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Humar SS, Jung J, Krause S, Selzner N, Abbey S. Gift Discourse in Transplant and Its Implications in Anonymous Living Liver Donation. Transplant Proc 2023; 55:274-278. [PMID: 36822887 DOI: 10.1016/j.transproceed.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
The Gift of Life metaphor is prevalent in pro-donation dialogue, aiming to promote transplant programs and conceptualize the act of organ donation. To obtain a better understanding of living donor perceptions on the term Gift of Life, we analyzed thematic views presented by anonymous living donors (ALLDs). Twenty-six ALLDs completed a semi-structured qualitative interview consisting of questions regarding their motivations, experiences, and perceptions on donation. The following 5 major themes relating to the Gift of Life terminology were elucidated: (1) Complete agreement with the term and its relevance to donation. (2) Their donation did not represent a Gift of Life. (3) The term was too grandiose. (4)A belief that the term has more meaning for the recipient rather than donor. (5 )That the "gift" goes both ways, with the donor also benefiting from the experience.
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Affiliation(s)
- Sapna S Humar
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Center for Mental Health, University Health Network, Toronto, Ontario, Canada.
| | - Judy Jung
- Multi-Organ Transplant & Medical Specialties, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sandra Krause
- Center for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Nazia Selzner
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Abbey
- Center for Mental Health, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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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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3
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Reluctance and Willingness for Organ Donation After Death Among the Slovene General Population. Zdr Varst 2019; 58:155-163. [PMID: 31636723 PMCID: PMC6778422 DOI: 10.2478/sjph-2019-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/29/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction The paper presents the findings of the first large-scale survey on post-mortem organ donation among the general Slovenian population. It focuses on the reported donation willingness, the barriers to joining the register of organ donors and the position towards consent to donate organs of deceased relatives. Methods A face-to-face survey was conducted on a probability sample of 1,076 Slovenian residents between October and December 2017. The performed analyses included estimations of means and proportions for target variables, an evaluation of between-group differences and a partial proportional odds model to study the relations between organ donation willingness and socio-demographic characteristics. Results The mean reported willingness to donate one’s own organs after death was 3.77 on a 5-point scale, with less than a third of respondents claiming to be certainly willing. Only 6% of those at least tentatively willing to donate organs were certain to join the register of organ donors in the future. The most frequently reported barriers to registration were unfamiliarity with the procedure and a lack of considering it beforehand. The reported willingness to donate organs of a deceased relative strongly depended on the knowledge of the relative’s wishes, yet 80% of the respondents did not discuss their wishes with any family members. Conclusions The findings confirm the gap between the reported donation willingness and joining the register of donors. Future post-mortem organ donation strategies need to consider socio-demographic and attitudinal factors of donation willingness and help stimulate the communication about organ donation wishes between family members.
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Podara K, Figgou L, Dikaiou M. Accounting for organ donation decision-making: Analyzing interview discourse of the donors' relatives and intensive care unit physicians in Greece. J Health Psychol 2019; 26:905-916. [PMID: 31170829 DOI: 10.1177/1359105319854147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study casts light on the organ donation decision-making process by exploring the experiences of families and physicians involved. Specifically, semi-structured interviews were conducted with 11 family members of 11 different donors and with 13 intensive care unit physicians. Data collection and analysis draws on the principles of Grounded Theory Methodology. Analysis indicated that in the accounts of both groups, organ donation is represented as a multi-faceted process that includes various social and ideological dilemmas. Overlap and mutual influence was found connecting the experiences of family members and those of physicians, highlighting the need for further education and training for physicians and aftercare for families.
