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Le Dorze M, Barthélémy R, Lesieur O, Audibert G, Azais MA, Carpentier D, Cerf C, Cheisson G, Chouquer R, Degos V, Fresco M, Lambiotte F, Mercier E, Morel J, Muller L, Parmentier-Decrucq E, Prin S, Rouhani A, Roussin F, Venhard JC, Willig M, Vernay C, Chousterman B, Kentish-Barnes N. Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences. BMC Med Ethics 2024; 25:110. [PMID: 39385217 PMCID: PMC11462860 DOI: 10.1186/s12910-024-01093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/23/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD. METHODS In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation. RESULTS Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall. CONCLUSIONS cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses. TRIAL REGISTRATION This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).
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Affiliation(s)
- Matthieu Le Dorze
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France.
- INSERM, CESP, U1018, Université Paris-Saclay, UVSQ, Villejuif, France.
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France
| | - Olivier Lesieur
- Médecine Intensive Réanimation, CH La Rochelle, La Rochelle, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, CHRU, Nancy, France
| | - Marie-Ange Azais
- Médecine Intensive Réanimation, CHD Vendée, La Roche-Sur-Yon, France
| | - Dorothée Carpentier
- Department of Medical Intensive Care, Rouen University Hospital, Rouen, France
| | - Charles Cerf
- Department of Intensive Care, Foch Hospital, Suresnes, France
| | - Gaëlle Cheisson
- Département d'anesthésie Réanimation Chirurgicale - Coordination Des Prélèvements d'organes Et de Tissus - Hôpital de Bicêtre - GHU Paris Saclay - APHP, Kremlin-Bicêtre, France
| | - Renaud Chouquer
- Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France
| | - Vincent Degos
- APHP, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Clinical Research Group ARPE, Sorbonne University, Paris, France
- INSERM UMR 1141, PROTECT, Paris, France
| | - Marion Fresco
- Department of Anesthesia and Critical Care Medicine, Hôpital Laënnec, CHU Nantes, Nantes, France
| | - Fabien Lambiotte
- Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Emmanuelle Mercier
- Médecine Intensive Et Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network, Tours, France
| | - Jérôme Morel
- Département d'anesthésie Et Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Laurent Muller
- Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
- UR UM 103 IMAGINE, Faculty of Medicine, University of Montpellier, Nîmes, France
| | - Erika Parmentier-Decrucq
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, 59037, Lille Cedex, Lille, France
| | - Sébastien Prin
- CHU Dijon-Bourgogne, Service de Médecine Intensive Et Réanimation, Coordination Hospitalière de Prélèvement d'organes Et de Tissus, Dijon, France
| | - Armine Rouhani
- Service d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Nantes, France
| | - France Roussin
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France
| | | | - Mathieu Willig
- Departement of Anesthesiology and Intensive Care Medecine, Dijon University Hospital, Dijon, France
| | - Catherine Vernay
- Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France
| | - Benjamin Chousterman
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France
| | - Nancy Kentish-Barnes
- Famiréa Research Group, Medical Intensive Care Unit, APHP, Hospital Saint-Louis, Paris, France
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Batten JN, O'Meeghan R, Catarino PA, Nurok M, Cotler MP. Changing the Focus in the Donation After Circulatory Death Debates. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:48-49. [PMID: 36681907 DOI: 10.1080/15265161.2022.2159094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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3
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Le Dorze M, Martouzet S, Cassiani-Ingoni E, Roussin F, Mebazaa A, Morin L, Kentish-Barnes N. "A Delicate balance"-Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study. Transpl Int 2022; 35:10648. [PMID: 36148004 PMCID: PMC9485469 DOI: 10.3389/ti.2022.10648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022]
Abstract
Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs. However, healthcare professionals may feel uncomfortable as end-of-life care and organ donation overlap in cDCD, creating a potential barrier to its development. The aim of this qualitative study was to gain insight on the perceptions and experiences of intensive care units (ICU) physicians and nurses regarding cDCD. We used thematic analysis of in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. 17 staff members (8 physicians and 9 nurses) participated in the study. Analysis showed a gap between ethical principles and routine clinical practice, with a delicate balance between end-of-life care and organ donation. This tension arises at three critical moments: during the decision-making process leading to the withdrawal of life-sustaining treatments (LST), during the period between the decision to withdraw LST and its actual implementation, and during the dying and death process. Our findings shed light on the strategies developed by healthcare professionals to solve these ethical tensions and to cope with the emotional ambiguities. cDCD implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.
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Affiliation(s)
- Matthieu Le Dorze
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
- Université Paris-Saclay, UVSQ, INSERM, CESP, U1018, Villejuif, France
| | - Sara Martouzet
- Université de Tours, EA 7505 Éducation, Éthique et Santé, Tours, France
| | - Etienne Cassiani-Ingoni
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
| | - France Roussin
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
| | - Alexandre Mebazaa
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
- Université de Paris, Inserm, UMRS 942 Mascot, Paris, France
| | - Lucas Morin
- INSERM CIC 1431, University Hospital of Besançon, Besançon, France
| | - Nancy Kentish-Barnes
- AP-HP, Saint Louis University Hospital, Famiréa Research Group, Medical Intensive Care Unit, Paris, France
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4
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Washburn L, Galván NTN, Moolchandani P, Price MB, Rath S, Ackah R, Myers KA, Wood RP, Parsons S, Brown RP, Ranova E, Goss M, Rana A, Goss JA. Survey of public attitudes towards imminent death donation in the United States. Am J Transplant 2021; 21:114-122. [PMID: 32633023 DOI: 10.1111/ajt.16175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/25/2023]
Abstract
Imminent death donation (IDD) is described as living organ donation prior to a planned withdrawal of life-sustaining care in an imminently dying patient. Although IDD was ethically justified by United Network for Organ Sharing, the concept remains controversial due to presumed lack of public support. The aim of this study was to evaluate the public's attitudes towards IDD. A cross-sectional survey was conducted of US adults age >18 years (n = 2644). The survey included a case scenario of a patient with a devastating brain injury. Responses were assessed on a 5-point Likert scale. Results showed that 68% - 74% of participants agreed or strongly agreed with IDD when posed as a general question and in relation to the case scenario. Participants were concerned about "recovery after a devastating brain injury" (34%), and that "doctors would not try as hard to save a patient's life" (33%). Only 9% of participants would be less likely to trust the organ donation process. In conclusion, our study demonstrates strong public support for IDD in the case of a patient with a devastating brain injury. Notably, participants were not largely concerned with losing trust in the organ donation process. These results justify policy change towards imminent death donation.
