The Heart of the Matter: Staff Insights Into Organ Donation Conversations.

BACKGROUND: Organ donation in intensive care units (ICU) involves complex, emotional conversations with families during end-of-life care. While literature often examines consent rates, clinical protocols and family experiences, less is known about the factors that shape donation discussions from the perspective of ICU staff. AIMS: To understand ICU staff experiences and perspectives of factors influencing organ donation discussions and family decision-making in New Zealand ICUs. STUDY DESIGN: A qualitative descriptive study using reflexive thematic analysis of focus group data from 11 ICU staff (medical, nursing and health psychology) across three tertiary ICU facilities. FINDINGS: Three key themes were developed: Having a 'Good' Conversation, Acknowledging the Emotional and Mental Weight and Having the Will to Endure and Feeling Equipped to Care. Participants emphasised the importance of trust-based communication with families; culturally and emotionally responsive care tailored to families' individual needs; and regulating the emotional demands of donation work. Staff relied on regular collegial support to maintain emotional resilience and valued structured education, team preparation and access to resources that built their confidence in donation conversations. Participants identified practices and values that fostered a positive unit culture around organ donation, contributing to team resilience and meaningful family interactions. CONCLUSIONS: This study offers insight into the interpersonal, emotional and practical aspects of organ donation work in NZ ICUs from the perspective of staff. Findings show that supportive team culture, underpinned by quality communication, team preparation, emotional safety and adequate resources, enables more meaningful donation conversations with families. These insights highlight opportunities for strengthening practice, education and unit culture in donation work. RELEVANCE TO CLINICAL PRACTICE: Findings support the need for regular, multidisciplinary education; emotional support structures; and clear, standardised team processes to enhance donation conversations. Improving systemic infrastructure, such as robust donor identification pathways and public-facing education, can further prepare staff and families to navigate donation as a normalised aspect of end-of-life care.