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

Opening a Donor Management Center

ABSTRACT

In the United States alone, more than 100,000 people are waiting for a lifesaving organ transplant. In response to the growing need for viable organs to transplant, donor management centers have opened to provide care to brain-dead organ donors prior to the organ procurement operation. This article describes donor management center operations, details the opening of one such unit, and describes the results and lessons learned. More research is needed on the impact of nursing care on the specialized organ donor population.

"Untold and unexpected clinical practice stress," nursing students' experience of disgust: A phenomenological approach

BACKGROUND

In the clinical learning environment, nursing students often face situations that cause physical disgust. Previous studies have shown that more than half of the students experienced disgust, and that high disgust sensitivity in students was related to negative results in terms of academic and caring behavior.

OBJECTIVES

This study aims to understand the experience of disgust felt by nursing students in a clinical learning environment.

DESIGN

A qualitative study using phenomenological method.

METHODS

In-depth, one-on-one interviews were conducted with 18 nursing students at a university in South Korea. The data obtained through the interviews were used to explore the essential structure and meaning of disgust using phenomenological analysis.

RESULTS

This study derived four categories, nine theme clusters, and twenty-one themes. The four categories were "fear that stimulates the senses," "untold and unexpected clinical practice stress," "ambivalence towards myself and patients," and "struggling to become a nursing professional."

CONCLUSIONS

Nurse educators must be aware that nursing students may feel disgust in clinical settings and are therefore under stress. They must also assist students so that their concerns caused by emotions that they cannot easily reveal do not affect their nursing careers.

Burnout, mental health symptoms, and empathy in healthcare workers who care for children treated in a liver transplant center

OBJECTIVE

The healthcare workers in pediatric liver transplantation units are exposed to various stresses; however, their burnout has not been clarified yet. This study aimed to determine burnout, psychological symptoms and empathy levels in healthcare workers, to examine the relationship between these variables and to investigate the predictors of burnout.

METHOD

This cross-sectional study was conducted on healthcare workers in Turgut Özal Medical Center Pediatric Liver Transplant Institute. The participants filled out a questionnaire that investigating demographic and occupational characteristics, and including questions from Toronto Empathy Questionnaire, Maslach Burnout Inventory, and Brief Symptom Inventory.

RESULTS

Fifty healthcare workers participated in the study. Based on moderate and higher severity scores, 48% of the participants were emotionally exhausted, 22% of them were depersonalized. All of them had a high perception of personal accomplishment. There was a correlation between psychological symptoms level and emotional exhaustion and personal accomplishment as well as empathy and personal accomplishment. Not choosing the profession and the department willingly, age, education level, marital status, duration of profession, unit, not receiving in-service training, empathy, depressive symptoms and hostility scores predicted different aspects of burnout.

CONCLUSION

Considering that burnout and psychological stress lead to reduced professional abilities and the development of serious complications, the results obtained can guide managers on the measures to be taken.

Worker Experiences of the Work Health and Safety Impacts of Exposure to Dying and Death in Clinical Settings: A Qualitative Scoping Review

Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PURPOSE

International operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia.

DESIGN

The phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences.

METHODS

Semistructured interview data were transcribed verbatim.

FINDINGS

International OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice.

CONCLUSIONS

Recognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.

Lived experiences of international operating room nurses in organ procurement surgery: A phenomenological study

International operating room nurses come from different regions of the world with diverse social and cultural backgrounds, religions, personal beliefs, and education. They are likely to form unique attitudes toward multi-organ procurement that potentially might affect their opinions and clinical practices. The aim of this phenomenological study was to explore the lived experiences of international operating room nurses participating in deceased organ procurement procedures in Australia. Semistructured interviews were conducted with 18 international operating room nurses. van Manen's phenomenological data analysis method was adopted to uncover and interpret meanings from these nurses' descriptions. Four essential themes emerged and evolved to signify the meanings of participants' experiences in organ procurement procedures: the surreality of death, personal and professional challenges, becoming stronger, and personal beliefs and wishes. The present study highlights the importance of cultural awareness in dealing with death, organ procurement, and interprofessional collaboration in the multi-cultural perioperative context. It is essential to provide clinical education and support around culture and practice transition for international operating room nurses to increase and maintain their professional confidence, career satisfaction, health, and well-being during organ procurement surgery.

