Offering the Option: The Decoupling Process

By Maurice Van Zant, Supervisor of Hospital Development

"Decoupling" is a very strange word to be associated with the donation process, but it may be the most important step in presenting the donation option to families. In its simplest form, decoupling means separating events from each other. In the donation process, decoupling separates notifying family of the death of their loved one from discussion of issues surrounding the death-issues such as donation, autopsy and funeral arrangements. There must be a clear separation of events based on the needs of the family, not the needs of the hospital, transplant agency or funeral home. Another way to think about decoupling is timing the events, discussions, and paperwork that must be handled when a patient dies.

Decoupling is important because the family must have time to come to terms with a loved one's death. This time varies with each family and also depends on the circumstances of the death. In an expected death, such as end-stage cancer, the pronouncement of death may be no less painful than if the death were sudden. The family may need time to sit at the patient's bedside and really come to terms with the event. In other cases, the family may just need to say their goodbyes. In a sudden event, the pronouncement of death is usually shocking to the family. In addition to notification of the death itself, a very clear explanation of circumstances surrounding the death must be given to the family and

fully understood and accepted. If a family is in denial over the death, the process will be slower. Explanations may need to be repeated until the bereaved really un-derstand what has happened and come to terms with the loss.

The length of time to wait depends on the family and circumstances, so you must use your own judgment. At times I have gone back into the room just to check on the family's needs, see how they are doing, and see if they needed me to make any calls for them. At other times, they have come out of the room, and I knew that the time was right. I would then sit with them in a quiet area, answer any other questions they had, and let them know that there are some important de-cisions they need to consider such as donation, funeral arrangements, autopsy and so on.
Even if donation is not an option due to unsuita-bility, the family still needs time to come to terms with their loss and will greatly appreciate your patience, understanding and care.

Decoupling and other issues are covered in much more detail through Designated Requestor workshops provided by members of the Indiana Donation Alliance. If you would like more information on these workshops or are interested in becoming a Designated Requestor in your hospital, please contact the Indiana Lions Eye Bank at 1-800-232-4384.