Educating palliative care clinicians in corneal donations: A DonateLife clinical partnership

In a 30 hed inpatient palliative care unit, around 600 patients receive end of life care each year, however the number of relatives approached to give permission for post mortem corneal donation is low. We know that rates in the wider palliative care setting are also low1 and that families would often be open to corneal donation discussions if initiated by staff2

Rates of donation can be increased by simple measures especially if made routine.3

The aims of the study were to improve palliative care unit staff knowledge and confidence in corneal donation issues; and to improve corneal donation rates. Pre and post education surveys of 80 staff (mostly nursing) were carried out, to evaluate the respondents' experience in death and dying, attitudes to organ donation in general and corneal donation in particular, and clinical questions about patients' suitability to be corneal donors.

An education program of several in-services was provided by Lions' Eye Bank and the Eastern Health DonateLife (Organ, Tissue and Eye Donation) Team.

Pre-education, 70% of respondents felt they were not confident to discuss corneal donation with patients and families, - however in the "post" survey, those who attended an in-service were not confident in 21% of cases, compared with 90% who had not attended an in-service.

Thirty-two percent correctly identified the settings where corneal donation was possible pre-education, compared with 55% post education. Frequent errors noted in the surveys included: patients dying in the palliative care unit, patients who were reported to the Coroner, and patients with diabetes not being eligible.

Respondents were more accurately able to identify medical conditions that made corneal donation impossible after the education (28% vs 76%).

Barriers to donation suggested by staff included: lack of patient and family awareness, lack of staff awareness and familiarity with process, lack of information resources for staff and families.
Three corneal donations were carried out in the ward over a 3 month period which represents an increase from five donations in the previous two years. Some but not all staff were more confident in discussing corneal donation with patients and families after the education program. Barriers to donation were identified. Dialogue about and interest in this issue has been opened up.

 1. Corneal donation within palliative care: a review of the literature. Edwards P.
     lnt J Palliat Nurse 2005 Sep; 11(9):481-6
 2. The experiences of donorfamilies in the hospice. Carey J, Forbes K.
     Palliat Med 2003 Apr; 17(3):241-7
 3. Corneal donation in the palliative care setting: "Don't look at me! It's hard enough
     to ask the burial/cremation question" Toose, J; Stone, J. Unexplored Territory 2006
     (PCA-NSW), The Palliative Care Association of NSW, paper, 2006