The impact of multi-organ procurement surgery in the nursing team: An Italian qualitative study

The removal of organs and tissues is characterized by a high level of stress and can be very traumatic for the nursing team. This study was informed by a grounded theory approach and was based on data drawn from two focus groups with 15 nurses. Main themes centered on factors that modulate the level of stress (first experiences, children donors, doubts about death, organizational factors), and coping strategies (including nurses' attitudes toward organ donation and training needs). There is a need to implement training for the stress management of the operating nurses and to provide supportive interventions.

Perioperative nurses' experiences of caring for donation after cardiac death organ donors and their family within the operating room

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.

Dead on the table: A theoretical expansion of the vicarious trauma that operating room clinicians experience when their patients die

The practice of operating room (OR) clinicians - nurses, surgeons, and anesthetists - is fundamentally about preserving life. Some patients, however, die in the OR. Clinicians are therefore vulnerable to moral and emotional trauma. In this paper, we discuss three forces that shape clinicians' moral and emotional experiences in OR care: biomedical values, normative death discourse, and socially (un)sanctioned grief. We suggest how each of these forces increases clinicians' vulnerability to feel traumatized when their patients die. We hope this discussion will stimulate clinicians and researchers to engage with social and cultural determinants of clinicians' experiences when patients die.

Burnout in transplant nurses

Context-Burnout is a response to chronic strain within the workplace and is common across nursing professions. Little has been published about burnout in organ transplant nurses. Objective-To report the prevalence of the 3 main components of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) in organ transplant nurses and to examine factors that contribute to the development of burnout in transplant nurses. Design-Cross-sectional survey of transplant nurses (recruited via listservs) on professional and personal demographics, decisional authority, psychological job demands, supervisor and coworker support, frequency and comfort with difficult patient interactions, and burnout. Participants-369 transplant nurses. Results-About half reported high levels of emotional exhaustion, 15.7% reported high levels of depersonalization, and 51.8% reported low levels of personal accomplishment. Working more hours per week, lower decisional authority, greater psychological job demands, lower perceived supervisor support, and greater frequency and discomfort with difficult patient interactions were significant predictors of emotional exhaustion. Greater frequency and discomfort with difficult patient interactions were significant predictors of depersonalization. Younger age, lower decisional authority, and greater discomfort with difficult patient interactions were predictors of low personal accomplishment. Conclusions-The study provides strong evidence of the presence of burnout in transplant nurses and opportunities for focused and potentially very effective interventions aimed at reducing burnout.

Coping and caring: support resources integral to perioperative nurses during the process of organ procurement surgery

AIMS AND OBJECTIVES

To discuss and explore the levels of support provided to perioperative nurses when participating in multi-organ procurement surgery and the impact to their overall well-being.

BACKGROUND

Assisting within multi-organ procurement surgical procedures has been recognised to impact on the well-being of perioperative nurses leaving little opportunity for them to recover from their participation or to seek available support resources. To date, this area has remained largely unexplored with limited evidence of how nurses manage and cope with these procedures, in addition to the support received in the workplace.

DESIGN

A qualitative grounded theory method.

METHODS

The study was informed by perioperative nurses (n = 35) who had previous participatory experience in these surgical procedures from two Australian states. Theoretical sampling directed the collection of data via semistructured in-depth interviews. Data were analysed using the constant comparative method.

RESULTS

Three components of levels of support were identified from the data: lacking support within the operating room organisation; surgical team support and access to external professional support.

CONCLUSION

These findings offer new insights into how nurses manage and cope with their participation in organ procurement surgical procedures and what types of support resources can be seen as barriers or enablers to their overall experiences. The need for timely and adequate support is vital to their overall well-being and future participation in organ procurement surgery. These findings have the potential to guide further research with implications for clinical initiatives and practices, looking at new ways of supporting perioperative nurses within the clinical environment both locally and internationally.

