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Choi W. The conceptual injustice of the brain death standard. THEORETICAL MEDICINE AND BIOETHICS 2024; 45:261-276. [PMID: 38714610 DOI: 10.1007/s11017-024-09663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/10/2024]
Abstract
Family disputes over the diagnosis of brain death have caused much controversy in the bioethics literature over the conceptual validity of the brain death standard. Given the tenuous status of brain death as death, it is pragmatically fruitful to reframe intractable debates about the metaphysical nature of brain death as metalinguistic disputes about its conceptual deployment. This new framework leaves the metaphysical debate open and brings into focus the social functions that are served by deploying the concept of brain death. In doing so, it highlights the epistemic injustice of medicolegal authorities that force people to uniformly accept brain death as a diagnosis of death based on normative considerations of institutional interests, such as saving hospital resources and organ supplies, rather than empirical evidence of brain death as death, which is insufficient at best and nonexistent at worst. In light of this injustice, I propose the rejection of the uniform standard of brain death in favor of a choice-based system that respects families' individualized views of death.
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Affiliation(s)
- William Choi
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Omelianchuk A, Capron AM, Ross LF, Derse AR, Bernat JL, Magnus D. Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion. Hastings Cent Rep 2024; 54:14-23. [PMID: 38768312 DOI: 10.1002/hast.1584] [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] [Indexed: 05/22/2024]
Abstract
In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's-more and higher-quality organs and more efficient allocation-can be achieved by removing organs from deceased donors and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call "ethical parsimony," which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy-makers should favor NMP over NRP.
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Chen X, Zhou X, Xu Y, Pan L, Li P, Liang W, Jin L, Zhang C, He C. Mediating effects of attitude on the relationship between knowledge and willingness to organ donation among nursing students. Front Public Health 2024; 12:1370635. [PMID: 38655518 PMCID: PMC11035869 DOI: 10.3389/fpubh.2024.1370635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background The current rate of organ donation in China falls significantly below the global average and the actual demand. Nursing students play a crucial role in supporting and promoting social and public welfare activities. This study primary aims to analyze the levels of knowledge, attitudes, willingness toward organ donation, and attitudes toward death among nursing students, and investigate the mediating role of attitude in the relationship between knowledge and willingness. The secondary aims to identify factors that may influence the willingness. Methods A convenience sample of nursing students completed online-administered questionnaires measuring the level of knowledge, attitudes, and willingness toward organ donation before and after clinical internship. Spearman correlation and mediation analyses were used for data analyses. Results Before the clinical internship, there were 435 nursing students who had not yet obtained their degrees and were completing their clinical internships. After the internship, this number decreased to 323. The mean score for knowledge before and after the clinical internship (7.17 before and 7.22 after, with no significant difference), the attitude (4.58 before and 4.36 after, with significant difference), the willingness (12.41% before and 8.67% after, with significant difference), the Death Attitude Profile-Revised (DAP-R) score (94.41 before and 92.56 after, with significant difference). The knowledge indirectly affected nursing students' willingness to organ donation through attitude. Knowledge had a direct and positive impact on attitudes (β = 1.564). Additionally, nursing students' attitudes positively affected their willingness (β = 0.023). Attitudes played a mediating role in the relationship between knowledge and willingness (β = 0.035). Additionally, attitude toward death, fear of death, and acceptance of the concept of escape were found to be correlated with their willingness. Conclusion Organ donation willingness was found to be low among nursing students. Positive attitudes were identified as a mediating factor between knowledge and willingness. Additionally, DAP-R was a related factor. Therefore, it is recommended to focus on improving knowledge and attitude, as well as providing death education to help nursing students establish a positive attitude toward death. These efforts can contribute to the promotion of organ donation.