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Affiliation(s)
- Laura Washburn
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | | | - Priyanka Moolchandani
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew B Price
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Smruti Rath
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Ruth Ackah
- Department of Surgery, Ohio State University, Columbus, Ohio, USA
| | | | | | | | | | | | - Matthew Goss
- McGovern Medical School at UT Health, Houston, Texas, USA
| | - Abbas Rana
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
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5
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Degenholtz HB, Creppage K, DaCosta D, Drozd A, Enos M, Himber M, Lazzara K, Razdan M, Resnick A, Shaw Y. The Patients Save Lives Program to Facilitate Organ Donor Designation in Primary Care Offices. Prog Transplant 2019; 29:204-212. [PMID: 31232179 DOI: 10.1177/1526924819853836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are about 120 000 people on the US waiting list for a solid organ transplant; nearly 22 people die every day who could be helped through organ donation. Joining a donor registry and informing one's family of one's preferences increases recovery rates and can avoid misunderstandings during an emotionally difficult time. Although the vast majority of people support organ donation, only about half of adults have joined a state donor registry. Methods. A 3-group design was used. Primary care physician offices were randomly assigned to either web-based training, in-person training, or a control condition. The control condition consisted of a poster and traditional brochure and donor form placed in the waiting room. In the 2 intervention groups, the Patients Save Lives form was distributed during the check-in process in addition to the poster. RESULTS A total of 1521 physicians and office staff at 81 clinic sites (48 in-person and 33 web-based) received the training; there were 33 control locations. A total of 21 189 patients were exposed to the intervention over a 6-month period; 761 (8.1%) of 9428 people who were not already registered completed the designation form to be organ donors. There were no donor designations in the control group locations. CONCLUSION Organ donor designation can be incorporated into the office check-in procedure without disrupting the workflow or burdening clinicians. The program is available online and can be sustained inexpensively with cooperation between primary care offices and regional Organ Procurement Organizations.
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Affiliation(s)
- Howard B Degenholtz
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Kathleen Creppage
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,3 Department of Epidemiology
| | - Damian DaCosta
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Alexandra Drozd
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Misty Enos
- 4 Center for Organ Recovery and Education, Pittsburgh, PA, USA
| | - Meleah Himber
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Kristin Lazzara
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Manik Razdan
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Abby Resnick
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
| | - Yomei Shaw
- 1 University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Health Policy and Management
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6
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Smith Z. Perioperative nurses' experiences of caring for donation after cardiac death organ donors and their family within the operating room. J Perioper Pract 2019; 30:69-78. [PMID: 31081736 DOI: 10.1177/1750458919850729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Worldwide, operating rooms have seen the re-emergence of donation after cardiac death organ donors to increase the number of available organs. There is limited information on the issues perioperative nurses encounter when caring for donor patients after cardiac death who proceed to organ procurement surgery. Objectives The purpose of this paper is to report a subset of findings derived from a larger study highlighting the difficulties experienced by perioperative nurses when encountering donation after cardiac death organ donors and their family within the operating room during organ procurement surgery from an Australian perspective. Methods A qualitative grounded theory method was used to explore perioperative nurses’ (n = 35) experiences of participating in multi-organ procurement surgery. Results This paper reports a subset of findings of the perioperative nurses’ experiences directly related to donation after cardiac death procedures drawn from a larger grounded theory study. Participants revealed four aspects conceptualised as: ‘witnessing the death of the donation after cardiac death donor’; ‘exposure to family’; ‘witnessing family grief’ and ‘stepping into the family’s role by default’. Conclusion Perioperative nurses’ experiences with donation after cardiac death procedures are complex, challenging and demanding. Targeted support, education and training will enhance the perioperative nurses’ capabilities and experiences of caring for the donation after cardiac death donor and their family with the operating room context.
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Affiliation(s)
- Zaneta Smith
- Faculty of Medicine & Health, School of Health, University of New England, Armidale, Australia
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7
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Ismail SY, Kums E, Mahmood SK, Hoitsma AJ, Jansen NE. Increasing Consent and Assent Rate for Organ and Tissue Donation: Communication About Donation-Telephone Advice by Psychologist. Transplant Proc 2018; 50:3017-3024. [PMID: 30577161 DOI: 10.1016/j.transproceed.2018.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022]
Abstract
A high percentage of family refusal is found for several outcomes in the Donor Register. Misconceptions and concerns regarding donation impede next of kin from making a well-considered decision. The donation request is the moment in which such concerns should be addressed by the requestor. The Communication about Donation-Telephone Advice by Psychologist (CaD-TAP) is a direct telephone intervention for requestors who are about to request the relatives for donation. The aim of this intervention is to improve requestors' communication skills regarding the donation request and thereby increase the consent rate for organ and/or tissue donation. The intervention started on the April 1, 2014, and lasted until December 31, 2014. To determine the effects, the consent and assent rates were compared between requestors who received the CaD-TAP intervention and those who did not. The requestors who received the CaD-TAP intervention (N = 141) had a significantly (P < .001) higher consent rate (58%) compared with the group who did not receive the intervention (N = 1563, consent rate: 34%). More tissue donor requestors received the intervention (74%) and most interventions took place outside office hours (82%). No significant difference was found in the effect of the intervention with regard to type of donation, time, or day. Furthermore, the intervention increased requestors' self-confidence in requesting for donation (P < .001), and a higher self-confidence indicated a significant association with increased consent rate. The intervention is unanimously experienced as positive and valuable by users. Based on these results the intervention is effective in increasing the consent rate for organ and tissue donation.