RELEVANCE TO CLINICAL PRACTICE

Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health and well-being of nurses impacted by these surgical procedures and provide appropriate and timely clinical support within the work environment.

Providing Support to Families considering the Option of Organ Donation: An Innovative Training Method

Families must make decisions about organ donation for a loved one during intensely emotional circumstances in the hospital, where support from others is crucial to their coping. Research about families' experiences during the decision-making process regarding donating their loved ones' organs has shown that quality of hospital care and receiving psychosocial support are important factors influencing their decision. Typically, a donation coordinator from the local organ procurement organization approaches the family about the option of donation, whereas the role of medical and nursing staff is to convey diagnostic and prognostic information to the family. Currently, no requirement is in place for training of professional staff in communication skills for approaching and interacting with families about organ donation. This article discusses a simulated training method in empathic communication used for supporting families who are approached about organ donation. This innovative method can be adapted to and should be tested with professional audiences.

Perioperative nurses' attitudes towards organ procurement: a systematic review

AIMS AND OBJECTIVES

To explore and evaluate perioperative nurses' experience of organ procurement.

BACKGROUND

Organ procurement is part of the organ donation process, and is typically performed in the perioperative setting. This experience may contribute to perioperative nurses' feelings of distress and negative attitudes towards organ donation.

DESIGN

Systematic review of the literature.

METHOD

Primary research studies, published in the English language between 1990-2014 were identified, screened and appraised using Joanna Briggs Institute appraisal tools. Data extraction and analysis followed.

RESULTS

The quality assessment resulted in seven qualitative and three quantitative research studies. The main findings were: (1) Perioperative nurses reported feeling emotionally distressed, challenged, lonely and physically drained throughout the entire organ procurement procedure. (2) Perioperative nurses reported finding their own unique self-coping strategies and ways of eliciting support. (3) Perioperative nurses had positive and negative attitudes towards organ donation.

CONCLUSION

Perioperative nurses reported feelings of sadness, feeling challenged and physically drained through the entire organ procurement procedure, which were influenced by differing factors in the preoperative, intraoperative and postoperative stages. It is acknowledged that personal coping strategies and support are important to help perioperative nurses improve their psychological well-being, and their experiences and attitudes towards organ procurement and donation. The meaningfulness of these findings for practice policy and research is described.

RELEVANCE TO CLINICAL PRACTICE

Perioperative nurses play a vital role in the organ procurement procedure and require ongoing support to ensure their psychological welfare, in particular, newly qualified or inexperienced nurses' participating in organ procurement.

Experiential learning not enough for organ procurement surgery: implications for perioperative nursing education

CONTEXT

Perioperative nurses play a vital role in assisting in surgical procedures for multiorgan procurement, receiving little education apart from on-the-job experiential learning when they are asked to participate in these procedures.

OBJECTIVES

Within an Australian context and as part of a larger study, this article describes issues that hindered perioperative nurses' participatory experiences as a result of lacking education, previous exposure, and preparation for assisting in surgical procedures for organ procurement.

DESIGN

The grounded theory method was used to develop a substantive theory of perioperative nurses' experiences of participating in surgical procedures for multiorgan procurement.

PARTICIPANTS

Thirty-five perioperative nurses who had experience in surgical procedures for organ procurement from regional, rural, and metropolitan hospitals of 2 Australian states, New South Wales and Western Australia, participated in the research.

RESULTS

Levels of knowledge and experience emerged from the data as an influencing condition and was reported to affect the perioperative nurses' participatory experiences when assisting in procurement surgical procedures. Six components of levels of knowledge and experience were identified and are described.

CONCLUSION

The findings from this study provide a unique contribution to the existing literature by providing an in-depth understanding of the educational needs of perioperative nurses in order to assist successfully in multiorgan procurement procedures. These findings could guide further research with implications for clinical initiatives or education programs specifically targeting the perioperative nursing profession both locally and internationally.

