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Akeely YY, Al Otaibi MM, Alesa SA, Bokhari NN, Alghamdi TA, Alahmari MS, AlRasheed NK. Organ Donation in the Emergency Department: Awareness and Opportunities. Cureus 2023; 15:e49746. [PMID: 38161899 PMCID: PMC10757646 DOI: 10.7759/cureus.49746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background The only cure for end-organ failure is transplantation. Unfortunately, there are fewer organ donors than patients. Currently, the majority of organ donations come from live or brain-dead donors. In order to expand the pool of potential organ donors, the emergency department should be utilized effectively. Objectives The primary goal of this research is to determine emergency physicians' knowledge, awareness, and attitude about organ donation. Methodology A cross-sectional study was conducted through different hospitals in Saudi Arabia. It includes 106 physicians in the adult emergency departments. Results The majority (84.9%) of the participants never reported any case in the emergency department as a potential case for organ donation. In addition, 54.8% of the participants report having little to no knowledge of the ethical issues of organ donation. Furthermore, 66.1% of respondents claim to have little to no knowledge of the goals and duties of the SCOT (Saudi Center for Organ Transplantation). It was interesting to see that 96.2% of the participants reported that their organizations do not have any policies or procedures in place regarding organ donations. Regarding education, 99 (93.4%) physicians did not participate in any organ donation course, training, or teaching program about organ donation. At the same time, 67 (63.2%) physicians concurred that participation in a training program is essential. Moreover, 68 (64.2%) physicians believed that organ donation should be a part of every end-of-life case. In order to improve the donation process in the emergency department, 88 (83%) physicians would want a well-established program with defined policies and procedures. Conclusion According to our findings, the emergency physician has inadequate expertise and information on organ donation rules and procedures, which has resulted in a missed opportunity to recruit more potential donors. We recommend instituting clear policy and procedures and educating the physicians and all emergency medicine staff to have better outcome.
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Affiliation(s)
- Yahia Y Akeely
- Emergency Department, Security Forces Hospital, Riyadh, SAU
| | | | - Saleh A Alesa
- Emergency Department, Security Forces Hospital, Riyadh, SAU
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Eversmann C, Shah A, Lazaridis C, Ross LF. Coding the Dead: Cardiopulmonary Resuscitation for Organ Preservation. AJOB Empir Bioeth 2023; 14:167-173. [PMID: 36854130 DOI: 10.1080/23294515.2023.2180106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND There is lack of consensus in the bioethics literature regarding the use of cardiopulmonary resuscitation (CPR) for organ-preserving purposes. In this study, we assessed the perspectives of clinicians in critical care settings to better inform donor management policy and practice. METHODS An online anonymous survey of members of the Society of Critical Care Medicine that presented various scenarios about CPR for organ preservation. RESULTS The email was sent to 10,340 members. It was opened by 5,416 (52%) of members and 405 members (4%) completed the survey with few missing data. A majority of respondents (81%) answered that donation status should not influence whether CPR is performed on an imminently dying patient. There was very strong agreement (>85%) that 1) CPR should be performed on a registered donor who experiences a cardiac arrest with an unknown code status before death by neurological criteria (DNC) and 2) CPR should be performed if the patient is not a registered donor and experiences cardiac arrest but the surrogate/power of attorney (POA) has not yet been approached regarding code status and donation. When a registered donor with a DNR order experiences cardiac arrest before DNC, 98% of respondents would not perform CPR. However, after DNC, respondents were evenly divided on whether they would (49%) or would not (51%) perform CPR on a registered donor with an undocumented code status. When asked whether consent should be required for CPR for organ-preserving purposes, 39% answered "Yes" when a patient arrests before DNC and 48% answered "Yes" when a patient arrests after DNC (P = 0.2). CONCLUSIONS The majority of respondents did not consider donor status relevant to CPR decisions before DNC, and virtually all would respect a DNR order in a registered donor before DNC. Respondents were divided about the need for an affirmative consent for CPR for organ-preserving purposes both before and after DNC.
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Affiliation(s)
- Colin Eversmann
- The MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Ayush Shah
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christos Lazaridis
- Departments of Neurology and Neurosurgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Lainie F Ross
- Departments of Pediatrics, Medicine, Surgery and the College, University of Chicago, Chicago, IL, USA
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Lee DE, Kim H, Park KH, Park SY, Park SM, Jung YH, Jeong W, Park KH. Analysis of Factors Affecting Emergency Physicians' Attitudes toward Deceased Organ & Tissue Donation. J Korean Med Sci 2021; 36:e329. [PMID: 34931495 PMCID: PMC8688344 DOI: 10.3346/jkms.2021.36.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. METHODS We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents' sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. RESULTS Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. CONCLUSION For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.
