Organ and tissue donation : an evaluation of health care professionals' knowledge and training and implications for education

The United Kingdom (UK) has one of the highest transplant waiting lists in Europe, with currently 7,000 people in the UK waiting for a transplant with many people dying before an organ becomes available (NHSBT 2013). An organ or tissue transplant has been proven to be an effective life enhancing treatment for end-stage organ or tissue failure (Collins 2005). The Department of Health (DH) in 2008 recommended that all health care professionals who had potential involvement in donor patients should receive regular education and training. This study provides an original contribution to knowledge as no research has been undertaken since to evaluate whether these recommendations have been implemented and whether any relationship exists between education and its influence towards health care professionals perceived attitude, confidence, knowledge and decision making within three different health professions working within critical care areas within the NHS. This post-positive mixed methods methodology study utilised a self-completion questionnaire distributed to doctors, nurses and operating department practitioners (ODPs) n=3000 working in Intensive Care, Emergency Departments and Operating Theatres within 18 hospitals and focus group interviews involving 8 nurses from 3 hospitals within England. The questionnaire response rate was 1180; quantitative data was analysed using the Statistical Package for Social Sciences (SPSS). The results revealed that only 23.7% of the sample were given pre-registration donation education and only 56.2% stated they received education as part of post-registration continuing professional development (CPD). Data established knowledge deficits relating to contraindications for solid organ and tissue donation, ability to discuss brain stem death to relatives and differences in clinical management between circulatory and non-circulatory donation approaches. Results found a direct relationship that CPD education improves attitude and participation in donation care amongst health professionals. Data established that there was no bias towards attitude or education provision if the participant worked within a transplant centre versus a non-transplant centre. The study found that there was a direct relationship between the more experienced and senior the practitioner was the more knowledge and confidence they had towards donation. Doctors consistently demonstrated more knowledge and perceived confidence relating to donation issues compared to nurses or ODPs. ODPs consistently demonstrated less knowledge and confidence when compared to doctors and nurses and were less likely to be provided with donation education. Practitioners working within intensive care were significantly more likely to have received donation CPD. The majority of education delivered to health care professionals (HCP) is informally by Specialist Nurses for Organ Donation. The study was underpinned by the theoretical perspectives of Eraut and Dreyfus relating to professional learning and development. This study provides a contemporary assessment of HCPs’ attitude, knowledge and education provision relating to donation establishing that mandatory training as advocated by the DH (2008) and NICE (2011) has not been implemented into frontline practice. The study concluded that HCPs have knowledge deficits relating to organ and tissue donation with education opportunities being limited. The results found a recurring theme that the more experience the HCP has the more knowledge and confidence they have relating to donation. The results will be used to inform and recommend future pre-registration and post registration education and learning strategies relating to donation care.