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Affiliation(s)
| | - Lia Figgou
- Aristotle University of Thessaloniki, Greece
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5
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Prescott J, Gardiner D, Hogg L, Harvey D. How the mode of organ donation affects family behaviour at the time of organ donation. J Intensive Care Soc 2018; 20:204-207. [PMID: 31447912 DOI: 10.1177/1751143718807842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction End of life and organ donation discussions come at a time of acute emotional unrest for grieving relatives. Their attitudes and eventual decisions regarding consent to organ donation are shaped by multiple factors during these stressful periods. At our tertiary centre intensive care unit, we anecdotally observed that the mode of organ donation affects family behaviour as to whether families stay until transfer to theatre for organ recovery, or leave after consenting for donation. We sought to ascertain if this observation was true and then to hypothesise reasons for why this may be the case. Methods Records of patients consented for deceased organ donation between 1 January 2015 and 31 December 2017 at the Nottingham University Hospitals NHS Trust were reviewed and analysed. Results After exclusion criteria were applied, 91 patient cases were included in the final analysis (donation after brainstem death (DBD), 36; donation after circulatory death (DCD), 55). Thirty-six per cent of DBD families stayed until the point of organ recovery compared to 80% of DCD families (p < 0.00001). Discussion We hypothesise that this family behaviour may be indicative of an acceptance in DBD of the patient's death, and therefore that the patient has moved beyond further harm. For this reason, the family may feel able to leave after consent for donation. A greater understanding of how family behaviours differ depending on the mode of organ donation may aid how these families are best cared for in the intensive care unit.
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Affiliation(s)
- Joel Prescott
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lorraine Hogg
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dan Harvey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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López JS, Martínez JM, Soria-Oliver M, Aramayona B, García-Sánchez R, Martín MJ, Almendros C. Bereaved relatives' decision about deceased organ donation: An integrated psycho-social study conducted in Spain. Soc Sci Med 2018; 205:37-47. [DOI: 10.1016/j.socscimed.2018.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 12/31/2022]
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7
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López JS, Soria-Oliver M, Aramayona B, García-Sánchez R, Martínez JM, Martín MJ. An Integrated Psychosocial Model of Relatives' Decision About Deceased Organ Donation (IMROD): Joining Pieces of the Puzzle. Front Psychol 2018; 9:408. [PMID: 29692744 PMCID: PMC5902731 DOI: 10.3389/fpsyg.2018.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Organ transplantation remains currently limited because the demand for organs far exceeds the supply. Though organ procurement is a complex process involving social, organizational, and clinical factors, one of the most relevant limitations of organ availability is family refusal to donate organs of a deceased relative. In the past decades, a remarkable corpus of evidence about the factors conditioning relatives' consent has been generated. However, research in the field has been carried out mainly by means of merely empirical approaches, and only partial attempts have been made to integrate the existing empirical evidence within conceptual and theoretically based frameworks. Accordingly, this work articulates the proposal of an Integrated Psychosocial Model of Relatives' Organ Donation (IMROD) which offers a systematic view of the factors and psychosocial processes involved in family decision and their interrelations. Relatives' experience is conceptualized as a decision process about the possibility of vicariously performing an altruistic behavior that takes place under one of the most stressful experiences of one's lifetime and in the context of interaction with different healthcare professionals. Drawing on this, in the proposed model, the influence of the implied factors and their interrelations/interactions are structured and interpreted according to their theoretically based relation with processes like rational/heuristic decision-making, uncertainty, stress, bereavement, emotional reactions, sense of reciprocity, sense of freedom to decide, and attitudes/intentions toward one's own and the deceased's organ donation. Our model also develops a processual perspective and suggests different decisional scenarios that may be reached as a result of the combinations of the considered factors. Each of these scenarios may imply different balances between factors that enhance or hinder donation, such as different levels of uncertainty and potential decisional conflict. Throughout our work, current controversial or inconsistent results are discussed and interpreted on the basis of the relationships that are posited in the proposed model. Finally, we suggest that the structure of the relationships and interactions contained in our model can be used by future research to guide the formulation of hypotheses and the interpretation of results. In this sense, specific guidelines and research questions are also proposed.
