Organ Donation and Elective Ventilation: A Necessary Strategy

Knowledge, Attitude, and Practice of Organ Donation Among the Population of Al-Majma'ah Region, Saudi Arabia

BACKGROUND

Organ donation plays a pivotal role in addressing the global demand for transplantable organs and saving lives. The success of organ transplantation relies not only on medical advancements but also on the willingness of communities to participate in organ donation programs. In Saudi Arabia, specifically within the Al-Majma'ah region, understanding the dynamics of knowledge, attitudes, and practices related to organ donation is crucial for promoting a sustainable and ethical organ donation system.

METHODS

A cross-sectional, retrospective study was utilized in this research, employing data from a sample of 564 participants from the general population of the Al-Majma'ah region, Saudi Arabia. The participants completed a self-administered questionnaire and ensured anonymity.

RESULTS

About 545 (96.6%) respondents were familiar with the concept of organ donation, and 455 (80.7%) participants recognized the necessity for the blood groups of the donor and recipient to match before the transplant process. About 412 (73.0%) participants agreed with the practice of organ donation with 326 (57.8%) expressing support for the practice. About 417 (73.9%) participants reported that their religion permits or endorses organ donation/transplantation. A total of 151 individuals (26.8%) had a low knowledge level, with total scores below 50% (6 or lower). In contrast, 280 people (4.7%) demonstrated a moderate level of knowledge (scoring between 50% and 75%) (7 to 9). Additionally, 133 individuals (23.5%) showcased a high level of knowledge, with scores exceeding 75% (10 or higher). The study established a statistically significant association between age, marital status with p-values < 0.05 (0.001*), and the knowledge score toward organ donation. However, gender and monthly household income were not significantly associated with knowledge score toward organ transplant with p-values (p-value > 0.05).

CONCLUSION

The research findings indicated a moderate level of knowledge and a positive attitude toward organ donation among the general population of the Al-Majma'ah region in Saudi Arabia. Age and marital status were found to be significantly associated with the knowledge score toward organ donation. The study noted the desire and willingness to save lives through organ donation by the residents of the Al-Majma'ah region in Saudi Arabia.

Evaluation of Reasons for Not Giving Donor Consent by Families of Patients With Brain Death: A Retrospective, Mixed-Method Study

OBJECTIVES

The number of patients with organ failure is increasing day by day; today, the numbers of organs and tissues for transplant remain inadequate. This study, which was carried out in a hospital of Sivas Cumhuriyet University in Turkey, aimed to determine reasons for not giving consentfor organ donation after brain death and to clarify the familial causes listed among these reasons.

MATERIALS AND METHODS

This study was a retrospective, mixed-method study. Records of patients diagnosed with brain death and patient relatives who stated that they did not donate organs and who agreed to participate were included in the study.

RESULTS

Of 48 patients diagnosed with brain death, 39 (81.3%) did not donate organs. Reasons for not donating could be grouped under 5 themes: distrust (communication defects, frustration, anger, not meeting expectations), thoughts that the procedure would not provide benefits, fear (not accepting death, not understanding brain death, and experiencing loss), unwillingness to impair body integrity, and phobia of social reactions.

CONCLUSIONS

We found that some patient relatives who were not against and even supported organ donation decided not to donate organs at the last minute. Reasons for not giving donation consent included distrust, anger, and frustration resulting from communication problems with health professionals, making the candidate donor feel valueless, previous bad experiences and prejudgments about the institution, and not providing the appropriate physical conditions related to the comfort ofthe patient relative during the process. It is important to keep in mind that the organ donation process begins with the patient's admission to the hospital; if managed correctly, the process can affect the decision of relatives in a positive way. Identifying and preventing potential obstacles that could affect decisions may increase donation rates. Health professionals with special training on this subject are needed for these situations.