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Affiliation(s)
- Xiaohang Chen
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
| | - Xin Zhou
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
| | - Yan Xu
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
| | - Li Pan
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
| | - Peizheng Li
- Department of Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Wenjin Liang
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
| | - Lv Jin
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
| | - Chunhua Zhang
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chongxiang He
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Wuhan, China
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Shrivastav V, Murugan Y, Gandhi R, Nagda J. Knowledge, Attitudes, and Practices Regarding Organ Donation Among Medical Students in India: A Mixed Methods Study. Cureus 2024; 16:e56136. [PMID: 38618406 PMCID: PMC11015158 DOI: 10.7759/cureus.56136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Deceased organ donation rates are extremely low in India. As future physicians, medical students can advocate organ donation in society. However, their knowledge, attitudes, and practices regarding organ donation remain understudied in India. Therefore, the present study aimed to assess the knowledge, attitudes, and practices related to deceased organ donation among undergraduate medical students in India using a mixed methods approach. MATERIALS AND METHODS This is a mixed-method study with a cross-sectional survey conducted among 400 randomly selected medical students at a medical college in India using a pretested questionnaire. Additionally, 20 in-depth interviews were conducted to gain qualitative insights. RESULTS Knowledge was high regarding organ donation (90%) but lower for brain death (27.5%). Most had positive attitudes, but only 11% were registered donors, and 10% had discussed organ donation with family. Multivariate regression revealed that having third- and fourth-year-old students, urban upbringing, good knowledge, and positive attitudes were associated with increased willingness to donate. Qualitative findings revealed gaps in brain death understanding, religious myths, lack of conviction, and family disapproval as barriers. CONCLUSION Despite good awareness, gaps in the comprehension of brain death persist among students. However, the registration and family discussion rates are very low. Targeted strategies such as integrating ethical issues into medical curricula, public awareness campaigns busting myths, simplifying donor registration, and promoting family conversations are strongly recommended. This can empower students to become physician advocates driving organ donation uptake in India.
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Affiliation(s)
| | - Yogesh Murugan
- Family Medicine, Guru Gobindsingh Government Hospital, Jamnagar, IND
| | - Rohankumar Gandhi
- Community Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Jay Nagda
- Internal Medicine, Narendra Modi Medical College, Ahmedabad, IND
- Community Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
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Febrero B, Almela-Baeza J, Ros-Madrid I, Iniesta M, Martínez-Alarcón L, Ramírez P. Attitude of the Older Population Toward Controlled Asystole Donation. Transplant Proc 2023; 55:2250-2252. [PMID: 37775403 DOI: 10.1016/j.transproceed.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Studies about the knowledge of and attitude toward new lines of organ donation in a group of older people are important due to the increase in older organ donors. OBJECTIVES To analyze the attitude of citizens over 65 years of age in southeastern Spain toward controlled asystole donation (CAD) and to determine the psycho-social profile that influences this attitude. METHODS The study population consisted of citizens over 65 years of age. A representative sample was obtained in southeastern Spain (N = 420). A questionnaire about attitudes toward CAD was used, detailing in the questionnaire that this is a type of donation from people who have died of circulatory and respiratory criteria after the limitation of life support treatment. Several psychosocial variables were also taken into account. Statistical analysis included the χ2 test and multivariate analysis. RESULTS The completion rate was 84% (n = 351). Favorable attitude toward organ donation and transplantation (ODT) was 98% (n = 344) overall, and CAD was viewed favorably by 45% (n = 158). The psychosocial variables that influenced attitude toward CAD were mainly having received a talk about ODT (odds ratio [OR] 5.6), knowing the opinion of one's partner (OR 7.95), acceptance of cremation (OR 1.09), and acceptance of autopsy (OR 3.002). CONCLUSIONS The attitude of older people toward CAD is unfavorable despite a willingness to support ODT in general. This attitude is influenced by variables of social and family dialogue about ODT, attitude to body manipulation, and having received information about ODT.
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Affiliation(s)
- Beatriz Febrero
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Javier Almela-Baeza
- Faculty of Communication and Documentation, University of Murcia, Murcia, Spain.
