Appreciation in practice

Organ or tissue donation is a delicate process. Discussions, examinations, decisions, and organization must take place in a relatively short time. Everything focuses on precision and timing. At the same time, it is crucial to do justice to the loved ones, who must process the shocking news that their beloved can no longer recover or has passed away. Donation demands extra time and energy from them: having conversations, reflecting, and waiting longer for the actual farewell. 'We ask a lot of loved ones. It is important to appreciate that,' says Laura van Haaften.

Standing alongside the family

Van Haaften is a donation intensivist at the Meander Medical Center in Amersfoort. She finds it essential that healthcare providers consciously make room for recognition and meaning-making. Both in the hospital and at professional conferences, she draws attention to the family perspective. 'The donation process must run smoothly from a logistical standpoint, but supporting grieving loved ones is just as important. They are saying goodbye to a loved one and have to go on with their lives.'

Organ donation in the IC in Amersfoort is an uncommon event that is intense for the entire team. 'You have to arrange a lot, but also talk to the family multiple times a day.' That suits Van Haaften well. 'I derive a lot of job satisfaction from the human side of my profession. Even when someone passes away, I can feel that I've had a good day because I was able to guide the loved ones well.' In doing so, she does not stand opposite them, but alongside them. For her, that means listening well, showing respect, and tuning into what someone needs. 'I want to make them feel that we are walking this path together.'

That attitude manifests in small, concrete actions. Instead of standing at the foot of the bed, she sits down. She places a hand on a shoulder. She lets a silence fall during moments of grief, or gets a cup of water. According to her, the core of appreciation is: making people feel that they are truly seen.

At the IC in Amersfoort, this human-centric approach is part of the culture. 'I have encountered a fantastic group of intensivists who dare to be human in addition to being doctors.' That culture does not maintain itself. 'By being aware of it and expressing appreciation when a colleague does something good for a patient, you keep it alive.' The intensivists also pass on their approach to physician assistants.

Taking time

Standing alongside the family also means: taking time. 'You cannot say all at once: your loved one has had a major brain hemorrhage, they are brain dead, and they are a donor. That has to happen in multiple steps.'

A crucial moment is the breaking-bad-news conversation, in which it becomes clear that recovery is no longer possible. In that conversation, Van Haaften never brings up donation. 'Otherwise, people might get the impression that treatment is being stopped to make donation possible. They first need to understand that things are not going to get better.'

Only later does the donation conversation follow. In it, she explains how someone is registered in the Donor Register and what donation entails, including the uncertainties. She has little hesitation in bringing up the subject. 'It can feel like you are burdening a grieving family. But if you don't do it, you also deprive them of an opportunity to mean something to other people.' Donation can be valuable for loved ones, the intensivist observes. 'The idea that something good still comes out of the passing away can help with the grieving process.'

She does not ask families directly what they think of donation, because the potential donor's registration is leading. 'When the decision lies with the surviving relatives (in the case of a relative decision or a specific person, ed.), loved ones regret a "no" more often than a "yes". Research shows that having to make that choice is burdensome. Therefore, you are allowed to be a little paternalistic. If donation does not suit someone, you will hear about it naturally.'

Attuning

The keyword in her work is attuning. 'You cannot cast these kinds of conversations into a protocol. It is your professionalism that allows you to sense what someone needs.' That also means she does not always share all technical details. 'You have a duty to provide good information, but it is not helpful for everyone.' Each time, she makes the assessment: what helps this family at this moment?

That attention works both ways. 'If families feel seen, you as a healthcare provider receive that appreciation back as well. That connection provides a lot of positive energy.'

For Van Haaften, that connection holds the essence of appreciation in donation practice. 'We are professionals, doctors, and nurses. But what people remember is that we are there for them, as humans. Perhaps that is the core: that, precisely during the most emotional moments, we continue to see who it is really about.'

This article comes from Transparant magazine (no. 98).
Curious about more stories and background? Read the full magazine here.