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Affiliation(s)
- Jorge S López
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain.,Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Soria-Oliver
- Facultad de Ciencias de la Salud, UNIR-Universidad Internacional de la Rioja, Logroño, Spain
| | - Begoña Aramayona
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rubén García-Sánchez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - José M Martínez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - María J Martín
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
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8
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Dicks SG, Ranse K, Northam H, van Haren FMP, Boer DP. A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study. Health Psychol Open 2018; 5:2055102917753706. [PMID: 29399367 PMCID: PMC5788101 DOI: 10.1177/2055102917753706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of 'communication' between researchers contributes to information being 'lost' and then later 'rediscovered'. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.
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Affiliation(s)
| | | | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University, Australia
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9
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Dicks SG, Northam H, van Haren FMP, Boer DP. An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis. Health Psychol Open 2018; 5:2055102918782172. [PMID: 30083368 PMCID: PMC6069040 DOI: 10.1177/2055102918782172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.
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Affiliation(s)
| | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University,
Australia
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10
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Dicks SG, Ranse K, Northam H, Boer DP, van Haren FM. The development of a narrative describing the bereavement of families of potential organ donors: A systematic review. Health Psychol Open 2017; 4:2055102917742918. [PMID: 29379629 PMCID: PMC5779939 DOI: 10.1177/2055102917742918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.
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Affiliation(s)
| | | | | | | | - Frank Mp van Haren
- University of Canberra, Australia.,Australian National University, Australia
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11
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Gewarges M, Poole J, De Luca E, Shildrick M, Abbey S, Mauthner O, Ross H. Canadian Society of Transplantation Members' Views on Anonymity in Organ Donation and Transplantation. Transplant Proc 2016; 47:2799-804. [PMID: 26707291 DOI: 10.1016/j.transproceed.2015.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anonymity has been central to medical, psychosocial, and societal practices in organ donation and transplantation. The purpose of this investigation was to explore transplant professionals' views on anonymity in the context of organ transplantation. METHODS The study consisted of an electronic 18-item survey distributed to the Canadian Society of Transplantation membership, asking about anonymity vs open communication/contact between organ recipients and donor families. RESULTS Of the 541 members surveyed, 106 replied. Among respondents, 71% felt that organ recipients and donor families should only communicate anonymously, yet 47% felt that identifying information could be included in correspondence between consenting recipients and donor families. When asked whether organ recipients and donor families should be allowed to meet, 53% of respondents agreed, 27% disagreed, and 20% neither agreed nor disagreed. With social media facilitating communication and eliminating the ability to maintain donor/recipient anonymity, 38% of respondents felt that a reexamination of current policies and practices pertaining to anonymity was necessary. CONCLUSION In conclusion, there was no dominant position on the issue of anonymity/communication between donor families and transplant recipients. Further research and discussion concerning the views of healthcare professionals, organ recipients, and donor families on the mandate of anonymity is needed and may influence future policy.
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Affiliation(s)
- M Gewarges
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - J Poole
- School of Social Work, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - E De Luca
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - M Shildrick
- Tema Genus, Linköping University, Linköping, Sweden
| | - S Abbey
- Department of Psychiatry, Toronto General Hospital, Toronto, Ontario, Canada
| | - O Mauthner
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - H Ross
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada.
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12
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de Groot J, van Hoek M, Hoedemaekers C, Hoitsma A, Schilderman H, Smeets W, Vernooij-Dassen M, van Leeuwen E. Request for organ donation without donor registration: a qualitative study of the perspectives of bereaved relatives. BMC Med Ethics 2016; 17:38. [PMID: 27401351 PMCID: PMC4940748 DOI: 10.1186/s12910-016-0120-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/07/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In the Netherlands, consent from relatives is obligatory for post mortal donation. This study explored the perspectives of relatives regarding the request for consent for donation in cases without donor registration. METHODS A content analysis of narratives of 24 bereaved relatives (14 in-depth interviews and one letter) of unregistered, eligible, brain-dead donors was performed. RESULTS Relatives of unregistered, brain-dead patients usually refuse consent for donation, even if they harbour pro-donation attitudes themselves, or knew that the deceased favoured organ donation. Half of those who refused consent for donation mentioned afterwards that it could have been an option. The decision not to consent to donation is attributed to contextual factors, such as feeling overwhelmed by the notification of death immediately followed by the request; not being accustomed to speaking about death; inadequate support from other relatives or healthcare professionals, and lengthy procedures. CONCLUSION Healthcare professionals could provide better support to relatives prior to donation requests, address their informational needs and adapt their message to individual circumstances. It is anticipated that the number of consenting families could be enlarged by examining the experience of decoupling and offering the possibility of consent for donation after circulatory death if families refuse consent for donation after brain-death.