| | | | - María Iniesta
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Laura Martínez-Alarcón
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
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Sarti AJ, Honarmand K, Sutherland S, Hornby L, Wilson LC, Priestap F, Carignan R, Joanne B, Brewster H, Elliott-Pohl K, Weiss M, Shemie SD. When is a person dead? The Canadian public's understanding of death and death determination: a nationwide survey. Can J Anaesth 2023; 70:617-627. [PMID: 37131025 PMCID: PMC10202975 DOI: 10.1007/s12630-023-02409-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE We aimed to describe the Canadian public's understanding and perception of how death is determined in Canada, their level of interest in learning about death and death determination, and their preferred strategies for informing the public. METHODS We conducted a nationwide cross-sectional survey of a representative sample of the Canadian public. The survey presented two scenarios of a man who met current criteria for neurologic death determination (scenario 1) and a man who met current criteria for circulatory death determination (scenario 2). Survey questions evaluated understanding of how death is determined, acceptance of death determination by neurologic and circulatory criteria, and interest and preferred strategies in learning more about the topic. RESULTS Among 2,000 respondents (50.8% women; n = 1,015), nearly 67.2% believed that the man in scenario 1 was dead (n = 1,344) and 81.2% (n = 1,623) believed that the man in scenario 2 was dead. Respondents who believed that the man was not dead or were unsure endorsed several factors that may increase their agreement with the determination of death, including requiring more information about how death was determined, seeing the results of brain imaging/tests, and a third doctor's opinion. Predictors of disbelief that the man in scenario 1 is dead were younger age, being uncomfortable with the topic of death, and subscribing to a religion. Predictors of disbelief that the man in scenario 2 is dead were younger age, residing in Quebec (compared with Ontario), having a high school education, and subscribing to a religion. Most respondents (63.3%) indicated interest in learning more about death and death determination. Most respondents preferred to receive information about death and death determination from their health care professional (50.9%) and written information provided by their health care professional (42.7%). CONCLUSION Among the Canadian public, the understanding of neurologic and circulatory death determination is variable. More uncertainty exists with death determination by neurologic criteria than with circulatory criteria. Nevertheless, there is a high level of general interest in learning more about how death is determined in Canada. These findings provide important opportunities for further public engagement.
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Affiliation(s)
- Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Stephanie Sutherland
- Department of Critical Care, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | | | | | | | - Robert Carignan
- Canadian Medical Association Patient Voice, Ponteix, SK, Canada
| | - Brennan Joanne
- Vascular Research, The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Sam D Shemie
- Division of Critical Care, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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Murphy NB, Hartwick M, Wilson LC, Simpson C, Shemie SD, Torrance S, Chandler JA. Rationale for revisions to the definition of death and criteria for its determination in Canada. Can J Anaesth 2023; 70:558-569. [PMID: 37131021 PMCID: PMC10203013 DOI: 10.1007/s12630-023-02407-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 05/04/2023] Open
Abstract
Clarity regarding the biomedical definition of death and the criteria for its determination is critical to inform practices in clinical care, medical research, law, and organ donation. While best practices for death determination by neurologic criteria and circulatory criteria were previously outlined in Canadian medical guidelines, several issues have arisen to force their reappraisal. Ongoing scientific discovery, corresponding changes in medical practice, and legal and ethical challenges compel a comprehensive update. Accordingly, the A Brain-Based Definition of Death and Criteria for its Determination After Arrest of Neurologic or Circulatory Function in Canada project was undertaken to a develop a unified brain-based definition of death, and to establish criteria for its determination after devastating brain injury and/or circulatory arrest. Specifically, the project had three objectives: (1) to clarify that death is defined in terms of brain functions; (2) to clarify how a brain-based definition of death is articulated; and (3) to clarify the criteria for determining if the brain-based definition is met. The updated death determination guideline therefore defines death as the permanent cessation of brain function and describes corresponding circulatory and neurologic criteria to ascertain the permanent cessation of brain function. This article explores the challenges that prompted revisions to the biomedical definition of death and the criteria for its determination and outlines the rationales underpinning the project's three objectives. By clarifying that all death is defined in terms of brain function, the project seeks to align guidelines with contemporary medicolegal understandings of the biological basis of death.
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Affiliation(s)
- Nicholas B Murphy
- Department of Medicine, Western University, 1151 Richmond St., London, ON, N6A 3K7, Canada
- Department of Philosophy, Western University, London, Canada
| | - Michael Hartwick
- Divisions of Critical Care and Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Trillium Gift of Life, Ottawa, ON, Canada
| | | | - Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada
- Canadian Blood Services, Halifax, NS, Canada
| | - Sam D Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- MUHC Research Institute, Montreal, QC, Canada
- Canadian Blood Services, Montreal, QC, Canada
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Jenkin RA, Garrett SA, Keay KA. Altruism in death: Attitudes to body and organ donation in Australian students. ANATOMICAL SCIENCES EDUCATION 2023; 16:27-46. [PMID: 35344291 PMCID: PMC10084255 DOI: 10.1002/ase.2180] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 05/25/2023]
Abstract
Health education, research, and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for a next-of-kin agreement to donation, irrespective of the deceased's pre-death consent. Research suggests health workers are less likely to support the donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self-body donation (26.5%) was much lower than support for self-organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over 4% would not support the election of a family member to donate their organs, with one-to-two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family, or the public, and registration as an organ donor. Exposure decreased participants' willingness to donate their own body, with those who practiced a religion least likely to support body donation. Gross anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with a recognition that religious or cultural beliefs may affect willingness to donate.
