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Weng LC, Chiang YJ, Huang HL, Tsai YH, Chen KH, Wang WS, Lin MH. Factors associated with registration for organ donation among clinical nurses. PLoS One 2021; 16:e0247424. [PMID: 33606803 PMCID: PMC7895373 DOI: 10.1371/journal.pone.0247424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Healthcare professionals play an important role in the organ donation process. The aim of this study was to examine the organ donation registration rate and related factors among clinical nurses. MATERIAL AND METHODS In this cross-sectional, correlational study, we used mailed questionnaires to collect data from four geographical areas and three hospital levels in Taiwan from June 6 to August 31, 2018. Two thousand and thirty-three clinical nurses participated in this study. RESULTS Participants' mean age was 34.47 years, and 95.7% were women. Of them, 78.3% were willing to donate their organs and 20.6% had registered for organ donation after death. The results of logistic regression showed that in the personal domain, higher age (odds ratio (OR) = 1.03, p < 0.001), better knowledge of organ donation (OR = 1.09, p < 0.001), and a positive attitude toward organ donation (OR = 2.91, p < 0.001) were positively associated with organ donation registration, while cultural myths (OR = 0.69, p < 0.001) were negatively correlated. In the policy domain, the convenience of the registration procedure (OR = 1.45, p < 0.001) was positively associated with registration. A gap between willingness to donate and actual registration was observed. CONCLUSIONS Personal factors played an important role in organ donation registration. Therefore, efforts to improve knowledge and inculcate positive cultural beliefs about organ donation among clinical nurses are recommended. There is also a need to cooperate with government policies to provide appropriate in-service training and policy incentives and establish an efficient registration process.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of General Surgery, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
- * E-mail:
| | - Yang-Jen Chiang
- Division of Transplant Urology, Department of Surgery, Chang Gung Medical Foundation, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Yu-Hsia Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiovascular Medicine, Chang Gung Medical Foundation, Linkou Medical Center, Taoyuan, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung Medical Foundation, Linkou Medical Center, Taoyuan, Taiwan
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Hsiu Lin
- Division of Transplant Urology, Department of Surgery, Chang Gung Medical Foundation, Linkou Medical Center, Taoyuan, Taiwan
- Department of Nursing, Chang Gung Medical Foundation, Linkou Medical Center, Taoyuan, Taiwan
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Frenette AJ, Williamson D, Weiss MJ, Rochwerg B, Ball I, Brindamour D, Serri K, D'Aragon F, Meade MO, Charbonney E. Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines. Can J Anaesth 2020; 67:1839-1857. [PMID: 32949008 DOI: 10.1007/s12630-020-01815-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The objectives of this study were to systematically identify and describe guidelines for the care of neurologically deceased donors and to evaluate their methodological quality, with the aim of informing and supporting the new Canadian guidelines for the management of organ donors. METHODOLOGY Following a systematic search, we included any document endorsed by an organ donation organization, a professional society, or a government, that aims to direct the medical management of adult, neurologically deceased, multi-organ donors. We extracted recommendations pertaining to six domains: the autonomic storm, hemodynamic instability, hormone supplementation, ventilation, blood product transfusions, and general intensive care unit (ICU) care. Methodological quality of the guidelines was assessed by the validated AGREE-II tool. MAIN FINDINGS This review includes 27 clinical practice guidelines representing 26 countries published between 1993 and 2019. Using the AGREE-II validated tool for the evaluation of guidelines' quality, documents generally scored well on their scope and clarity of presentation. Nevertheless, quality was limited in terms of the scientific rigor of guideline development. Recommendations varied substantially across the domains of managing the autonomic storm, subsequent management of hemodynamic instability, hormone therapy, mechanical ventilation, blood product transfusion, and general ICU care. We found consistent recommendations for low tidal volume ventilation subsequent to the publication of a landmark clinical trial. CONCLUSION Highly inconsistent recommendations for deceased donor care summarized in this review likely reflect the relatively slow emergence of high-quality clinical research in this field, as well as a late uptake of recent validated guideline methodology. Even in this context of few randomized-controlled trials, our group supported the need for new Canadian guidelines for the management of organ donors that follow rigorous recognized methodology and grading of the evidence. TRIAL REGISTRATION PROSPERO (CRD42018084012); registered 25 February 2016.
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Affiliation(s)
- Anne Julie Frenette
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada.