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Affiliation(s)
- Jack de Groot
- Radboud Institute for Health Sciences, Radboud University Medical Center, DGVP 20, PO Box 9101, 6500, HB, Nijmegen, The Netherlands. .,Department of Spiritual and Pastoral Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Maria van Hoek
- Radboud Institute for Health Sciences, Radboud University Medical Center, DGVP 20, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Cornelia Hoedemaekers
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andries Hoitsma
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Schilderman
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Wim Smeets
- Radboud Institute for Health Sciences, Radboud University Medical Center, DGVP 20, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,Department of Spiritual and Pastoral Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Myrra Vernooij-Dassen
- Radboud Institute for Health Sciences, Radboud University Medical Center, DGVP 20, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,Kalorama Foundation, Nijmegen, The Netherlands
| | - Evert van Leeuwen
- Radboud Institute for Health Sciences, Radboud University Medical Center, DGVP 20, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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13
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Poole J, Ward J, DeLuca E, Shildrick M, Abbey S, Mauthner O, Ross H. Grief and loss for patients before and after heart transplant. Heart Lung 2016; 45:193-8. [PMID: 26897722 DOI: 10.1016/j.hrtlng.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of the study was to examine the loss and grief experiences of patients waiting for and living with new hearts. BACKGROUND There is much scholarship on loss and grief. Less attention has been paid to these issues in clinical transplantation, and even less on the patient experience. METHODS Part of a qualitative inquiry oriented to the work of Merleau-Ponty, a secondary analysis was carried out on audiovisual data from interviews with thirty participants. RESULTS Patients experience loss and three forms of grief. Pre-transplant patients waiting for transplant experience loss and anticipatory grief related to their own death and the future death of their donor. Transplanted patients experience long-lasting complicated grief with respect to the donor and disenfranchised grief which may not be sanctioned. CONCLUSIONS Loss as well as anticipatory, complicated and disenfranchised grief may have been inadvertently disregarded or downplayed. More research and attention is needed.
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Affiliation(s)
- Jennifer Poole
- School of Social Work, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - Jennifer Ward
- School of Social Work, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| | - Enza DeLuca
- Division of Cardiology and Transplant, University Health Network, 585 University Avenue, PMB 11-137, Toronto, Ontario M5G 2N2, Canada
| | | | - Susan Abbey
- Department of Psychiatry, University Health Network, 585 University Avenue, PMB 11-100D, Toronto, Ontario M5G 2N2, Canada
| | - Oliver Mauthner
- Institute of Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Heather Ross
- Division of Cardiology and Transplant, University Health Network, 585 University Avenue, PMB 11-137, Toronto, Ontario M5G 2N2, Canada
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14
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Walker W, Sque M. Balancing hope and despair at the end of life: The contribution of organ and tissue donation. J Crit Care 2015; 32:73-8. [PMID: 26826752 DOI: 10.1016/j.jcrc.2015.11.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Concern for the grieving family can moderate the intentions of critical care staff to advocate deceased organ and tissue donation. Conversely, benevolent actions may provoke distress through missed opportunities to save or transform lives. This article provides insight into the perceived benefits of organ and tissue donation for grieving families who experienced end-of-life care in the intensive care unit. METHODS Data were collected via semistructured, face-to-face or telephone interviews with 43 participants from 31 donor families. Audio recordings were transcribed verbatim and subjected to qualitative content analysis. RESULTS The study findings affirmed the importance of person-centered end-of-life care. Donor families shared examples of good-quality care and communication that contained the hallmarks of compassion, respect, dignity, and choice. We uncovered a trajectory of hope and despair in which the option of organ and tissue donation appeared to give meaning to the life and death of the deceased person and was comforting to some families in their bereavement. CONCLUSIONS Our study findings underlined the significance of donation decision making for grieving families. Organ and tissue donation has the potential to balance hope and despair at the end of life when the wishes of the dying, deceased, and bereaved are fulfilled.