Cardio-pulmonary resuscitation of brain-dead organ donors: a literature review and suggestions for practice

"Organ preserving cardiopulmonary resuscitation (OP-CPR)" is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical to provide OP-CPR in a brain-dead organ donor to save organs that would otherwise be lost? To answer this question, we review the literature on brain-dead organ donors, conduct an ethical analysis, and make recommendations. We conclude that OP-CPR can benefit patients and families by fulfilling the wish to donate. However, it is an aggressive procedure that can cause physical damage to patients, and risks psychological harm to families and healthcare professionals. In a brain-dead organ donor, OP-CPR is acceptable without specific informed consent to OP-CPR, although advance discussion with next of kin regarding this possibility is strongly advised. In a patient where brain death is yet to be determined, but there is known wish for organ donation, OP-CPR would only be acceptable with a specific informed consent from the next of kin. When futility of treatment has not been established or it is as yet unknown if the patient wished to be an organ donor then OP-CPR should be prohibited, in order to avoid any conflict of interest.

Australian perioperative nurses' experiences of assisting in multi-organ procurement surgery: a grounded theory study

INTRODUCTION/BACKGROUND

Multi-organ procurement surgical procedures through the generosity of deceased organ donors, have made an enormous impact on extending the lives of recipients. There is a dearth of in-depth knowledge relating to the experiences of perioperative nurses working closely with organ donors undergoing multi-organ procurement surgical procedures.

AIM

The aim of this study was to address this gap by describing the perioperative nurses experiences of participating in multi-organ procurement surgical procedures and interpreting these findings as a substantive theory.

DESIGN

This qualitative study used grounded theory methodology to generate a substantive theory of the experiences of perioperative nurses participating in multi-organ procurement surgery.

SETTING

Recruitment of participants took place after the study was advertised via a professional newsletter and journal. The study was conducted with participants from metropolitan, rural and regional areas of two Australian states; New South Wales and Western Australia.

PARTICIPANTS

Thirty five perioperative nurse participants with three to 39 years of professional nursing experience informed the study.

METHODS

Semi structured in-depth interviews were undertaken from July 2009 to April 2010 with a mean interview time of 60 min. Interview data was transcribed verbatim and analysed using the constant comparative method.

RESULTS

The study results draw attention to the complexities that exist for perioperative nurses when participating in multi-organ procurement surgical procedures reporting a basic social psychological problem articulated as hiding behind a mask and how they resolved this problem by the basic social psychological process of finding meaning.

CONCLUSION

This study provides a greater understanding of how these surgical procedures impact on perioperative nurses by providing a substantive theory of this experience. The findings have the potential to guide further research into this challenging area of nursing practice with implications for clinical initiatives, management practices and education.

Impact of Organ Donation Education on US Undergraduate Nursing Students

Experts advocate educational programs addressing misinformation regarding donation decisions to increase the potential donor pool. However, few researchers have measured outcomes with nursing students. The purpose of this study was to evaluate the impact of an educational intervention on nursing students' knowledge, attitudes, registering as an organ donor, and family discussions. This quasi-experimental study used a pretest-posttest design with a control group. The research group consisted of 42 volunteers and the control group consisted of 73 volunteers. The written survey included 15 true-false knowledge items and 8 Likert items asking about attitude toward donation, registering as an organ donor, and family discussion. Normally distributed data showed no significant differences between groups on the pretest. The research group had no change in knowledge level 3 months later, but the control group had a significantly decreased knowledge level at that point. More members of the research group than the control group registered as organ donors after the intervention (χ2 = 4.5, P = .03). The control group had no change in registering as an organ donor between the pretest and posttest. Family discussions did not differ significantly from pretest to posttest in either group. One lecture/laboratory experience did make a difference in registering as an organ donor but not in discussing the decision with family members. Students can learn about organ donation from more than one specific class. Recommendations for educators and future research are provided.

