New guidance designed to boost the number of organs for transplant has been issued to the NHS.
It contains advice on how staff should approach families as their loved ones near the end of their lives, including using “positive” phrases to describe donation and avoiding “apologetic or negative language”.
Some 29% of people are on the organ donor register but donation rates in the UK remain poor.
Experts believe one reason may be because bereaved relatives do not consent to the process.
More than 10,000 people in the UK currently need a transplant and around 1,000 people die every year waiting for an organ.
The guidance, from the National Institute for Health and Clinical Excellence (NICE), sets out a clinical checklist to identify all potentially suitable donors as early as possible.
This includes those patients whose serious brain injury means they are highly likely to have brain stem death, and those patients where the intention to withdraw life-sustaining treatment will, or is expected to, result in death.
Staff are also told to seek information on the patient’s wishes surrounding donation before approaching their loved ones.
An assessment should also be made of what support the family might need, such as having a family liaison officer or religious person present, alongside identification of any cultural and religious issues that may have an impact on consent.
The guidance goes on: “Discussions about organ donation with those close to the patient should only take place when it has been clearly established that they understand that death is inevitable or has occurred.”
When approaching those close to the patient, staff should say donation is a usual part of the end-of-life care process and ask open-ended questions such as “How do you think your relative would feel about organ donation?”.
Staff should also “use positive ways to describe organ donation, especially when patients are on the NHS organ donor register or they have expressed a wish to donate during their lifetime, for example ‘by becoming a donor your relative has a chance to save and transform the lives of many others’.”
Staff should avoid the use of “apologetic or negative language”, such as saying “I am asking you because it is policy” or “I am sorry to have to ask you”.
Reassurance should also be provided that the main focus is care and dignity of the patient, whether donation occurs or not.
There should also be “explicit confirmation and reassurance that the standard of care received will be the same whether they consider giving consent for organ donation or not”.
The document, which is the first of its kind from NICE, says each hospital in England and Wales should have a policy and protocol for managing organ donation, as set out in the recommendations.
Dr Fergus Macbeth, centre for clinical practice director at NICE, said: “Organ donation can be a sensitive subject, particularly if decisions are made at a time of bereavement.
“It is, therefore, crucial that there is a clear guideline in place to support and assist healthcare professionals at this time. I am sure it will be helpful to all those involved in this important process.”
Karen Morgan, guideline development group member, said: “As a nurse, I understand what a very difficult and emotional time the end of a person’s life can be, and often the last thing loved ones want to think about at this time is organ donation.
“But sadly, there is a big shortage of donors, so it is imperative that more people seriously consider donating their organs.
“Although it is an important decision to make, many people are comforted knowing that some good will come out of their death.”
A spokeswoman for the Department of Health said a donated organ can give another person the chance of life.
She added: “We know that these conversations happen at a traumatic and emotional time for people.
“This guidance will give frontline staff crucial support and advice on how to have these conversations with families, at this difficult time.”