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Affiliation(s)
- Wendy Walker
- Faculty of Education, Health and Wellbeing, Centre for Health and Social Care Improvement, University of Wolverhampton, Wolverhampton WV1 1DT, UK.
| | - Magi Sque
- Faculty of Education, Health and Wellbeing, Centre for Health and Social Care Improvement, University of Wolverhampton, Wolverhampton WV1 1DT, UK.
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15
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Chuong KH, O'Doherty KC, Secko DM. Media Discourse on the Social Acceptability of Fecal Transplants. QUALITATIVE HEALTH RESEARCH 2015; 25:1359-1371. [PMID: 25595150 DOI: 10.1177/1049732314568199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Advances in human microbiome research have generated considerable interest in elucidating the role of bacteria in health and the application of microbial ecosystem therapies and probiotics. Fecal transplants involve the introduction of gut microbes from a healthy donor's stool to the patient and have been documented as effective for treating Clostridium difficile infections (CDIs) and some other gastrointestinal disorders. However, the treatment has encountered regulatory hurdles preventing widespread uptake. We examined dominant representations of fecal transplants in Canadian media and found that fecal transplants are often represented as being inherently disgusting or distasteful (the "ick factor"). This "ick factor" is used to construct different messages about the treatment's social acceptability and legitimacy. We conclude that an over-emphasis on the "ick factor" constrains public discourse from a more nuanced discussion of the social challenges, scientific concerns, and regulatory issues surrounding the treatment.
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16
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VanderKnyff J, Friedman DB, Tanner A. Framing life and death on YouTube: the strategic communication of organ donation messages by organ procurement organizations. JOURNAL OF HEALTH COMMUNICATION 2014; 20:211-219. [PMID: 25494919 DOI: 10.1080/10810730.2014.921741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Using a sample of YouTube videos posted on the YouTube channels of organ procurement organizations, a content analysis was conducted to identify the frames used to strategically communicate prodonation messages. A total of 377 videos were coded for general characteristics, format, speaker characteristics, organs discussed, structure, problem definition, and treatment. Principal components analysis identified message frames, and k-means cluster analysis established distinct groupings of videos on the basis of the strength of their relationship to message frames. Analysis of these frames and clusters found that organ procurement organizations present multiple, and sometimes competing, video types and message frames on YouTube. This study serves as important formative research that will inform future studies to measure the effectiveness of the distinct message frames and clusters identified.
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Affiliation(s)
- Jeremy VanderKnyff
- a Department of Anthropology, College of Arts and Sciences , University of South Carolina , Columbia , South Carolina , USA
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O'Brien GM, Donaghue N, Walker I, Wood CA. Deservingness and gratitude in the context of heart transplantation. QUALITATIVE HEALTH RESEARCH 2014; 24:1635-47. [PMID: 25192762 DOI: 10.1177/1049732314549018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Heart transplantation is now routinely offered as a treatment for end-stage heart failure, and the "gift-of-life" metaphor has become pervasive in this context, forming the foundation on which transplantation discourses rest. In this article, we question organ-as-gift understandings of transplantation. One can also legitimately think of the transplanted organ as a donation, with distinct implications in terms of the transplantation experience for the recipient. We explored the transplantation experience of 13 heart recipients in Australia. We conducted semistructured interviews, and our interpretative phenomenological analysis of the data resulted in three themes: deservingness, nuances of gratitude, and giving forward. Our results indicate that differences between organ-as-gift and organ-as-donation understandings of transplantation are more than merely semantic. Organ-as-donation understandings raise the issue of deservingness, with recipients' assessments of their worthiness influencing their posttransplant experience of gratitude and, ultimately, the meaning(s) gleaned from their transplant experiences.
