Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach.

Care pathways standardize care based on the latest evidence. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact. A RAND modified three-round Delphi approach was used to build consensus about potential key interventions and quality indicators identified in existing guidelines, review articles, process flow diagrams and the results of the Organ Donation European Quality System (ODEQUS) project. Comments and additional key interventions and quality indicators, identified in the first round, were evaluated in the following rounds and a subsequent physical meeting. This was conducted over a 4 month time period in 2016. A multidisciplinary panel consisting of 18 Belgian experts completed the three Delphi rounds. Out of a total of 80 key interventions assessed throughout the Delphi process, 65 were considered to contribute to the quality of care for the management of a potential donor after brain death (DBD); 11 out of 12 quality indicators were validated for relevance and feasibility. Detection of all potential DBD in the intensive care unit and documentation of cause of no donation were rated as the most important quality indicators. Using a Delphi approach, consensus was reached for a set of 65 key interventions and 11 quality indicators in the management of a potential DBD. This set is considered to be universally applicable in quality improvement programs for the care of potential DBD.

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