Intensive Care Staff Attitudes to Deceased Organ Donation

Intensive care staff may harbour mixed emotions toward organ donation after circulatory death. We wished to compare these attitudes to donation after brainstem death, as well as explore attitudes toward Specialist Nurses in Organ Donation, who have been embedded into UK intensive care units since 2008. At the Mid-Trent Critical Care Network (MTCCN) annual conference, participants were asked, in small group workshops, to write down words they associated with donation after brainstem death, controlled donation after circulatory death and Specialist Nurses in Organ Donation. The words were later collated and assigned to have either a positive or negative association by three blinded individuals: a medical lawyer, a hospital communications manager and a final year medical student. One hundred and eight intensive care staff participated: 24 (22%) doctors, 61 (57%) nurses and 23 (21%) allied health professionals; 75 (69%) of the participants were female. Participants at the workshop offered a total of 211 words, 93 associated with donation after brainstem death (44%) and 118 (56%) associated with controlled donation after circulatory death. The numbers of positive and negative words associated with the two forms of donation were significantly different (p<0.001) (donation after brainstem death - 68 positive words, 25 negative words; donation after circulatory death - 29 positive words, 89 negative words). This difference remained significant (p<0.001) even after all words (n=48) that did not have unanimous agreement between the three blinded word assigners were excluded. Significantly more positive words (95) were attributed to the Specialist Nurse in Organ Donation than negative words (18) (p<0.001). We conclude that this group of intensive care staff were generally positive toward donation after brainstem death and the embedded Specialist Nurse in Organ Donation, but could harbour negative attitudes toward controlled donation after circulatory death. Only by continuing to address the opinions of healthcare professionals will donation after circulatory death become a usual and not an unusual event.

The co-existence of life and death for the perioperative nurse

Death and life co-exist in organ procurement surgery; untimely death for one provides hope for continued life for others. Drawing from interactionist theory, the impact of personal and environmental forces and functions specific to organ procurement surgery were examined. Seven nurses (6 women, 1 man aged 34-58 years) were provided with an opportunity to describe their experiences. Three core themes emerged from the qualitative analysis of the interviews: existential issues, coping strategies, and support for each other. Nurses spoke of ways in which they contribute to this challenging work and draw on inner resources.

Honoring Deceased Donors with a Unique Family-Designed Statement Followed by a Moment of Silence: Effect on Donation Outcomes

Context

Studies indicate that donor families and hospital staff, particularly operating room staff, fear that organ donors will not be treated with dignity, honor, and respect.

Objective

The ritual of a unique, family-designed statement of honor followed by a 15-second moment of silence in the operating room before organ recovery was implemented to honor organ donors and their families. The purpose of this study was to describe the development of the ritual and to investigate its impact on donation rates in the California Transplant Donor Network's service area.

Design

Cross-sectional observational study.

Setting

The California Transplant Donor Network, an organ procurement organization.

Participants

58 organ donors and families in 39 donor hospitals.

Main Outcome Measures

Variables of interest included hospital rate of referral and of timely referral to their organ procurement organization, collaborative conversion rates, and donor families' response to implementation of the new ritual.

Results

The ritual was implemented in 2011 in several randomly selected hospitals locally. Seventy-one unique rituals were performed in 22 local hospitals in the trial period. No families or health care providers declined to participate. Families reported that the ritual honored their loved ones. Although the collaborative conversion rates were similar in hospitals before implementation (2010), implementation of the ritual affected donation rates in 2011.

Conclusions

The 15-second moment of silence honors deceased donors and their families and improves donation rates in donor hospitals.