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Affiliation(s)
| | | | - Iain Walker
- Murdoch University, Perth, Western Australia, Australia
| | - Clare A Wood
- Royal Perth Hospital, Perth, Western Australia, Australia
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Zeiler K. A phenomenological approach to the ethics of transplantation medicine: sociality and sharing when living-with and dying-with others. THEORETICAL MEDICINE AND BIOETHICS 2014; 35:369-388. [PMID: 25227276 DOI: 10.1007/s11017-014-9307-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Ponty's philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors' relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine.
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Affiliation(s)
- Kristin Zeiler
- Department of Thematic Studies - Technology and Social Change, Linköping University, 581 83, Linköping, Sweden,
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Kilcullen JK. "As good as dead" and is that good enough? Public attitudes toward brain death. J Crit Care 2014; 29:872-4. [PMID: 25056846 DOI: 10.1016/j.jcrc.2014.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jack K Kilcullen
- Medical Critical Care Services, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA 22042.
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Sharp C, Randhawa G. Altruism, gift giving and reciprocity in organ donation: a review of cultural perspectives and challenges of the concepts. Transplant Rev (Orlando) 2014; 28:163-8. [PMID: 24973193 DOI: 10.1016/j.trre.2014.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/07/2014] [Accepted: 05/20/2014] [Indexed: 11/19/2022]
Abstract
Living and deceased organ donation are couched in altruism and gift discourse and this article reviews explores cultural views towards these concepts. Altruism and egoism theories and gift and reciprocity theories are outlined from a social exchange theory perspective to highlight the key differences between altruism and the gift and the wider implications of reciprocation. The notion of altruism as a selfless act without expectation or want for repayment juxtaposed with the Maussian gift where there are the obligations to give, receive and reciprocate. Lay perspectives of altruism and the gift in organ donation are outlined and illustrate that there are differences in motivations to donate in different programmes of living donation and for families who decide to donate their relative's organs. These motivations reflect cultural views of altruism and the gift and perceptions of the body and death.
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Affiliation(s)
- C Sharp
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - G Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK.
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21
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Zeiler K. Neither property right nor heroic gift, neither sacrifice nor aporia: the benefit of the theoretical lens of sharing in donation ethics. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:171-181. [PMID: 24048921 DOI: 10.1007/s11019-013-9514-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Two ethical frameworks have dominated the discussion of organ donation for long: that of property rights and that of gift-giving. However, recent years have seen a drastic rise in the number of philosophical analyses of the meaning of giving and generosity, which has been mirrored in ethical debates on organ donation and in critical sociological, anthropological and ethnological work on the gift metaphor in this context. In order to capture the flourishing of this field, this article distinguishes between four frameworks for thinking about bodily exchanges in medicine: those of property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. These frameworks represent four different ways of making sense of donation of organs as well as tissue, gametes and blood, draw on different conceptions of the relations between the self and the other, and bring out different ethical issues as core ones. The article presents these frameworks, argues that all of them run into difficulties when trying to make sense of reciprocity and relational interdependence in donation, and shows how the three gift-giving frameworks (of heroism, sacrifice and aporia) hang together in a critical discussion about what is at stake in organ donation. It also presents and argues in favour of an alternative intercorporeal framework of giving-through-sharing that more thoroughly explicates the gift metaphor in the context of donation, and offers tools for making sense of relational dimensions of live and post mortem donations.
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Affiliation(s)
- Kristin Zeiler
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
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Hyde MK, Wihardjo KR, White KM. Do the myths still exist? Revisiting people’s negative beliefs about organ donation upon death. PSYCHOL HEALTH MED 2012; 17:530-41. [DOI: 10.1080/13548506.2011.647698] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Verble M, Worth J. Addressing the Unintended Adverse Consequences of First-Person Consent and Donor Registries. Prog Transplant 2012; 22:25-32. [DOI: 10.7182/pit2012952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
One of the most common reasons given for the refusal to donate in both the United States and the United Kingdom is that the potential donor, in his lifetime, said he did not want to be a donor. This objection has not always been given by families refusing to donate and appears to be an unintended consequence of donation strategies based on public education, donor registries, and first-person consents. A history of the objection is given, possible meanings are explored, and strategies for dealing with it are suggested.
