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American Family Children's Hospital
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Effective Requesting 101: What Every Designated Requestor Needs to Know About Discussing the Opportunity for Donation

Key points:

  • Effective requesting is a process, not an event. Giving families time, not asking for an immediate answer, asking families what questions they have, etc., are all part of the effective requesting process.
  • Listen, acknowledge and support families as we offer them the opportunity to donate.
    The first two minutes of any interaction are the most important. And your words are only a small part of that first impression: your openness, your facial expression, your body language, your willingness to help. All these factors influence families' responses to you.
  • Families in crisis have the right to express intense feelings, including anger, and to have those feelings accepted and acknowledged. When families become angry, it has little to do with the "timing" of your discussion but has everything to do with their loss.
  • A family in crisis may only remember 25 percent of what has been said.
  • Anger is an opportunity to become involved with the family.
  • Closed-ended questions such as, "Did you ever talk to your loved one about donation?" elicit only a yes or no answer, which will lead you to a one-time ask or approach. Open-ended questions such as, "What questions do you have about donation?" begin a conversation, which helps create an ongoing discussion and effective requesting process. "How" and "why" are great starts to asking open-ended questions.

Helpful phrases to discuss donation:

 

Families present with very different inclinations to donation, ranging from a family initiated-discussion with a positive interest all the way to families who are extremely distressed and have already rejected the idea of donation. We believe the approach with families can be adapted to the full range of responses and offer the following examples.

 

The following phrases are intended as examples, not scripts. We recommend that you practice several of the phrases by saying them out loud and then develop your own voice.

  • "I know you have prayed for a miracle today, hoping Sam's life could be saved. Today, the miracle is yours to give. Although Sam has died, you have the ability to offer the miracle of life to another family by donating Sam's organs."
  • "Your loved one has the special opportunity to save other people's lives. I am here to help guide you through the process."
  • "It looks as though your family may have an opportunity that not many families have, to consider the option of donation."
  • "I know it is upsetting to be thinking about this, but many families tell us that they are comforted that something good came out of their tragedy. You don't have to make your decision right now."
  • "As a donation specialist, I have seen the good that donation can do. There is benefit to donor family and recipient alike." (Relate story.)
  • "You seem unsure about donating your daughter's organs. I may not have all the answers, but I can maybe help with some of your questions. What concerns do you have with this process?"
  • "I know this is a difficult time and you will be making many decisions in the next few days. One that I can help you with involves your family's decision about organ/tissue/eye donation. I am here to help guide you through the process and answer any questions you might have."
  • "Up to this moment you've looked to us to save Sarah's life. Unfortunately, despite all of our efforts and technology, we couldn't save Sarah. As you know, Sarah was pronounced dead at 2pm and you do genuinely have the heartfelt condolences of all our staff. Mrs. Jones, what you have now is the ability to offer another family what you have wanted more than anything - hope that your loved one can live on."
  • (When a family reacts angrily to the mention of donation): "It is so hard to hear this mentioned, and we are not going to talk about donation at this time. There are many ways I may be able to help you and your family, like making sure you have the information you need, finding a more private room to wait in..."
  • (When a family immediately rejects donation): "I understand this is too hard when you have just heard from the doctor about your loved one's condition. You probably have a lot of questions about what has happened. I will be glad to assist you and your family in any way I can."
  • When trust is difficult to establish, the following phrases are used to reassure families who are tending to say no because they do not trust hospital personnel. A high percentage of these families consent when they are reassured and listen to the information.
    • "Whether or not you choose donation, I would like to assist you."
    • "I don't know whether donation is right for your family but I would like you to have all the information."
    • "This is your decision and no one will pressure you. However, you have a right to all the information about donation."
    • "Donation may not be your family's choice, but many families tell us that in later years, the decision to consent to donation can be a comfort, so I would like you to have all the information before you finalize your decision."

Adapted from Cherry Wise, PhD, California Transplant Donor Network