10 Organ Donation Practices and End-of-life Care ... 251doctors about organ donation can also affect donation rates. When doc-
tors hold more ambivalent views towards organ donation, consent is less
likely to be gained from family members (Sanner 2007 ). This highlights
the importance of educating hospital staff about organ donation pro-
cesses and how to talk with families about donation.
Depending on the outcome of family discussions about organ dona-
tions, deceased patients will either go forward with organ donation, or,
if consent is not given, treatments will be withdrawn. For brain dead
patients progressing to organ donation, this raises another challenging
concept. Although the patient has been declared brain dead, the body
must now be kept artificially alive until organ retrieval can be organised.
This requires a substantial shift in thinking for donor families. Strategies
used by staff to help families understand that the patient is dead include
language switch—from caring for ‘a patient’ to caring for ‘a body’—and
instead of talking to the patient during care, staff are more likely to talk
about the person in the past tense (Forsberg et al. 2014 ).
While the physiological management of the body is optimised prior
to organ retrieval, other practical arrangements also need to be made. As
referenced earlier, specialist teams are required in the operating theatre
for the organs to be retrieved. In some countries, such as New Zealand,
these teams may be based in other hospitals. We read in Tesh’s story of
the delays to organ donation, as retrieval teams were unable to travel
due to poor weather conditions. Such logistical challenges introduce
an element of the unpredictable, and means that families may be wait-
ing with the deceased until full theatre teams are available. The impact
of this on families is unclear: while some families experience this extra
time as helpful (Berntzen and Bjørk 2014 ), for others it creates an addi-
tional burden when they are already grieving (Kesselring et al. 2007 ).
What is clear is that the trajectory of care for brain dead patients is
very different to that surrounding circulatory death. Where the sequelae
of brain death and organ donation can take place over hours to days,
the events of end-of-life care resulting in circulatory death is much
more rapid and usually takes place over the course of hours or minutes
(Wunsch et al. 2005 ). This places different demands on families and
staff, with wider implications for the healthcare system.