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Affiliation(s)
- Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, Korea
- Department of Medical Education, College of Medicine, Dong-A University, Busan, Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University, Gwangju, Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University, Wonju College of Medicine, Wonju, Korea
- Department of Emergency Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
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Weiss MJ, van Beinum A, Harvey D, Chandler JA. Ethical considerations in the use of pre-mortem interventions to support deceased organ donation: A scoping review. Transplant Rev (Orlando) 2021; 35:100635. [PMID: 34174656 DOI: 10.1016/j.trre.2021.100635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
AIM Pre-mortem interventions (PMIs) are performed on patients before the determination of death in order to preserve or enhance the possibility of organ donation. These interventions can be ethically controversial, and we thus undertook a scoping review of the ethical issues surrounding diverse PMIs. METHODS Using modified scoping review methods, we executed a search strategy created by an information specialist. Screening and iterative coding of each article was done by two researchers using qualitative thematic analysis, and narrative summaries of coded themes were presented. RESULTS We identified and screened 5365 references and coded 196 peer-reviewed publications. The most frequently cited issues were related to possible harms to the patient who is a potential donor, and legitimacy of consent. The most controversial issue was that PMIs may place patients at risk for physical harm, yet benefit is accrued mainly to recipients. Some authors argued that lack of direct medical benefit to the still living patient precluded valid consent from surrogate decision makers (SDMs), while many stated that some medical risk could be approved by SDMs if it aligns with non-medical benefits valued by the patient. CONCLUSION PMIs require consensus that benefit includes concepts beyond medical benefit to the patient who is a potential donor. Informed consent must be confirmed for each PMI and not assumed to be part of general consent for donation. Risk must be proportionate to the potential benefit and newly proposed interventions should be reviewed carefully for medical efficacy and potential risks.
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Affiliation(s)
- Matthew J Weiss
- Transplant Québec, 4100 Rue Molson #200, Montréal, QC H1Y 3N1, Canada; Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Division of Pediatric Intensive Care, Centre Mère-Enfant Soleil du CHU de Québec, 2705 boul Laurier, Québec, Québec, Canada.
| | - Amanda van Beinum
- Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Department of Sociology and Anthropology, B750 Loeb Building, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Dan Harvey
- Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG72UH, UK; University of Nottingham, University Park, Nottingham NG72RD, UK; National Health Services Blood & Transplant, Fox Den Road, Stoke Gifford, Avon, Bristol BS348RR, UK
| | - Jennifer A Chandler
- Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Bertram Loeb Research Chair, University of Ottawa, 57 Louis Pasteur St., Ottawa, Ontario K1N 6N5, Canada; Centre for Health Law, Policy and Ethics, Faculty of Law, University of Ottawa, 57 Louis Pasteur St., Ottawa, Ontario K1N 6N5, Canada.
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Dicks SG, Burkolter N, Jackson LC, Northam HL, Boer DP, van Haren FM. Grief, Stress, Trauma, and Support During the Organ Donation Process. Transplant Direct 2020; 6:e512. [PMID: 32047840 PMCID: PMC6964929 DOI: 10.1097/txd.0000000000000957] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022] Open
Abstract
The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.
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Affiliation(s)
- Sean G. Dicks
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
| | | | | | - Holly L. Northam
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Douglas P. Boer
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Frank M.P. van Haren
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
- School of Medicine, Australian National University, Canberra, ACT, Australia
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Abstract
Deceased donation medicine involves unique ethical challenges. Physicians who are focused on deceased donation medicine as part of their practice can expect to encounter these challenges. The goal of this review is to identify and describe these challenges, highlight existing guidelines and policy regarding the management of these challenges and to describe how the donation physician role might promote ethical practice in deceased donation medicine. Themes of discussion include: communication with families, interprofessional conflict, donation physician personal characteristics, donation clinical processes, health resource allocation, research and education, and remuneration. The information presented in this review can be used to inform development of recommendations and guidelines for the management of ethical challenges encountered by donation physicians.
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Dailey M, Geary SP, Merrill S, Eijkholt M. Enabling Donation after Cardiac Death in the Emergency Department: Overcoming Clinical, Legal, and Ethical Concerns. J Emerg Med 2017; 52:588-592. [DOI: 10.1016/j.jemermed.2016.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/21/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
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Abstract
Palliative and end-of-life care, once the purview of oncologists and intensivists, has also become the responsibility of the emergency physician. As our population ages and medical technology enables increased longevity, it is essential that all medical professionals know how to help patients negotiate the balance between quantity and quality of life. Emergency physicians have the opportunity to educate patients and their loved ones on how to best accomplish their goals of care while also enhancing quality of life through treatment of symptoms. The emergency physician must be aware of the ethical and medico-legal parameters that govern decision making.
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Jesus JE, Michael GE. Organ Donation and the Emergency Department: Ethically Appropriate and Legally Supported. J Emerg Med 2014; 47:209-12. [DOI: 10.1016/j.jemermed.2014.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Rady MY, McGregor JL, Verheijde JL. Transparency and accountability in mass media campaigns about organ donation: a response to Morgan and Feeley. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:869-876. [PMID: 23354495 DOI: 10.1007/s11019-013-9466-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We respond to Morgan and Feeley's critique on our article "Mass Media in Organ Donation: Managing Conflicting Messages and Interests." We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: "to educate the general public about organ donation process" and "help individuals make informed decisions" about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to "information from pilot work or focus groups" but should include evidence-based facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley's claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ requestors at the Department of Motor Vehicles offices. We conclude that organ donation is a medical procedure subject to all the ethical obligations that the medical profession must uphold including that of transparency and truthfulness.
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Affiliation(s)
- Mohamed Y Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA,
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Ortega-Deballon I, Vailhen DRA, Smith MJ. Uncontrolled donation after circulatory determination of death protocols: ethical challenges and suggestions for improvement. Ann Emerg Med 2013; 61:255-6. [PMID: 23331654 DOI: 10.1016/j.annemergmed.2012.07.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 07/17/2012] [Accepted: 07/25/2012] [Indexed: 11/25/2022]
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Death on the Waiting List: A Failure in Public Health. Ann Emerg Med 2012; 60:492-4. [DOI: 10.1016/j.annemergmed.2012.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 05/08/2012] [Accepted: 05/09/2012] [Indexed: 11/21/2022]
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