussions enables a relationship between the family and specialist nurse to develop and for the specialist nurse to better support the family through the end of life care process.

Despite these advantages to the family, the timing of specialist nurse involvement can differ depending on local practices. In particular the time the referral is made, the confirmation of death using neurological criteria and the timings of the two sets of tests.

View more information about donation after brainstem death

NICE guidelines recommend that a patient should be referred as a potential donor as soon as the intention to either withdraw life sustaining treatments or perform brain-stem death tests has been reached.

NICE Guidance on identifying patients who are potential donors

Professional guidance advocates that as a standard of care, specialist nurses be involved in planning the family care and initial end-of-life care discussion. This enables the specialist nurse to consider carefully when the possibility of organ donation is best raised with the family.

There are three key stages to approaching the families of potential organ donors:

  • Planning
  • Confirming understanding and acceptance of loss
  • Discussing donation

Routine practice

In most cases a senior clinician will lead the breaking bad news conversation before making the transition to the specialist nurse to lead the discussion about donation. Donation must not be raised until a family are coming to an acceptance of their loved one’s death.  If this is not the case, the discussion about end of life care decisions and donation should be delayed and strategies employed to gain acceptance. The discussion around donation should be presented positively, a legacy, helping others and the benefits, never in a negative or apologetic way.

Evidence that a patient has previously registered a decision on the NHS Organ Donor Register is always sought before approaching the family.  If a decision is registered, this will be communicated and the specialist nurse will discuss with the family, ensuring that this is their loved one’s last known decision.

Once consent/authorisation has been obtained the specialist nurse will coordinate the process of organ offering, retrieval and donor and donor family after care in partnership with the hospitals clinical team. The specialist nurse will remain as a link and support for the donor family through the Family Aftercare Department.