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Affiliation(s)
- S Y Ismail
- Erasmus Medical Center, Psychiatry-Medical Psychology and Psychotherapy, Rotterdam, The Netherlands.
| | - E Kums
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - S K Mahmood
- Erasmus Medical Center, Psychiatry-Medical Psychology and Psychotherapy, Rotterdam, The Netherlands
| | - A J Hoitsma
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - N E Jansen
- Dutch Transplant Foundation, Leiden, The Netherlands
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Barriers and Enablers to Organ Donation After Circulatory Determination of Death: A Qualitative Study Exploring the Beliefs of Frontline Intensive Care Unit Professionals and Organ Donor Coordinators. Transplant Direct 2018; 4:e368. [PMID: 30046658 PMCID: PMC6056272 DOI: 10.1097/txd.0000000000000805] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background A shortage of transplantable organs is a global problem. The purpose of this study was to explore frontline intensive care unit professionals' and organ donor coordinators' perceptions and beliefs around the process of, and the barriers and enablers to, donation after circulatory determination death (DCDD). Methods This qualitative descriptive study used a semistructured interview guide informed by the Theoretical Domains Framework to interview 55 key informants (physicians, nurses, and organ donation coordinators) in intensive care units (hospitals) and organ donation organizations across Canada. Results Interviews were analyzed using a 6-step systematic approach: coding, generation of specific beliefs, identification of themes, aggregation of themes into categories, assignment of barrier or enabler and analysis for shared and unique discipline barriers and enablers. Seven broad categories encompassing 29 themes of barriers (n = 21) and enablers (n = 4) to DCDD use were identified; n = 4 (14%) themes were conflicting, acting as barriers and enablers. Most themes (n = 26) were shared across the 3 key informant groups while n = 3 themes were unique to physicians. The top 3 shared barriers were: (1) DCDD education is needed for healthcare professionals, (2) a standardized and systematic screening process to identify potential DCDD donors is needed, and (3) practice variation across regions with respect to communication about DCDD with families. A limited number of differences were found by region. Conclusions Multiple barriers and enablers to DCDD use were identified. These beliefs identify potential individual, team, organization, and system targets for behavior change interventions to increase DCDD rates which, in turn, should lead to more transplantation, reducing patient morbidity and mortality at a population level.
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9
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Jawoniyi O, Gormley K, McGleenan E, Noble HR. Organ donation and transplantation: Awareness and roles of healthcare professionals-A systematic literature review. J Clin Nurs 2018; 27:e726-e738. [PMID: 29098739 DOI: 10.1111/jocn.14154] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES To examine the role of healthcare professionals in the organ donation and transplantation process. BACKGROUND Globally, there remains a perennial disequilibrium between organ donation and organ transplantation. Several factors account for this disequilibrium; however, as healthcare professionals are not only strategically positioned as the primary intermediaries between organ donors and transplant recipients, but also professionally situated as the implementers of organ donation and transplantation processes, they are often blamed for the global organ shortage. DESIGN Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 checklist. METHODS Databases were searched including CINAHL, MEDLINE, Web of Science and EMBASE using the search terms "organ donation," "healthcare professionals," "awareness" and "roles" to retrieve relevant publications. RESULTS Thirteen publications met the inclusion criteria. The global organ shortage is neither contingent upon unavailability of suitable organs nor exclusively dependent upon healthcare professionals. Instead, the existence of disequilibrium between organ donation and transplantation is necessitated by a web of factors. These include the following: healthcare professionals' attitudes towards, and experience of, the organ donation and transplantation process, underpinned by professional education, specialist clinical area and duration of professional practice; conflicts of interests; ethical dilemmas; altruistic values towards organ donation; and varied organ donation legislations in different legal jurisdictions. CONCLUSION This review maintains that if this web of factors is to be adequately addressed by healthcare systems in different global and legal jurisdictions, there should be sufficient organs voluntarily donated to meet all transplantation needs. RELEVANCE TO CLINICAL PRACTICE There is a suggestion that healthcare professionals partly account for the global shortage in organ donation, but there is a need to examine how healthcare professionals' roles, knowledge, awareness, skills and competencies might impact upon the organ donation and transplantation process.
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Affiliation(s)
| | - Kevin Gormley
- School of Nursing & Midwifery, Queens University Belfast, Belfast, UK
| | - Emma McGleenan
- School of Nursing & Midwifery, Queens University Belfast, Belfast, UK
| | - Helen Rose Noble
- School of Nursing & Midwifery, Queens University Belfast, Belfast, UK
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10
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Pediatric Donation After Circulatory Determination of Death: Canadian Guidelines Define Parameters of Consensus and Uncertainty. Pediatr Crit Care Med 2017; 18:1068-1070. [PMID: 29099447 DOI: 10.1097/pcc.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Smith Z. Duty and dilemma: Perioperative nurses hiding an objection to participate in organ procurement surgery. Nurs Inq 2016; 24. [PMID: 28004463 DOI: 10.1111/nin.12173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/19/2023]
Abstract
Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger doctoral research study exploring the experiences of perioperative nurses participating in multi-organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses' experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience-based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly.