Families' reflections on the process of brain donation following coronial autopsy

This study aims to explore families' reflections on their decision to donate brain tissue to the NSW Tissue Resource Centre (NSW TRC), Australia. Specifically, the study aims to investigate respondents' initial reactions to the request for donation, primary reasons for their decision, and subsequent satisfaction levels. Participants were next-of-kin (NOK) contacted between May 2002 and May 2008, on the day of their relative's autopsy, who agreed to donate brain tissue to the NSW TRC for medical research. All 111 NOK were invited to participate, and those who agreed completed an anonymous questionnaire. Fifty completed questionnaires were received. Results showed that 74% of respondents were not upset by the donation call and 98% were satisfied with their decision to donate. Of the 22% who reported having been upset, many indicated that their distress was partly related to their circumstances. When asked the main reason for their donation, 66% had wanted to help others, or help research, while 24% stated their primary reason as a belief that they were respecting the wishes of their deceased relative. These findings show that NOK are not further distressed by being asked to donate brain tissue, give altruistic reasons for consent and are satisfied with the decision they made. In both this study and previous literature, the importance of discussion about organ donation amongst relatives is a recurring theme. Knowledge about a relative's wishes is likely to help facilitate decision-making, overcoming at least one crucial barrier to lifting rates of organ donation for transplantation and research.

Attitude of Nursing Staff toward Organ Donation in a Spanish Hospital with a Solid-Organ Transplant Program

Context

Nursing personnel are fundamental in the organ donation and transplantation process, and their attitude toward donation has a decisive effect on patients, patients' families, and the general public.

Objective

To analyze the attitudes of nursing personnel toward donation in a transplant hospital and the factors that determine those attitudes.

Materials and Methods

A random sample of 305 nurses in different hospital services was taken and stratified by type of service. A validated psychosocial questionnaire was used to evaluate attitudes toward donation. The survey was completed anonymously and was self-administered. Student t test, χ2 test, and logistic regression analysis were used for statistical analysis.

Results

Most respondents (63%) favored organ donation. The following variables affected attitude: (1) having a favorable attitude toward donation of a family member's organs ( P < .001), (2) knowing the concept of brain death ( P < .001), (3) having discussed organ donation and transplantation within the family ( P = .001), (4) having a favorable attitude toward autopsy ( P = .006), (5) fearing mutilation of the body ( P < .001), (6) a partner's attitude toward organ donation and transplantation ( P < .001), and (7) the respondent's religion ( P = .009). Multivariate analysis yielded the following significant factors: (1) fear of mutilation of the body (odds ratio, 9.5), (2) partner's attitude toward organ donation and transplantation (odds ratio, 0.2), and (3) respondent's religion (odds ratio, 2.7).

Conclusions

Attitudes toward organ donation among nurses are similar to attitudes of the general public in Spain. Given the influence of nurses on the general public, promotional campaigns directed at nurses are a priority.

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

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.

Attitudes of intensive care nurses towards brain death and organ transplantation: instrument development and testing

AIMS

This paper reports the development and testing of an instrument assessing attitudes of Korean intensive care unit nurses.

BACKGROUND

Reluctance by healthcare professionals to identify brain-dead patients as a potential donor is one reason for a shortfall in transplantable organs in all countries. Organ donation from brain-dead patients is a particularly contentious issue in Korea, following recent legal recognition of brain death within the cultural context of Confucian beliefs.

METHOD

A 38-item instrument was developed from the literature and key informant interviews, and validated by an expert panel and a pilot study. A survey was conducted with Korean intensive care unit nurses (n = 520) from October 2003 to January 2004. Principal component analysis with varimax rotation was used to determine construct validity. Item-to-total correlations and Cronbach's coefficient alpha were used to determine the scale's internal consistency and unidimensionality.

RESULTS

The scale demonstrated high internal consistency (alpha = 0.88). Principal component analysis yielded a four-component structure: Discomfort, Enhancing quality of life, Willingness to be a donor and Rewarding experience. Overall, Korean intensive care unit nurses showed positive attitudes towards organ transplantation, despite some mixed feelings.

CONCLUSION

The attitude scale was reliable and valid for this cohort. Areas were identified where professional development may enhance positive attitudes towards organ transplantation from brain-dead donors. Effective education for intensive care unit nurses is necessary to increase the organ donor pool in Korea. Further research could test the instrument with other populations.

Ethics guidelines for research with the recently dead

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