Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario

Medical students' knowledge and attitude toward brain death and the influence of medical education: a cross-sectional study

BACKGROUND

The medical students' knowledge and attitude toward brain death has not been investigated in China. The aims of this study were to assess the knowledge and attitude toward brain death among medical students in China and assess the influence of medical education on the knowledge and attitude.

METHODS

An online questionnaire consisting of 17 questions was developed and completed by undergraduates majoring in clinical medicine in China Medical University. The students' demographic data, knowledge and attitude toward brain death were collected and analyzed.

RESULTS

A total of 1075 medical students participated in the survey, and 1051 of them completed the valid questionnaire. The exploratory factor analysis grouped the 17 items into four dimensions, which explained 63.5% of the total variance. These dimensions were named as knowledge (5 items), attitude (5 items), concern (3 items) and education needs (4 items) respectively. The global Cronbach α of the questionnaire was 0.845 and the Cronbach α of the four dimensions ranged from 0.756 to 0.866. The mean dimension scores of knowledge, attitude, concern and education needs was 3.67 ± 0.89, 3.67 ± 0.87, 3.10 ± 1.03 and 4.12 ± 0.72 respectively. The clinical students had a better knowledge than the preclinical students (P < 0.001). The clinical students had a more favorable attitude in stopping the treatment for a brain-dead family member and using the organs and/or tissues of brain-dead patients for transplantation (P < 0.001). The clinical students showed more concerns than the preclinical students (P < 0.001). There was no significant difference in the education needs between the clinical and pre-clinical students.

CONCLUSIONS

Most medical students in China had insufficient knowledge about brain death. Although their knowledge of brain death increased with their university degree, their attitude toward organ donation after brain death did not evolve accordingly. Their concerns about brain death increased with seniority. Most students had great education needs about brain death.

Organ Donation Awareness among Family Members of ICU Patients

Background and Objectives: With one of the lowest donation rates in the European Union, Romania faces challenges in organ donation from brain death donors, within an opt-in system. This study aims to measure the attitudes and knowledge of ICU patient's relatives toward organ donation. Materials and Methods: A descriptive cross-sectional study was conducted in the intensive care unit of the Emergency Clinical County Hospital of Oradea, Romania. A 24-item self-administered questionnaire (N = 251) was used to collect data on knowledge about organ and tissue donation and transplantation, as well as the willingness to donate. Results: A high degree of awareness and willingness for organ donation and transplantation was recorded. The main positive predictor of willingness to donate was the perception of helping others by donating their organs after brain death (β = 0.537, OR = 1.711, p < 0.05), and the main negative predictor was the idea that the whole body should be buried intact (β = -0.979, OR = 0.376, p < 0.01). Conclusions: A basic understanding of organ donation and transplantation and favorable attitudes toward organ donation were registered. Families' interviews for organ donation consent may be affected due to extreme emotional distress.

A Critical Ethnographic Study of Families of Brain-Dead Patients: Their Experiences and Attitudes to Organ Donation

Background

Despite the difficulty of making decisions providing facilitating mediators and removing barriers to making decisions about choosing the right path to donate the organs of brain-dead patients by families can assist in improving the services and help the lives of fellow human beings. This study aimed to explain the decision-making mediator for organ donation in families with brain-dead patients in a cultural context.

Materials and Methods

This qualitative study with a critical ethnographic approach was conducted based on Carspecken's stages from August 2021 to March 2022. In this regard, 22 participants were selected through the purposive sampling method and considering the inclusion and exclusion criteria. Sampling was continued until data saturation. After obtaining the required ethical approval, data collection was performed through observation, semi-structured interviews, and document review. All data were recorded and managed using MAXQDA 18 software.

Results

Based on the results, the main themes and subthemes of this study included "inefficient decision-making mediator" (the shadow of the socioeconomic situation on the medical status of organ recipients, as well as pessimistic influential individuals, social accountability, dialect difference, and ethnic beliefs) and "efficient decision-making mediator" (social learning, material, and spiritual motivation, mother role, and divine reward).

Conclusions

The results of this study, derived from a cultural context, can be applied to carrying out future applied and empirical research. Moreover, they can be used in the field of various nursing roles, especially management, care, and education.

Decision-making About Premortem Interventions for Donation: Navigating Legal and Ethical Complexities

Premortem interventions (PMIs) for organ donation play a vital role in preserving opportunities for deceased donation or increasing the chances of successful transplantation of donor organs. Although ethical considerations relating to use of particular PMIs have been well explored, the ethical and legal aspects of decision-making about the use of PMIs have received comparatively little attention. In many countries, there is significant uncertainty regarding whether PMIs are lawful or, if they are, who can authorize them. Furthermore, emphasis on consideration of therapeutic goals in substitute decision-making frameworks may discourage consideration of donation goals. In this article, we examine the fundamental questions of who should have the authority to make decisions about the use of PMIs on behalf of a potential donor and how such decisions should be made. We draw on international examples of legal reform that have sought to clarify the legal position in relation to administering PMIs and identify potential elements of an effective regulatory model for PMIs. In doing so, we argue that reforms are needed in many countries to provide legal certainty for clinicians who are responsible for supporting decision-making about PMIs and to ensure that the goals and preferences of potential donors are accorded due consideration in the decision-making process.

Willingness of intensive care unit patients' family members to donate organs: A cross-sectional study

The large gap between the demand for, and the supply of organs worldwide makes promoting organ donation an important global social issue. Even after someone has signed a consent form or registered for organ donation, ethically, the hospital still requires a family member's written permission before organ donation can proceed. As a result, a family member rather than the patient makes the final decision. This study investigated the willingness of the family members of hypothetical patients in intensive care units (ICUs) suffering from an irreversible condition to sign an organ donation consent form. A cross-sectional survey was conducted among family members of ICU patients recruited from one medical center in southern Taiwan from April to October 2014, which followed the STROBE guidelines. Of 110 ICU family members, 71 (64.5%) were willing to donate the organs of hypothetical patients with irreversible conditions. Based on logistic regression, family support, attitude, and knowledge of organ donation significantly predicted 34% of the variance in willingness to sign consent. Attitude toward organ donation and behavioral knowledge of organ donation correlated significantly with a willingness to sign a consent form. This study found that family support and organ donation attitudes were important factors in predicting the willingness to sign a consent form for the organ donation of hypothetical patients. The study provides evidence that nurses and healthcare staff need to consider family support and educate families on organ donation to encourage potential donors to accept and agree to organ donation.