Withdrawal of Treatment and Organ Donation

Team Approach in Cross-Cultural Ethical Decision Making: A Case Study

The increasing cultural diversity in modern society creates difficulties in cross-cultural ethical decision making for healthcare workers. Nurses need to be sensitive and knowledgeable about the cultural background of individual patients. Acknowledging an individual's cultural background and considering the characteristics of different cultures when planning the patient's care may facilitate the process of ethical decision making.

Ethical Considerations in Organ Donation and Transplantation

Organ transplantation continues to be an excellent therapeutic option for patients with end-stage organ disease. Due to advances made in immunosuppression, surgical techniques, and critical care management, graft and patient survival rates continue to improve. Although advances in technology have dramatically changed in the field of organ transplantation over the last several decades and complicated ethical decision-making, the fundamental ethical principles of beneficence, nonmaleficence, autonomy, and justice have not. Organ transplantation still remains a problem of supply and demand and challenges transplant professionals to meet society's push to find new organ donor sources.

The Impact of Trust Study Days on Organ and Tissue Donation among Critical Care Staff

The UK has one of the lowest rates of organ donation in Western Europe. Several barriers to the donation process have been identified. Among these are lack of knowledge, failure of staff to identify potential donors and feeling that it is someone else's responsibility to request for donation. Evidence suggests that educational programmes covering issues regarding organ and tissue donation enhance knowledge and confidence in the organ donation process and ultimately increase the number of potential donors. In 2002, Bolton NHS trust made changes aiming to increase donor rates. Trust study days were introduced, aiming to educate staff about aspects of donation. Since then, Bolton has had a significant increase in donor rates. The purposes of this audit were to assess present levels of knowledge and attitudes about organ and tissue donation and to see whether the introduction of trust study days has made a positive impact amongst critical care staff. The findings of this audit are encouraging, showing a positive impact on both staff knowledge and attitudes towards donation and reflecting a change in culture within the trust.

Ethics guidelines for research with the recently dead

The objective of the multidisciplinary expert Consensus Panel on Research with the Recently Dead (CPRRD) was to craft ethics guidelines for research with the recently dead. The CPRRD recommends that research with the recently dead: (i) receive scientific and ethical review and oversight; (ii) involve the community of potential research subjects; (iii) be coordinated with organ procurement organizations; (iv) not conflict with organ donation or required autopsy; (v) use procedures respectful of the dead; (vi) be restricted to one procedure per day; (vii) preferably be authorized by first-person consent, though both general advance research directives and surrogate consent are acceptable; (viii) protect confidentiality; (ix) not impose costs on subjects' estates or next of kin and not involve payment; (x) clearly explain ultimate disposition of the body.

Trauma and tribulation: the experiences and attitudes of operating room nurses working with organ donors

BACKGROUND

In the past two decades, significant medical advances have resulted in remarkable success and survival rates for organ recipients. However, the rates of donation have not kept pace with the demand, resulting in a critical shortage of available healthy organs. It has been suggested that the attitudes of medical personnel towards organ retrieval is a key success factor in improving organ donation. Yet there is evidence that those closest to the process of procurement are the most negative.

AIMS AND OBJECTIVES

This study sought to examine the attitudes towards organ donation of operating room nurses and their experiences of participating in the procurement of organs for transplant, in order to unravel factors that contribute to their attitudes.

METHODS

This study relied upon in-depth qualitative interviews with 14 operating room nurses who participated in organ procurement in a large urban trauma centre.

RESULTS

The results of this study suggest that the process of organ procurement is highly stressful and raises many concerns for operating room nurses. Factors, which added to participants' distress, include organizational factors such as strained relationships within surgical teams, concerns about the dignity of the patient and the well-being of the family and exposure to death and trauma.

CONCLUSIONS

Experiences of nurses participating in surgical removal of organs for transplantation resulted in personal feelings of distress and negative attitudes to the issue of organ donation which may be transmitted to others and undermine organ procurement efforts.

RELEVANCE TO CLINICAL PRACTICE

The concerns of these vital members of the organ procurement team should be heeded and actions taken to reduce their distress and improve their attitudes towards donation.

Team approach in cross-cultural ethical decision making: a case study

The increasing cultural diversity in modern society creates difficulties in cross-cultural ethical decision making for healthcare workers. Nurses need to be sensitive and knowledgeable about the cultural background of individual patients. Acknowledging an individual's cultural background and considering the characteristics of different cultures when planning the patient's care may facilitate the process of ethical decision making.

Brain death in ICUs and associated nursing care challenges concerning patients and families

In order to document the incidence and causes of brain death (BD) and the frequency of organ donation (OD) in a Swedish University Hospital, a retrospective review of deaths in a neurosurgical department and in the general intensive care units (ICUs), was carried out for the period 1988-1994. BD diagnosis was established in 197 (10.6%) of all deaths (n = 1843). The hospital records of all BD patients were examined in detail following a specific study plan. The majority of the BD patients (89%) were acute admissions to hospital, and among them 81 were transferred between hospitals often over a long distance. Among the BD patients the total number of OD was 65 (33%). The most common diagnosis leading to BD was spontaneous intracerebral bleeding and traumatic head injury. The BD diagnosis was established by neurological examination (60%) and by cerebral angiography (40%). Of the BD patients, 50% died within 48 hours in the ICU and the majority of requests for OD (67%) were made to the relatives of these patients. The findings are discussed with focus on the workload and psychological stress of ICU nurses when caring for BD patients and their families; a task which includes taking part in processes concerning BD diagnosis information and OD requests.