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Affiliation(s)
- Rebekah A. Jenkin
- Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Samuel A. Garrett
- Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- University of SydneyCamperdownNew South WalesAustralia
| | - Kevin A. Keay
- Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
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Leśniewski K, Antoszewska B, Baczewska B. Attitudes of Polish Doctors towards Brain Death. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13729. [PMID: 36360608 PMCID: PMC9658485 DOI: 10.3390/ijerph192113729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Brain death has been one of the most controversial issues in the medical and bioethical debate globally for more than fifty years. There is no unanimous acceptance of the understanding of brain death, and a single set of neurological criteria for the determination of human death that is accepted worldwide has yet to be established. Physicians from different specialisations understand brain death differently. Therefore, research is needed to understand and typologically classify their points of views as regards brain death. In Poland, this research is particularly important, as the views of anaesthesiologists, neurologists and transplantologists, who fully accept and support brain death as being synonymous with biological human death, have dominated the scholarly debate on this issue. This study presents the opinions of Polish physicians with various medical specialisations in relation to brain death. Free-form interviews with 28 doctors were conducted. Participants expressed their personal views on brain death, while exhibiting at the same time various emotions. We discuss our findings in relation to the existing framework of knowledge and debate concerning brain death and the Polish legal regulation in force when the interviews were carried out. Although participants had different beliefs with regard to brain death, the research team managed to classify their statements and opinions into five attitudes, taking into account what for them were the most important, namely: the escapist-protective attitude, the scientistic-medical attitude, the accepting-critical attitude, the ignorant-agnostic attitude, and the ambiguous attitude.
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Affiliation(s)
- Krzysztof Leśniewski
- Department of Orthodox Theology, Faculty of Theology, The John Paul II Catholic University of Lublin, Al. Racławickie 14, 20-950 Lublin, Poland
| | - Beata Antoszewska
- Department of Special Needs Pedagogy and Resocialisation, Faculty of Social Sciences, The University of Warmia and Mazury in Olsztyn, Żołnierska 14, 10-561 Olsztyn, Poland
| | - Bożena Baczewska
- Department of Internal Medicine and Internal Medicine in Nursing, Faculty of Health Sciences, Medical University of Lublin, Chodźki 7, 20-093 Lublin, Poland
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Qian L, Li MT, King KL, Husain SA, Cohen DJ, Mohan S. Healthcare students support opt-out organ donation for practical and moral reasons. JOURNAL OF MEDICAL ETHICS 2022; 48:522-529. [PMID: 34103365 PMCID: PMC8651801 DOI: 10.1136/medethics-2020-107053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/22/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Changes to deceased organ donation policy in the USA, including opt-out and priority systems, have been proposed to increase registration and donation rates. To study attitudes towards such policies, we surveyed healthcare students to assess support for opt-out and priority systems and reasons for support or opposition. METHODS We investigated associations with supporting opt-out, including organ donation knowledge, altruism, trust in the healthcare system, prioritising autonomy and participants' evaluation of the moral severity of incorrectly assuming consent in opt-in systems ('opt-in error') or opt-out systems ('opt-out error'), by conducting an online survey among healthcare students at a large academic institution. RESULTS Of 523 respondents, 86% supported opt-out, including 53% who strongly supported the policy. The most popular reason for supporting opt-out was the potential for increased donation rates, followed by convenience for those not registered but willing to donate. The most popular reason for opposing opt-out was the belief that presuming consent is morally wrong. Those strongly supporting opt-out viewed the opt-in error as more morally unacceptable, and had higher knowledge and altruism scores. Those opposing opt-out viewed the opt-out error as more unacceptable, and had higher autonomy scores. 48% of respondents supported priority within opt-in systems; 31% supported priority in opt-out. CONCLUSIONS There is strong support for opt-out organ donation among healthcare students, influenced by both practical and moral considerations.