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada.
| | - David Williamson
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Matthew-John Weiss
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec, Université Laval Research Center, Quebec, QC, Canada
- Pediatrics Department, Intensive Care Division, Faculté de Médecine, Université Laval, Quebec, QC, Canada
- Transplant Québec, Montreal, QC, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
| | - Dave Brindamour
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Karim Serri
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | | | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmanuel Charbonney
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
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de Tantillo L, González JM, Ortega J. Organ Donation After Circulatory Death and Before Death: Ethical Questions and Nursing Implications. Policy Polit Nurs Pract 2019; 20:163-173. [PMID: 31407946 DOI: 10.1177/1527154419864717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Scientific advances have enabled thousands of individuals to extend their lives through organ donation. Yet, shortfalls of available organs persist, and individuals in the United States die daily before they receive what might have been lifesaving organs. For years, the legal foundation of organ donation in the United States has been known as the Dead Donor Rule, requiring death to be defined for organ donation purposes by either a cardiac standard (termination of the heartbeat) or a neurological one (cessation of all brain function). In this context, one solution used by an increasing number of health care facilities since 2006 is donation after circulatory death, generally defined as when care is withdrawn from individuals who have known residual brain function. Despite its increased use, donation after circulatory death remains ethically controversial. In addition, some ethicists have advocated forgoing the Dead Donor Rule altogether and allowing donation before or near death in certain circumstances. However, nurses and other health professionals must carefully consider the practical and ethical implications of broadening the Dead Donor Rule-as may be already occurring-or removing it entirely. Such changes could harm both the integrity of the health care system as well as efforts to secure organ donation commitments from the public and are outweighed by the moral and pragmatic cost. Nurses should be prepared to confront the challenge posed by the ongoing scarcity of organs and advocate for ethical alternatives including research on effective care pathways and education regarding organ donation.
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Affiliation(s)
- Lila de Tantillo
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Juan M González
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Johis Ortega
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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Hoste P, Vandewoude K, Delesie L, Vogelaers D. Effectiveness of institutional policies, protocols and order sets on organ donation rates in the Intensive Care Unit. Intensive Crit Care Nurs 2018; 49:79-80. [PMID: 30270000 DOI: 10.1016/j.iccn.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Pieter Hoste
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Intensive Care, General Hospital Sint-Lucas, Ghent, Belgium.
| | - Koenraad Vandewoude
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
| | - Liesbeth Delesie
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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Hoste P, Hoste E, Ferdinande P, Vandewoude K, Vogelaers D, Van Hecke A, Rogiers X, Eeckloo K, Vanhaecht K. Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach. BMC Health Serv Res 2018; 18:580. [PMID: 30041683 PMCID: PMC6056930 DOI: 10.1186/s12913-018-3386-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/12/2018] [Accepted: 07/12/2018] [Indexed: 01/25/2023] Open
Abstract
Background A substantial degree of variability in practices exists amongst donor hospitals regarding the donor detection, determination of brain death, application of donor management techniques or achievement of donor management goals. A possible strategy to standardize the donation process and to optimize outcomes could lie in the implementation of a care pathway. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact. Methods A RAND modified three-round Delphi approach was used to build consensus within a single country about potential key interventions and quality indicators identified in existing guidelines, review articles, process flow diagrams and the results of the Organ Donation European Quality System (ODEQUS) project. Comments and additional key interventions and quality indicators, identified in the first round, were evaluated in the following rounds and a subsequent physical meeting. The study was conducted over a 4-month time period in 2016. Results A multidisciplinary panel of 18 Belgian experts with different relevant backgrounds completed the three Delphi rounds. Out of a total of 80 key interventions assessed throughout the Delphi process, 65 were considered to contribute to the quality of care for the management of a potential donor after brain death; 11 out of 12 quality indicators were validated for relevance and feasibility. Detection of all potential donors after brain death in the intensive care unit and documentation of cause of no donation were rated as the most important quality indicators. Conclusions Using a RAND modified Delphi approach, consensus was reached for a set of 65 key interventions and 11 quality indicators for the management of a potential donor after brain death. This set is considered to be applicable in quality improvement programs for the care of potential donors after brain death, while taking into account each country’s legislation and regulations regarding organ donation and transplantation. Electronic supplementary material The online version of this article (10.1186/s12913-018-3386-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pieter Hoste
- Department of General Internal Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Department of Intensive Care, General Hospital Sint-Lucas, Groenebriel 1, 9000, Ghent, Belgium.
| | - Eric Hoste
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Research Foundation - Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium
| | - Patrick Ferdinande
- Surgical and Transplantation ICU, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Koenraad Vandewoude
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,University Centre for Nursing and Midwifery, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Public Health, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xavier Rogiers
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Transplant Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,European Pathway Association, Kapucijnenvoer 35, 3000, Leuven, Belgium
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