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Affiliation(s)
- Zaneta Smith
- School of Nursing & Midwifery, Curtin University, Perth, WA, Australia
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12
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Mooney JJ, Hedlin H, Mohabir PK, Vazquez R, Nguyen J, Ha R, Chiu P, Patel K, Zamora MR, Weill D, Nicolls MR, Dhillon GS. Lung Quality and Utilization in Controlled Donation After Circulatory Determination of Death Within the United States. Am J Transplant 2016; 16:1207-15. [PMID: 26844673 PMCID: PMC5086429 DOI: 10.1111/ajt.13599] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 01/25/2023]
Abstract
Although controlled donation after circulatory determination of death (cDCDD) could increase the supply of donor lungs within the United States, the yield of lungs from cDCDD donors remains low compared with donation after neurologic determination of death (DNDD). To explore the reason for low lung yield from cDCDD donors, Scientific Registry of Transplant Recipient data were used to assess the impact of donor lung quality on cDCDD lung utilization by fitting a logistic regression model. The relationship between center volume and cDCDD use was assessed, and the distance between center and donor hospital was calculated by cDCDD status. Recipient survival was compared using a multivariable Cox regression model. Lung utilization was 2.1% for cDCDD donors and 21.4% for DNDD donors. Being a cDCDD donor decreased lung donation (adjusted odds ratio 0.101, 95% confidence interval [CI] 0.085-0.120). A minority of centers have performed cDCDD transplant, with higher volume centers generally performing more cDCDD transplants. There was no difference in center-to-donor distance or recipient survival (adjusted hazard ratio 1.03, 95% CI 0.78-1.37) between cDCDD and DNDD transplants. cDCDD lungs are underutilized compared with DNDD lungs after adjusting for lung quality. Increasing transplant center expertise and commitment to cDCDD lung procurement is needed to improve utilization.
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Affiliation(s)
- Joshua J Mooney
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Haley Hedlin
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Paul K Mohabir
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Rodrigo Vazquez
- Department of Medicine, University of New Mexico, Albuquerque, NM
| | | | - Richard Ha
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Kapilkumar Patel
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Martin R. Zamora
- Department of Medicine, University of Colorado Health Sciences Center, Aurora, CO
| | - David Weill
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mark R Nicolls
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Gundeep S Dhillon
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Sandiumenge A, Moreno G, Llauradó M, Masnou N, Oliver E, Ibañez M, Lopez M, Cancio B, Navas E, Miró G, Jurado M, Badia M, Bosque Cebolla MD, Twose J, Pont T, Bodi M. Impact of an on-line educational program on life support treatment limitation (lstl) and potentiality for donation after controlled cardiac death (cdcd) of critically ill patients in 11 hospitals of catalonia. Intensive Care Med Exp 2015. [PMCID: PMC4796668 DOI: 10.1186/2197-425x-3-s1-a652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Camut S, Baumann A, Dubois V, Ducrocq X, Audibert G. Non-therapeutic intensive care for organ donation. Nurs Ethics 2014; 23:191-202. [DOI: 10.1177/0969733014558969] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Purpose: Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. Participants and methods: A single-centre opinion survey of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Results: Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor’s family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient’s care. But more than 75% of respondents think that the advance patient’s consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. Conclusion: The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families’ support. But they ask to require previously expressed patient’s consent and family’s approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy.
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Affiliation(s)
| | - Antoine Baumann
- University Hospital, France; Ethos EA 7299, Université de Lorraine, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
| | - Véronique Dubois
- University Hospital, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
| | - Xavier Ducrocq
- University Hospital, France; Ethos, EA 7299, Université de Lorraine, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
| | - Gérard Audibert
- University Hospital, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
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Squires JE, Grimshaw JM, Taljaard M, Linklater S, Chassé M, Shemie SD, Knoll GA. Design, implementation, and evaluation of a knowledge translation intervention to increase organ donation after cardiocirculatory death in Canada: a study protocol. Implement Sci 2014; 9:80. [PMID: 24950719 PMCID: PMC4082291 DOI: 10.1186/1748-5908-9-80] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/17/2014] [Indexed: 11/18/2022] Open
Abstract
Background A shortage of transplantable organs is a global problem. There are two types of organ donation: living and deceased. Deceased organ donation can occur following neurological determination of death (NDD) or cardiocirculatory death. Donation after cardiocirculatory death (DCD) accounts for the largest increments in deceased organ donation worldwide. Variations in the use of DCD exist, however, within Canada and worldwide. Reasons for these discrepancies are largely unknown. The purpose of this study is to develop, implement, and evaluate a theory-based knowledge translation intervention to provide practical guidance about how to increase the numbers of DCD organ donors without reducing the numbers of standard NDD donors. Methods We will use a mixed method three-step approach. In step one, we will conduct semi-structured interviews, informed by the Theoretical Domains Framework, to identify and describe stakeholders’ beliefs and attitudes about DCD and their perceptions of the multi-level factors that influence DCD. We will identify: determinants of the evidence-practice gap; specific behavioural changes and/or process changes needed to increase DCD; specific group(s) of clinicians or organizations (e.g., provincial donor organizations) in need of behaviour change; and specific targets for interventions. In step two, using the principles of intervention mapping, we will develop a theory-based knowledge translation intervention that encompasses behavior change techniques to overcome the identified barriers and enhance the enablers to DCD. In step three, we will roll out the intervention in hospitals across the 10 Canadian provinces and evaluate its effectiveness using a multiple interrupted time series design. Discussion We will adopt a behavioural approach to define and test novel, theory-based, and ethically-acceptable knowledge translation strategies to increase the numbers of available DCD organ donors in Canada. If successful, this study will ultimately lead to more transplantations, reducing patient morbidity and mortality at a population-level.