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Affiliation(s)
| | - Judy Worth
- Verble, Worth, & Verble, Lexington, Kentucky
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Abstract
This study is aimed at identifying central themes of bereavement. A qualitative approach was employed in the analyses of interviews with 22 bereaved parents. The analyses yielded four central issues or themes of bereavement, each with its own set of sub-themes or categories, as the narrative demanded. The first of these themes, pertaining to the life of the family before the death of a child had taken place, was named the risk factor. Circumstances leading up to the death, surrounding the death, the cause of death, and the events following the death were coded as bereavement circumstances. The grief reactions codes were divided into categories of emotional, physical, behavioral, relational, spiritual, and cognitive reactions, as described by the participants. Finally, the mourning codes described the mechanisms employed by the participants in their attempts to survive and continue living after the death. These findings can be used in the training of support workers and the development of bereavement interventions.
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Abstract
Two studies examined the motives that lay behind patients' acceptance or reluctance at donating organs after death. They also examined the way these motives were related to demographic characteristics, personality, and signing a donor card. Six separable motives for donation were found: Financial Incentive, Humanistic or Religious Duty, Positive Consideration from Others, Living on Through a Receiver, Gift of Life, and Close Others. Five motives for not donating were found: Preserving the Absolute Integrity of the Corpus, Strict Individualism, Lack of Control over the Use of the Organs, Anonymity of the Procedure, and Respecting Family Wishes. These motives were linked to personality factors in a meaningful way. Willingness to sign was higher among female participants and among participants with lower scores on Integrity of the Corpus and higher scores on Duty and Gift of Life. When Integrity of the Corpus scored highly, however, the effect of the other factors was practically eliminated. In other words, Integrity of the Corpus acted as a protected value: Trying to change people's belief that the integrity of the corpus at death is a sacrosanct issue would come with its own ethical issues.
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Affiliation(s)
- Myriam Guedj
- Department of Psychology, Mirail University, Toulouse, France
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Abstract
Organ transplantation can provide important treatment benefits in a variety of situations. While a number of live donor procedures are now possible, procurement of organs from dead donors remains the mainstay of transplant programmes. However, cadaveric donation rates remain much lower than anticipated, and some patients who receive organs struggle to adapt to their new body. The reasons for this are not entirely explained by rational or logical means. This paper uses concepts drawn from magical thinking to try to explain some of the less apparent issues at play within the process of cadaveric organ transplantation, including both the donation and receiving of organs. Three themes are explored as potentially relevant: superstitions and rituals around death and the dead body, incorporation and the meanings attached to the transplanted organ, and survivor guilt. All three are shown to be relevant for some part of the transplantation process in at least a minority of cases. It is therefore suggested that focusing not only on the logical and scientific, but also on the ambiguous and magical may enhance the organ donation process and thus increase donation rates and the psychological adjustment of transplant recipients.
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Affiliation(s)
- Marina Vamos
- Centre for Brain and Mental Health Research, University of Newcastle, Psychiatry, John Hunter Hospital, New Lambton, NSW 2305, Australia.
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Jacoby L, Jaccard J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of kin. Am J Crit Care 2010; 19:e52-61. [PMID: 20810408 DOI: 10.4037/ajcc2010396] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Families' experiences in the hospital influence their decisions about donating organs of brain-dead relatives. Meeting families' support needs during this traumatic time is an obligation and a challenge for critical care staff. OBJECTIVES (1) To elicit family members' accounts of various types of support received and perceived quality of care for themselves and their loved ones when they made the donation decision, and (2) to examine the relationship between these factors and the families' donation decision. METHODS Retrospective telephone interviews of 199 families from different regions of the country were completed. Aside from demographic data, the survey addressed perceptions of informational, emotional, and instrumental support and quality of care. RESULTS One hundred fifty-four study participants consented to donation; 45 declined. White next of kin were significantly more likely than African Americans to consent. Specific elements of reported support were significantly associated with consent to donate. Donor and nondonor families had differing perceptions of quality care for themselves and their loved ones. Receiving understandable information about organ donation was the strongest predictor of consent. CONCLUSIONS Specific supportive behaviors by staff as recounted by family members of potential donors were significantly associated with consent to donation. These behaviors lend themselves to creative training and educational programs for staff. Such interventions are essential not only for next of kin of brain-dead patients, but also for staff and ultimately for the public as a whole.
