The experiences of clinical staff approaching families for organ donation consent: A systematic review and thematic synthesis of qualitative studies

Healthcare professionals (HCPs) play an essential role in organ donation (OD) particularly when approaching families to discuss consent to OD. We synthesized the evidence on experiences of HCPs when approaching potential organ donor families. Fourteen electronic databases were searched to identify studies describing HCP experiences or associations between HCP experiences and consent rates. Methodological quality was assessed by independent reviewers using the Mixed Methods Appraisal Tool. Qualitative data were analysed using thematic synthesis, while quantitative data were summarized by narrative review. Ninety-two studies were included. HCP experiences were conceptualised as a paradox due to the challenges to negotiate the boundaries between life and death. Organisational and personal aspects broadly shape the experiences of professionals. Studies suggest that staff experiences can be improved by training and education, however, quantitative studies did not show a strong association between OD training and improved consent rates. The complexities of the family approach were evident in the variety of interactions between HCPs and the donor family, which may explain why there is no uniform approach across settings and countries. The review highlights the challenges faced by professionals when negotiating policy and practice and informs recommendations to support staff involved in the OD process worldwide.