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Affiliation(s)
- Janet E Squires
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Room 1282, Box 711, Ottawa, ON K1H 8 L6, Canada.
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Coleman NL, Bonner A. Exploring Australian intensive care physicians clinical judgement during Donation after Cardiac Death: an exploratory qualitative study. Aust Crit Care 2014; 27:172-6. [PMID: 24860964 DOI: 10.1016/j.aucc.2014.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/16/2014] [Accepted: 04/22/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Donation after Cardiac Death (DCD) is one possible solution to the world wide organ shortage. Intensive care physicians are central to DCD becoming successful since they are responsible for making the clinical judgements and decisions associated with DCD. Yet international evidence shows health care professionals have not embraced DCD and are often reluctant to consider it as an option for patients. PURPOSE To explore intensive care physicians' clinical judgements when selecting a suitable DCD candidate. METHODS Using interpretative exploratory methods six intensive care physicians were interviewed from three hospital sites in Australia. Following verbatim transcription, data was subjected to thematic analysis. FINDINGS Three distinct themes emerged. Reducing harm and increasing benefit was a major focus of intensive care physicians during determination of DCD. There was an acceptance of DCD if there was clear evidence that donation was what the patient and family wanted. Characteristics of a defensible decision reflected the characteristics of sequencing, separation and isolation, timing, consensus and collaboration, trust and communication to ensure that judgements were robust and defensible. The final theme revealed the importance of minimising uncertainty and discomfort when predicting length of survival following withdrawal of life-sustaining treatment. CONCLUSION DCD decisions are made within an environment of uncertainty due to the imprecision associated with predicting time of death. Lack of certainty contributed to the cautious and collaborative strategies used by intensive care physicians when dealing with patients, family members and colleagues around end-of-life decisions, initiation of withdrawal of life-sustaining treatment and the discussion about DCD. This study recommends that nationally consistent policies are urgently needed to increase the degree of certainty for intensive care staff concerning the DCD processes.
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Affiliation(s)
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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17
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Abstract
OBJECTIVE To describe parents' experience of organ donation decision making in the case of donation after circulatory determination of death. DESIGN Qualitative exploratory analysis. SETTING Participants were recruited from the ICU of a single children's hospital located in the western United States. PARTICIPANTS Thirteen parents, 11 families who consented to donate their child's organs. INTERVENTIONS Interviews (average 82 min). MEASUREMENTS AND MAIN RESULTS Transcribed interviews were analyzed using the constant comparative method to identify themes that reflected similarities in parents' experiences. The themes we found included 1) factors contributing to parental decision making, 2) under the circumstances of the child dying, and 3) donation decision and its impact on parental grief. Factors that influenced the decision making all related to the child dying, including protecting the child's body and helping the child to die peacefully. Finally, parents made recommendations about the organ donation process, including empathy, attend to end-of-life concerns, and the provision of relevant information for donation decisions. CONCLUSIONS Parents' decision making was related directly to end-of-life experience and grief process. Providers need to orient to parents' end-of-life concerns to support parents' decision-making process and improve donation after circulatory determination of death procedures.
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GOUDET V, ALBOUY-LLATY M, MIGEOT V, PAIN B, DAYHOT-FIZELIER C, PINSARD M, GIL R, BELOUCIF S, ROBERT R. Does uncontrolled cardiac death for organ donation raise ethical questions? An opinion survey. Acta Anaesthesiol Scand 2013; 57:1230-6. [PMID: 24028284 DOI: 10.1111/aas.12179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Organ donation after uncontrolled cardiac death raises complex ethical issues. We conducted a survey in a large hospital staff population, including caregivers and administrators, to determine their ethical viewpoints regarding organ donation after uncontrolled cardiac death. METHODS Multicenter observational survey using a questionnaire, including information on the practical modalities of the procedure. Respondents were asked to answer 15 detailed ethical questions corresponding to different ethical issues raised in the literature. Ethical concerns was defined when respondents expressed ethical concerns in their answers to at least three of nine specifically selected ethical questions. RESULTS One thousand one hundred ninety-six questionnaires were received, and 1057 could be analysed. According to our definition, 573 respondents out of 1057 (54%) had ethical concerns with regard to donation after cardiac death and 484 (46 %) had no ethical concerns. Physicians (55%) and particularly junior intensivists (65%) tended to have more ethical issues than nurses (52%) and hospital managers (37%). Junior intensivists had more ethical issues than senior intensivists (59%), emergency room physicians (46%) and transplant specialists (43%). CONCLUSION Only 46% of hospital-based caregivers and managers appear to accept easily the legitimacy of organ donation after cardiac death. A significant number of respondents especially intensivists, expressed concerns over the dilemma between the interests of the individual and those of society. These results underline the need to better inform both healthcare professionals and the general population to help to the development of such procedure.
