Grief trajectories after ICU death: Impact of organ donation on family bereavement.

BACKGROUND: Death occurs in 10-30% of ICU admissions worldwide. Bereavement following ICU death is often complex and may lead to elevated grief symptoms, reported in 46-52% of relatives. AIM: To examine emotional responses and grief trajectories over 24 months among relatives exposed or not exposed to the organ donation decision-making process after ICU death. METHODS: This prospective longitudinal study was conducted in an academic ICU between November 2018 and August 2022. Relatives of deceased ICU patients were divided into three groups: consent to organ donation, refusal of donation, and no exposure to the donation process. Data were collected using interviews, the Inventory of Complicated Grief (ICG) and an emotion wheel, at 3, 6, 12, and 24 months after death. Analyses were exploratory and descriptive. RESULTS: Among 147 eligible relatives contacted, 78 participated (33 consented to organ donation, 15 refused, and 30 were not exposed to the organ donation decision-making process). At 3 months, more than 60% reported elevated grief symptoms on the ICG. No statistically significant between-group difference was observed at 3 months (p = 0.279). Differences emerged at 6 months (p = 0.013), remained borderline at 12 months (p = 0.054), and were significant at 24 months (p = 0.011). Over time, relatives who consented to donation increasingly reported emotions of pride and recognition, whereas those who declined donation more often reported relief. CONCLUSION: Exposure to organ donation after ICU death was associated with distinct bereavement trajectories. Donor relatives showed grief symptom levels similar to other groups in the early phase, with distinct trajectories emerging from 6 months onward and were more likely to report positive emotions, including pride and recognition. IMPLICATIONS FOR CLINICAL PRACTICE: These findings may inform future bereavement-support strategies and follow-up programs addressing both grief-related distress and meaning-making experiences. IMPACT STATEMENT: Organ donation decision-making is associated with distinct bereavement trajectories characterized by early distress and later emergence of emotions supporting tailored nursing and psychosocial care.