Barriers and Enablers to Joining the National Organ Donation Registry Among Patient Population at a Tertiary Care Hospital of Peshawar, Pakistan

Background Organ transplantation is a life-saving therapy for patients with end-stage organ failure. However, the demand for organs far exceeds their availability, leading to longer waiting times and increased mortality rates. Pakistan faces a similar situation, with a shortage of organ donors and several barriers to therapeutic organ donation, including cultural, religious, and political ones. Objective The objective of this study was to understand the barriers and enablers to joining the national organ donation registry among patient populations at a tertiary care hospital in Peshawar, Pakistan. The findings can then guide targeted educational campaigns to improve the state of therapeutic organ transplants in the country. Methods A descriptive, cross-sectional study was conducted at the Outpatient Departments of Lady Reading Hospital, Peshawar, targeting all patients and visitors aged 18 to 60 who presented to the outpatient departments of the hospital. A modified and validated questionnaire was used to collect data, which were analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: The study analyzed the attitudes of 342 individuals, among which 82.18% had not heard about Pakistan's Organ Donation Registry, 58.09% agreed with organ donation, and 23.68% suggested they would like to join the registry someday. Religious beliefs and the lack of knowledge about the laws related to organ donation stood out as statistically significant barriers to joining the national organ donation registry of Pakistan (p<0.05). The study also found that the willingness to donate was significantly higher among those who themselves encouraged organ donation and were willing to do so if the country's system were to support it (p<0.05). Conclusion The majority of participants had not heard of the organ donation registry, and a lack of knowledge about the legal framework and religious beliefs were significant barriers to joining the registry. This is hindering the growth of therapeutic organ transplantation in Pakistan. In addition, the willingness to donate was higher among those who supported organ donation and believed in its benefits. Increasing awareness and promoting a culture of organ donation in Pakistan can help address the shortage of organ donors and improve the state of therapeutic organ transplantation in the country.

Ethical considerations in the use of pre-mortem interventions to support deceased organ donation: A scoping review

AIM

Pre-mortem interventions (PMIs) are performed on patients before the determination of death in order to preserve or enhance the possibility of organ donation. These interventions can be ethically controversial, and we thus undertook a scoping review of the ethical issues surrounding diverse PMIs.

METHODS

Using modified scoping review methods, we executed a search strategy created by an information specialist. Screening and iterative coding of each article was done by two researchers using qualitative thematic analysis, and narrative summaries of coded themes were presented.

RESULTS

We identified and screened 5365 references and coded 196 peer-reviewed publications. The most frequently cited issues were related to possible harms to the patient who is a potential donor, and legitimacy of consent. The most controversial issue was that PMIs may place patients at risk for physical harm, yet benefit is accrued mainly to recipients. Some authors argued that lack of direct medical benefit to the still living patient precluded valid consent from surrogate decision makers (SDMs), while many stated that some medical risk could be approved by SDMs if it aligns with non-medical benefits valued by the patient.

CONCLUSION

PMIs require consensus that benefit includes concepts beyond medical benefit to the patient who is a potential donor. Informed consent must be confirmed for each PMI and not assumed to be part of general consent for donation. Risk must be proportionate to the potential benefit and newly proposed interventions should be reviewed carefully for medical efficacy and potential risks.

[Ethics of resuscitation and end of life decisions]

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.

European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.

Specific Needs of Medical Students for Organ Donation Courses: A Qualitative Study in China

BACKGROUND

Global promotion of organ transplantation is contingent upon continuous improvement of the donation rate. Organ donation education is an important measure for changing public awareness and promoting organ donation. Therefore, it is important and urgent to conduct a systematic study of the organ donation courses offered in China and around the world. The aim of this study was to learn the views and needs of Chinese medical students and provide a reference for international peers.

METHODS

Semistructured, in-depth interviews and purposive sampling were used in this study. A total of 18 university students majoring in medicine and nursing were selected according to the principle of data saturation and interviewed. The data were sorted and analyzed with phenomenology.