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Affiliation(s)
- V. GOUDET
- Medical Intensive Care Department; Poitiers University and Poitiers University Hospital; Poitiers France
| | - M. ALBOUY-LLATY
- Department of Quality; Poitiers University and Poitiers University Hospital; Poitiers France
| | - V. MIGEOT
- Department of Quality; Poitiers University and Poitiers University Hospital; Poitiers France
| | - B. PAIN
- Faculty of Medicine Poitiers; University of Poitiers; Poitiers France
| | - C. DAYHOT-FIZELIER
- Neurosurgical Intensive Care Department; Poitiers University and Poitiers University Hospital; Poitiers France
| | - M. PINSARD
- Organ Donation Coordinating Department; Poitiers University and Poitiers University Hospital; Poitiers France
| | - R. GIL
- Neuropsychological Unit; Poitiers University and Poitiers University Hospital; Poitiers France
| | - S. BELOUCIF
- Department of Anesthesiology and Critical Care Medicine; Paris 13 University and Avicenne University Hospital; Paris France
| | - R. ROBERT
- Medical Intensive Care Department; Poitiers University and Poitiers University Hospital; Poitiers France
- Inserm Unit U927; Poitiers University and Poitiers University Hospital; Poitiers France
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McIntyre J, Pratt C, Pentz RD, Haura EB, Quinn GP. Stakeholder perceptions of thoracic rapid tissue donation: An exploratory study. Soc Sci Med 2013; 99:35-41. [PMID: 24355468 DOI: 10.1016/j.socscimed.2013.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/19/2013] [Accepted: 08/27/2013] [Indexed: 12/01/2022]
Abstract
Rapid autopsy or rapid tissue donation (RTD) is a novel method of tissue procurement in which 'fresh' tissue is collected within 2-6 h following the death of a patient. While the use of RTD offers many opportunities to develop new therapies for lung cancer patients, it raises ethical concerns. The purpose of this study was to examine knowledge, perceptions and ethical concerns about recruiting patients for an RTD program. To achieve research goals, we conducted six focus groups, each containing 5-10 participants (N = 38). Participants were cancer patients (n = 17) their caregivers (n = 6), physicians (n = 6) and clinic staff (n = 9) from the Thoracic Oncology Program at Moffitt Cancer Center, in Tampa, Florida, USA. All focus groups were audio-recorded and conducted using a semi-structured focus group guide. The transcripts were analyzed using hand-coding methods. Data were coded independently by at least two researchers, and an inter-rater reliability rate of ≥90% was achieved. Knowledge about RTD was low among all groups, with physicians having slightly higher knowledge; all groups agreed that RTD offered major benefits to cancer research; physicians and clinic staff were mainly concerned about making a patient feel uncomfortable and reducing hope, while, patients and family members were more concerned about logistics and how the family would be affected during tissue retrieval. All groups agreed the physician was the appropriate person to begin a discussion about RTD and that recruitment should be individualized. All groups reported that physician training is necessary, as well as an awareness campaign for patients and families to be more receptive about RTD. The results of this study suggested more education is needed for all stakeholders to learn about RTD prior to the initiation of a research program. Our approach of querying all stakeholders provides a firm foundation for future training modules regarding RTD programs in lung cancer.
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Affiliation(s)
- Jessica McIntyre
- Cancer Prevention and Control, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Christie Pratt
- Thoracic Oncology Program, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Rebecca D Pentz
- Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Eric B Haura
- Thoracic Oncology Program, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 44, Tampa, FL 33612, USA
| | - Gwendolyn P Quinn
- Cancer Prevention and Control, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 44, Tampa, FL 33612, USA.
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20
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Rodríguez-Arias D, Tortosa JC, Burant CJ, Aubert P, Aulisio MP, Youngner SJ. One or two types of death? Attitudes of health professionals towards brain death and donation after circulatory death in three countries. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:457-67. [PMID: 22139386 DOI: 10.1007/s11019-011-9369-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This study examined health professionals' (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)--controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios--BD, uncontrolled DCD and controlled DCD--were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors' loss of circulatory function could be reversed, and raises questions about "death" as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs' discomfort must be further identified and addressed.
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Affiliation(s)
- D Rodríguez-Arias
- Institute of Philosophy, CCHS, Spanish National Research Council, CSIC, c/Albasanz 26-28, 28037 Madrid, Spain.
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21
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Systematic review of attitudes toward donation after cardiac death among healthcare providers and the general public. Crit Care Med 2013; 41:897-905. [PMID: 23328261 DOI: 10.1097/ccm.0b013e31827585fe] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Organ donation after cardiac death (DCD) is one promising possibility of combating the organ shortage, but it raises ethical issues that differ from those raised in donation after brain death (DBD). Also, DCD may be perceived differently than DBD by medical staff and the public. The aim of this article is to systematically review empirical studies on attitudes of medical personnel and the public toward DCD and to discuss the findings from an ethical perspective. Our study was conducted in accordance with a seven-step approach for systematic reviews of empirical studies in bioethics. DATA SOURCES The authors chose PubMed, EMBASE, CINAHL, PSYCINFO, and PSYNDEX, thus attempting to cover biomedical, sociological and ethical articles on the subject. STUDY SELECTION A search algorithm using controlled vocabulary of the respective databases (where applicable) was created, and criteria for the relevance assessment of the articles were established. Article quality was assessed using the Critical Appraisal Skills Programme tool. DATA EXTRACTION AND SYNTHESIS The authors took an integrative approach to the data, combining it for further analysis. Qualitative data were synthesized by means of thematic analysis, and a spectrum of relevant themes was identified. Then the authors extracted the quantitative data that corresponded with the identified themes. Quantitative data on common subjects were juxtaposed and presented later. CONCLUSIONS Identified themes were the levels of support for DBD vs. DCD, attitudes toward postmortem measures without previous consent, lack of knowledge about DCD, concerns about the Dead Donor Rule, the potential for conflict of interest, making donation happen, and the call for standardized DCD protocols. All of these issues are of ethical relevance and merit further discussion. We conclude that deep-rooted concerns about DCD exist among medical personnel and the general public. These need to be taken seriously in order to maintain or foster trust in the transplantation system.
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22
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Donation after cardiac death: ethical dilemmas and implications for advanced practice nurses. Dimens Crit Care Nurs 2012; 31:228-34. [PMID: 22664877 DOI: 10.1097/dcc.0b013e318256d7dc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Donation after cardiac death has always presented ethical concerns among health care providers. As advanced practice nurses and critical care nurses, it is our responsibility to ensure that health care providers and families are educated about the process and that we remain advocates for the potential donors. This article reviews the donation after cardiac death process, provides a donation after cardiac death hypothetical case report and its outcome, and addresses the ethical concerns associated with donation after cardiac death from both opponents' and proponents' points of view. It will also discuss the benefits of obtaining a palliative care consult and the roles of the advanced practice nurse in the care of the potential donor.
