Perspectives toward brain death diagnosis and management of the potential organ donor

Models of Quality Management Systems Applied in Specialized Services for the Donation and Transplantation of Human Organs and Tissues

BACKGROUND

Quality management tools and models are used to improve processes and products, including those related to organ and tissue donation and transplantation protocols. This study aims to map, discuss, and disseminate models/tools of quality management systems applied in health services, specializing in the donation and/or transplantation of human organs and tissues.

METHODS

This is an integrative literature review over the last 10 years, operationalized through searches carried out on the PubMed portal and the databases: SciVerse Scopus (SCOPUS), Scielo, Latin American and Caribbean Literature on Health Sciences (LILACS), Nursing Database (BDENF), and the Virtual Health Library (BVS). The organization of search results in the databases and the election of articles compatible with the guiding question and the inclusion and exclusion criteria for this study took place through the online and free application platform Rayyan.

RESULTS

Six hundred seventy-eight records were found, of which, after careful analysis, 18 articles were considered relevant to the theme. We identified 17 quality management models and/or tools that emphasize using scientifically proven and/or validated techniques to reduce or eliminate the possibility of risks in the processes that permeate the stages of donation and transplantation of organs and tissues.

CONCLUSION

This review brought the possible tools used and published, which can be perceived, reproduced, and improved, through the role of the multidisciplinary team in specialized centers for the donation and transplantation of human organs and tissues, aiming to offer a process of continuous improvement management to deliver better products and services.

Educational Actions to Raise Student Awareness About the Donation and Transplantation of Human Organs and Tissues

BACKGROUND

In Brazil, family refusal to donate organs and tissues is the main reason for not performing transplants, making it necessary to implement different educational strategies in diverse populations on this topic. Thus, this study aimed to raise awareness among school-aged adolescents about the method of organ and tissue donation and transplantation.

METHODS

This is a descriptive experience report with a quantitative and qualitative approach to educational actions in the school environment, mediated by the action research method, carried out with 936 students aged between 14 and 18 years from public schools in the interior of Sao Paulo, Brazil. These actions were developed according to the themes identified and worked on through the culture circle, using active methodologies. Two semistructured questionnaires were applied, pre- and postinterventions. For analysis, sample normality tests and Student's t test were used (P < .0001).

RESULTS

The topics identified were as follows: clarifications on the legislative history of donation and transplants; diagnosis of brain and circulatory death; bioethical aspects of transplants; reflections on mourning, death, and dying; maintenance and notification of the potential donor; types of viable organs and tissues for donation; and the process from collection to transplantation, among others. Comparative analysis showed statistical differences between pre- and postinterventions.

CONCLUSIONS

Educational interventions through active methodologies are presented as tools capable of making students aware of organ and tissue donation and transplantation.

Healthcare Professionals’ Understandings of the Definition and Determination of Death: A Scoping Review

Background.

During the 1950s, advances in critical care, and organ transplantation altered the relationship between organ failure and death. There has since been a shift away from traditional cardiocirculatory based to brain-based criteria of death, with resulting academic controversy, despite the practice being largely accepted worldwide. Our objective is to develop a comprehensive description of the current understandings of healthcare professionals regarding the meaning, definition, and determination of death.

Methods.

Online databases were used to identify papers published from 2003 to 2020. Additional sources were searched for conference proceedings and theses. Two reviewers screened papers using predefined inclusion and exclusion criteria. Complementary searches and review of reference lists complemented the final study selection. A data extraction instrument was developed to iteratively chart the results of the review. A qualitative approach was conducted to thematically analyze the data.

Results.

Seven thousand four hundred twenty-eight references were identified. In total, 75 papers met the inclusion criteria. Fourteen additional papers were added from complementary searches. Most were narratives (35%), quantitative investigations (21%), and reviews (18%). Identified themes included: (1) the historical evolution of brain death (BD), (2) persistent controversies about BD and death determination, (3) wide variability in healthcare professionals’ knowledge and attitudes, (4) critical need for BD determination revision.

Conclusions.

We concluded that although BD is widely accepted, there exists variation in healthcare providers’ understanding of its conceptual basis. Death determination remains a divisive issue among scholars. This review identified a need for increased opportunities for formal training on BD among healthcare providers.

The ethical obligation to provide care to patients diagnosed with brain death until the end stages based on grounded theory

Nurses are faced with tremendous pressure when providing brain-dead patients with care. There is limited guidance for nurses on the care of these patients. The present study aimed to report the experiences of nurses regarding the care of patients diagnosed with brain death.

Semi-structured interviews were conducted with 31 nurses and other stakeholders, and the observations and field notes were analyzed using continuous and comparative analysis based on grounded theory.

The qualitative analysis of the data resulted in extraction of six final categories, including 'facing increased tensions and conflicts', 'organ donation: a distinct care element', 'inconsistency of care management', 'effective care requirements', 'challenges, rights and duty requirements', and 'moral obligation to provide holistic care until the last minute'. Data analysis identified 'Challenges, rights and duty requirements' as the main issue and showed that the nurses managed this issue using the strategy of 'moral obligation to provide holistic care until the last minute' as the core variable.

According to the results, it is recommended that the healthcare system (especially hospital management) take supportive action for nurses in various fields of care of brain-dead patients to resolve educational, moral and legal challenges.

Nursing Diagnosis for Potential Organ Donors: Accuracy Study

The objective was to analyze the diagnostic accuracy of Impaired physiological balance syndrome in potential brain-dead organ donors. It is a study of diagnostic accuracy. Data was retrospectively collected from 145 medical records through the filling out of an instrument containing 25 indicators of the nursing diagnosis (ND). Descriptive and inferential statistics were used. The prevalence of the ND was 77 (53.1%). The indicator with the best measures of accuracy was altered heart rate. Therefore, it has the best predictive capacity for determining the ND. It was identified that the absence of the indicators altered heart rate, hyperglycemia, and altered blood pressure is associated with the absence of the ND, while the presence of the indicators hyperthermia, hypothermia, and altered heart rhythm is associated with the presence of the ND. Accurate indicators will assist in diagnostic inference and the interventions and results will have greater chances of targeting and effectiveness.

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.