RESULTS

These interviewees generally agreed that an organ donation course should be offered. They were in urgent need of knowledge regarding organ donation procedures and relevant policies and eager for a practical and experience-based teaching method design. The Chinese medical students surveyed also believed that the course should also be available to clinical practitioners, nonmedical students, and the public.

CONCLUSION

Medical students' demand for an organ donation course should be considered. To fully stimulate their interest in learning and to provide support and a guarantee for continuous improvement of transplant operations promotion and donation rate worldwide, specific organ donation courses and flexible training should be created.

[Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations]

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.

Deceased organ donation potential in Canada: a review of consecutive deaths in Alberta

BACKGROUND

Transplantation is the most effective treatment for many patients with end-stage organ failure. There is a gap between the number of patients who would benefit from transplantation and availability of organs. We assessed maximum potential for deceased donation in Alberta and barriers to increasing the donation rate.

METHODS

All deaths that occurred in Alberta in 2015 in areas where mechanical ventilation could be provided were retrospectively identified using administrative data. Medical records were reviewed by donation coordinators and critical care physicians with expertise in donation, using a standardized tool to determine whether deceased patients could potentially have been organ donors.

RESULTS

There were 2,706 deaths occurring in either an intensive care unit or emergency department, of which 1,252 were attributable to a non-neurologic cause: 946 involved cardiac arrests with unsuccessful resuscitation, and 57 were not mechanically ventilated. Of the remaining 451 deaths, 117 (28 donors per million population [dpmp]) either were, or could potentially have been, organ donors after neurologic determination of death (NDD). Of these, 19 (4.5 dpmp) were not appropriately identified or referred, and 45 approached families (10.8 dpmp) did not provide consent. Non-identified NDD cases accounted for a larger proportion of deaths due to neurologic causes in emergency departments (18%) than in intensive care units (2%) (P < 0.0001) and in rural (9%) compared with urban centres (3%) (P = 0.05). If routinely available, donation after circulatory death (DCD) could potentially have been possible in as many as 113 (27 dpmp) cases.

CONCLUSIONS

Maximum deceased organ donation potential in Alberta is approximately 55 dpmp. The current donation rate has potential to increase with more widespread availability of DCD and a higher consent rate.

[Critical care management of the potential organ donor : Current recommendation for adults]

The shortage of donor organs has not improved in recent years. To increase the number and success of transplantation it is crucial to optimize the processes of early identification of potential organ donors and structured critical care management. The therapy starts long before brain death is diagnosed. Structured in-house organ donor management protocols ensure a highly qualified critical care that has a direct impact on the transplantation outcome. The therapy is based on the established standards. The main focus is on differentiated catecholamine and volume therapy. Vasopressin, in combination with norepinephrine, is effective for both treating vasoplegia and electrolyte disturbances. Despite poor evidence, steroids are useful for stabilizing hemodynamics and treating the consequences of neuroendocrine dysfunction. Overall, prospective studies are required to give general recommendations for critical care.

[Therapy escalation for the potential organ donor : Are all intensive care measures also ethically justifiable?]

The gap between the number of organs needed and the number available has dramatically increased in Germany in the last decade-for intensivists and transplantation specialists, it is challenging to cover the demand responsibly. It is therefore increasingly important to identify potential organ donors in order to realize organ donation. An escalation of intensive care measures is often required, which raises critical ethical questions. In Germany, organ donation is only allowed after brain death with prior informed consent from the deceased or his/her relatives. Determining the willingness of the potential organ donor and adapting the subsequent intensive care to it requires experience and empathy. Therapy escalation for the realization of organ donation is not opposed to the basic ethical principles of medicine, but remains an individual decision. A time limitation of this last intensive therapy phase to achieve optimal conditions for transplantation should be discussed with the relatives and adapted to the medical requirements. This article would like to highlight ethical questions that are relevant in the context of therapy escalation of potential organ donors and, thus, support the decision-making process.