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23
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Reed CC, Gerhardt SD, Shaver K, Koebcke M, Mullins D. Case Study: Family Presence in the OR for Donation After Cardiac Death. AORN J 2012; 96:34-44. [DOI: 10.1016/j.aorn.2012.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 03/29/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
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D'Alessandro AM, Peltier JW, Dahl AJ. A Large-Scale Qualitative Study of the Potential Use of Social Media by University Students to Increase Awareness and Support for Organ Donation. Prog Transplant 2012; 22:183-91. [DOI: 10.7182/pit2012619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective A 2-year study funded by the United States Department of Health and Human Services, Health Resources and Services Administration was conducted to identify a conceptual model of how college students, particularly those in student organizations, can be the social media catalyst for viral communications designed to motivate others to learn about the need of organ donation and become organ donors. This study reports the qualitative findings. Design and Data Collection Methods used included an advisory committee, key informant interviews, and focus groups. A total of 317 individuals participated, including 246 students, 19 student organization advisors, 27 organ transplant experts, 20 university health care professionals, and 5 social media experts. Analytical Methods SPSS Text Smart content analysis software was used to code respondents' verbal comments into various categories. The analysis results in groupings of words that represent the main discussion topics. Results College students understand the need for organ donation and they want to make a difference. The donation community needs to overcome several barriers to motivate college students to become organ donors and donor advocates, including (1) lack of a personal connection with donation, (2) lack of (factual) knowledge about organ donation and how to sign up, (3) common myths and misconceptions, and (4) students have a short-term perspective on life. Conclusion and Implications Our findings suggest that the donation community can motivate college students to register as organ donors and become advocates through outreach efforts that use social media, student organizations, and other college-based media.
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Affiliation(s)
- Anthony M. D'Alessandro
- UW Organ Procurement Organization, Madison, Wisconsin (AMD), University of Wisconsin-Whitewater (JWP, AJD)
| | - James W. Peltier
- UW Organ Procurement Organization, Madison, Wisconsin (AMD), University of Wisconsin-Whitewater (JWP, AJD)
| | - A. J. Dahl
- UW Organ Procurement Organization, Madison, Wisconsin (AMD), University of Wisconsin-Whitewater (JWP, AJD)
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25
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Morrissey PE. The case for kidney donation before end-of-life care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:1-8. [PMID: 22650450 DOI: 10.1080/15265161.2012.671886] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor's death, this approach satisfies the dead donor rule. The donor family's wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.
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Affiliation(s)
- Paul E Morrissey
- Alpert Medical School of Brown University, Providence, RI 02903, USA.
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Affiliation(s)
- Kathy J. Kalkbrenner
- Center for Bioethics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - George E. Hardart
- Center for Bioethics, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Guibet Lafaye C, Puybasset L. Décider la mort et prélever les organes : la question de l’extension des conditions du prélèvement d’organes. ACTA ACUST UNITED AC 2011. [DOI: 10.4000/ethiquepublique.460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Peltier JW, D'Alessandro AM, Hsu M, Schibrowsky JA. A hierarchical communication model of the antecedents of health care professionals' support for donations after cardiac death. Am J Transplant 2011; 11:591-8. [PMID: 21299836 DOI: 10.1111/j.1600-6143.2010.03433.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Using structural equation modeling, the direct and indirect impact of five variables on the support of donation after cardiac death from the perspective of health care professionals were investigated: knowledge, trust in the transplant team, whether patients are in a state of irreversibility, whether health care professionals participate in a patient's death, and perceptions about the brain death versus cardiac death donation process. In total, 10/15 relationships posited in the model had significant pathways. The results provide insight into sequential communication strategies for generating support for donations after cardiac death.
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Affiliation(s)
- J W Peltier
- Department of Marketing, University of Wisconsin-Whitewater, McFarland, WI, USA.
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Morozumi J, Matsuno N, Sakurai E, Nakamura Y, Arai T, Ohta S. Application of an automated cardiopulmonary resuscitation device for kidney transplantation from uncontrolled donation after cardiac death donors in the emergency department. Clin Transplant 2011; 24:620-5. [PMID: 19888995 DOI: 10.1111/j.1399-0012.2009.01140.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vital-organ transplantation has become acceptable as the treatment of choice for end-stage organ failure. If the patient, facing the end of life, wishes to donate organs after cardiac arrest (CA), donation after cardiac death (DCD) is increasingly important for the realization of the patient's desires after CA. In Japan, kidney transplantation from uncontrolled DCD donors, who are identified in modified Maastricht categories II or V, is one of the critical factors in expanding the donor pool. However, according to the forensic code for post-mortems and the requirement of legal consent for transplantation, the time required to meet all procedural requirements has sometimes prohibited organ procurement from uncontrolled DCD donors. We have therefore attempted to use an automated cardiopulmonary resuscitation (CPR) device and maintain arterial pressure for uncontrolled DCD donors during all interim procedures after sudden CA. Comparing kidneys procured from standard DCD donors (n = 10) and uncontrolled DCD donors (n = 4), significant differences were seen in warm ischemic time (WIT), defined as the time from CA to initiation of cooling in situ. However, our early experience showed good tolerance and viability of uncontrolled DCD kidneys. Immediate availability of an automated CPR device might provide a bridge to kidney procurement from uncontrolled DCD donors.
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Affiliation(s)
- Junya Morozumi
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo Japan.