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Affiliation(s)
- Liva Jacoby
- Liva Jacoby is an associate professor in the Department of Medical Education and the Alden March Bioethics Institute at Albany Medical College in Albany, New York. Jim Jaccard is a professor in the Department of Psychology at Florida International University in Miami
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Hyde MK, White KM. Student and community perceptions about organ donors, non-donors and transplant recipients. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2009. [DOI: 10.1002/casp.979] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sque M, Long T, Payne S, Allardyce D. Why relatives do not donate organs for transplants: 'sacrifice' or 'gift of life'? J Adv Nurs 2008; 61:134-44. [PMID: 18186905 DOI: 10.1111/j.1365-2648.2007.04491.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM This paper is a report of a study to explore the reasons family members declined organ donation from a deceased relative. BACKGROUND In the United Kingdom family members' consent is usually sought before organ donation from their deceased relative can proceed. Knowledge of the concerns that may influence families' decision-making could be helpful to nurses supporting bereaved family members. METHOD A convenience sample of 26 family members, who declined donation of their deceased relatives' (n = 23) organs, were recruited via three media campaigns in large conurbations and from four intensive care units in the United Kingdom. Data were collected in 2005 using interviews. FINDINGS Donation decisions depended on a number of converging factors in a particular situation and not necessarily on the views of relatives about donation, or the reported wishes of the deceased in life, except if the person had stated that they did not wish to be an organ donor. Therefore, reported pro-donation views held by the family, or the deceased in life, did not guarantee donation. Protecting the dead body, which related to keeping the body whole and intact was the most frequently-recurring theme, being reported in 15 interviews. CONCLUSION Families' wishes to protect the dead body may stimulate tension between the notions of 'gift of life' as supported by transplant policy and 'sacrifice' of the body, which must be made if organ donation is to proceed. This could account for the decision of participants to decline donation even if their deceased relative previously held positive views about organ donation.
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Affiliation(s)
- Magi Sque
- School of Nursing and Midwifery, University of Southampton, UK.
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Morgan M, Mayblin M, Jones R. Ethnicity and registration as a kidney donor: The significance of identity and belonging. Soc Sci Med 2008; 66:147-58. [PMID: 17905501 DOI: 10.1016/j.socscimed.2007.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Indexed: 10/22/2022]
Abstract
Studies of attitudes towards cadaveric organ donation have failed to adequately explain the disproportionately low rates of cadaveric organ donation among ethnic minorities. This may reflect an unhelpfully static and narrow definition of 'culture' entailing a collection of predefined cognitive 'beliefs' and 'attitudes.' This paper takes a more integrative approach and considers how ethnicity shapes perceptions of identity and belonging that underpin organ donation discourse among a section of Black British Caribbean people, one of largest migrant groups in the UK. The study is based on 14 in-depth interviews with men and women of Caribbean descent living in south London. Respondents' accounts identified their Caribbean heritage and racial identity as producing a divided sense of loyalty and belonging accompanied by perceptions of discrimination and exclusion from the mainstream society that may have contributed to their lack of trust in doctors and the medical system in relation to organ donation. Furthermore, despite being supportive of kidney donation, death appeared to take on special significance in reaffirming their ethnic identity. This was reflected in their view of the Caribbean as their ideal place of burial and desire that their body should return whole. The study underlines the need for a fresh approach to the understanding of organ donation based on greater knowledge of the construction and significance of ethnic identity and belonging.
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Affiliation(s)
- Myfanwy Morgan
- King's College London, Division of Health and Social Care Research, Capital House, Weston Street, London SE1 3QD, UK.
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