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Bernat JL. Point: Are Donors After Circulatory Death Really Dead, and Does It Matter? Yes and Yes. Chest 2010; 138:13-6. [DOI: 10.1378/chest.10-0649] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bernat JL. How the Distinction between "Irreversible" and "Permanent" Illuminates Circulatory-Respiratory Death Determination. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2010; 35:242-55. [DOI: 10.1093/jmp/jhq018] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols. RESULTS It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of "irreversible" in the Uniform Determination of Death Act; and 3) does not violate the "Dead Donor Rule." CONCLUSIONS The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on "auto-resuscitation," we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.
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Paez G, Valero R, Manyalich M. Training of Health Care Students and Professionals: A Pivotal Element in the Process of Optimal Organ Donation Awareness and Professionalization. Transplant Proc 2009; 41:2025-9. [DOI: 10.1016/j.transproceed.2009.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Navarro AP, Asher J, Sohrabi S, Reddy M, Stamp S, Carter N, Talbot D. Peritoneal cooling may provide improved protection for uncontrolled donors after cardiac death: an exploratory porcine study. Am J Transplant 2009; 9:1317-23. [PMID: 19459821 DOI: 10.1111/j.1600-6143.2009.02633.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Uncontrolled donation after cardiac death (DCD) renal transplantation relies on rapid establishment of organ preservation interventions. We have developed a model of the uncontrolled DCD, comparing current in situ perfusion (ISP) techniques with additional peritoneal cooling (PC). Ten pigs were killed and subjected to a 2 h ischemia period. The ISP group modeled current DCD protocols. The PC group (PC) modeled current protocols plus PC. Two animals were used as controls and subjected to 2 h of warm ischemia. Core renal temperature and microdialysis markers of ischemia were measured. Preservation interventions began at 30 min, with rapid laparotomy and kidney recovery performed at 2 h, prior to machine perfusion viability testing. The final mean renal temperature achieved in the ISP group was 26.3 degrees C versus 16.9 degrees C in the PC group (p = 0.0001). A significant cryopreservation benefit was suggested by lower peak microdialysate lactate and glycerol levels (ISP vs. PC, p = 0.0003 and 0.0008), and the superiority of the PC group viability criteria (p = 0.0147). This pilot study has demonstrated significant temperature, ischemia protection and viability assessment benefits with the use of supplementary PC. The data suggests a need for further research to determine the potential for reductions in the rates of ischemia-related clinical phenomena for uncontrolled DCDs.
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Affiliation(s)
- A P Navarro
- Liver, Renal and Pancreatic Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
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Ogg M. Family member presence in the OR during organ procurement. AORN J 2009; 89:910-2. [DOI: 10.1016/j.aorn.2009.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mary Ogg
- AORN Center for Nursing Practice
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38
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Current world literature. Curr Opin Organ Transplant 2009; 14:211-7. [PMID: 19307967 DOI: 10.1097/mot.0b013e32832ad721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vincent JL, Maetens Y, Vanderwallen C, Van Nuffelen M, Wissing M, Donckier V. Non–Heart-Beating Donors: An Inquiry to ICU Nurses in a Belgian University Hospital. Transplant Proc 2009; 41:579-81. [DOI: 10.1016/j.transproceed.2009.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McDiarmid SV, Cherikh WS, Sweet SC. Preventable death: children on the transplant waiting list. Am J Transplant 2008; 8:2491-5. [PMID: 18976303 DOI: 10.1111/j.1600-6143.2008.02443.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Children, especially those under 5 years of age, have the highest death rate on the transplant waiting list compared to any other age range. This article discusses the concept, supported by OPTN data, that there is an age range of small pediatric donors, which are almost exclusively transplanted into small pediatric transplant candidates. Allocation policies that allow broader sharing of small pediatric donors into small pediatric candidates are likely to decrease death rates of children on the waiting list. As well, although the number of pediatric deceased donors continues to decline, improving consent rates for eligible pediatric donors, and judicious use of pediatric donors after cardiac death, can enhance the pediatric deceased donor supply.
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Affiliation(s)
- S V McDiarmid
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
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Verheijde JL, Rady MY, McGregor JL, Friederich-Murray C. Enforcement of presumed-consent policy and willingness to donate organs as identified in the European Union Survey: the role of legislation in reinforcing ideology in pluralistic societies. Health Policy 2008; 90:26-31. [PMID: 18845356 DOI: 10.1016/j.healthpol.2008.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 08/26/2008] [Accepted: 08/27/2008] [Indexed: 12/13/2022]
Abstract
To increase the supply of transplantable organs, some European Union (EU) countries have begun implementing and enforcing presumed consent policies for organ donation. Mossialos and colleagues performed an analysis of samples of citizens in 15 EU countries and found that legislation, enforcement, and awareness of presumed consent policies for organ donation increase people's willingness to donate their own organs and those of a deceased relative. The authors concluded that, in countries with enforced presumed consent, citizens are willing to donate because they accept organ donation as an ideology. This ideology originates in the thinking that organ donation is an implicit communal contract i.e., a mechanism by which individuals pay back society for the inclusion and social support that they have already experienced and hope to experience in the future. Acceptance of this ideology enhances people's willingness to donate organs and the efficiency in pursuing this collective action, thus, paving the way toward increased paternalism in society. We highlight some potential biases that may have been incorporated in the survey design and in Mossialos et al.'s conclusions, including (1) how the survey questions were constructed, (2) whether sufficient information was communicated about organ procurement practices in heart-beating and non-heart-beating donation before participants responded to the survey, and (3) whether respondents' knowledge about donation legislation can be equated with understanding of processes involved in organ donation. We address the consequences of using legislative authority to enforce the ideology of organ donation, thereby superseding the varying moral values, beliefs, and attitudes about human life and culture that are inherent in multicultural societies.
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End-of-life organ donation for transplantation: Stretching the ethical and legal boundaries of medical practice in society*. Crit Care Med 2008; 36:1364-6. [DOI: 10.1097/ccm.0b013e31816a0b68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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