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Affiliation(s)
- Long Qian
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Miah T Li
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Kristen L King
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Syed Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - David J Cohen
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Zheng K, Sutherland S, Hornby L, Shemie SD, Wilson L, Sarti AJ. Public Understandings of the Definition and Determination of Death: A Scoping Review. Transplant Direct 2022; 8:e1300. [PMID: 35415218 PMCID: PMC8989773 DOI: 10.1097/txd.0000000000001300] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 02/01/2023] Open
Abstract
Background. Advances in medicine and technology that have made it possible to support, repair, or replace failing organs challenge commonly held notions of life and death. The objective of this review is to develop a comprehensive description of the current understandings of the public regarding the meaning/definition and determination of death. Methods. This scoping review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Online databases were used to identify articles published from 2003 to 2021. Two reviewers (S.S. and K.Z.) screened the articles using predefined inclusion and exclusion criteria, extracted data for specific content variables, and performed descriptive examination. Complementary searches of reference lists complemented the final study selection. A search strategy using vocabulary of the respective databases was created, and criteria for the inclusion and exclusion of the articles were established. Results. Seven thousand four hundred twenty-eight references were identified. Sixty were retained for analysis, with 4 additional references added from complementary searches. A data extraction instrument was developed to iteratively chart the results. A qualitative approach was conducted to thematically analyze the data. Themes included public understanding/attitudes toward death and determination of death (neurological determination and cardiocirculatory determination of death), death and organ donation, public trust and legal variability, and media impacts. Conclusions. This review provides a current and comprehensive overview of the literature related to the general public’s understanding and attitudes toward death and death determination and serves to highlight the gaps in this topic.
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Healthcare Professionals’ Understandings of the Definition and Determination of Death: A Scoping Review. Transplant Direct 2022; 8:e1309. [PMID: 35372677 PMCID: PMC8963853 DOI: 10.1097/txd.0000000000001309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
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.
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Yee E, Hosseini SM, Duarte B, Knapp SM, Carnes M, Young B, Sweitzer NK, Breathett K. Sex Disparities in Organ Donation: Finding an Equitable Donor Pool. J Am Heart Assoc 2021; 10:e020820. [PMID: 34558313 PMCID: PMC8649146 DOI: 10.1161/jaha.121.020820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The majority of living organ donors are women, but few are deceased organ donors, which increases risks associated with sex mismatched organs. We sought to identify reasons for sex disparities in organ donation and strategies for equity. Methods and Results Using Amazon's Mechanical Turk, we examined US adults' perceptions regarding donation in a mixed‐methods survey study. Results were compared by sex with Fisher's exact test and T‐tests for quantitative results and qualitative descriptive analyses for write‐in responses. Among 667 participants (55% women), the majority of men (64.8%) and women (63.4%) self‐identified as registered donors. Women's willingness to donate their own organs to family members (P=0.03) or strangers (P=0.03) was significantly higher than men. Donors from both sexes were guided by: desire to help, personal experience, and believing organs would be useless to deceased donors. Non‐donors from both sexes were guided by: no reason, medical mistrust, contemplating donation. When considering whether to donate organs of a deceased family member, women were equally guided by a family member's wishes and believing the family member had no further use for organs. Men had similar themes but valued the family member's wishes more. Among non‐donors, both sexes would consider donation if more information was provided. Conclusions In a national survey, both sexes had similar reasons for becoming and not becoming an organ donor. However, compared with men, women were more willing to donate their organs to family members and strangers. Improving education and communicating wishes regarding organ donation with direct relatives may increase sex equity in deceased organ donation.
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Affiliation(s)
- Erika Yee
- School of Medicine and Sarver Heart Center Clinical Research Office University of Arizona Tucson AZ
| | | | | | - Shannon M Knapp
- Statistics Consulting Lab Bio5 InstituteUniversity of Arizona Tucson AZ
| | - Molly Carnes
- Department of Medicine University of Wisconsin Madison WI
| | - Bessie Young
- Division of Nephrology Department of Medicine University of Washington Seattle WA
| | - Nancy K Sweitzer
- Division of Cardiology Department of Medicine Sarver Heart Center University of Arizona Tucson AZ
| | - Khadijah Breathett
- Division of Cardiology Department of Medicine Sarver Heart Center University of Arizona Tucson AZ
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Robert P, Bégin F, Ménard-Castonguay S, Frenette AJ, Quiroz-Martinez H, Lamontagne F, Belley-Côté EP, D'Aragon F. Attitude and knowledge of medical students about organ donation - training needs identified from a Canadian survey. BMC MEDICAL EDUCATION 2021; 21:368. [PMID: 34225725 PMCID: PMC8258931 DOI: 10.1186/s12909-021-02736-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/13/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Appropriate training of health professionals has been recommended to increase organ donation rates. Some studies have shown insufficient knowledge among medical students. This survey aims to describe their knowledge and attitude toward organ donation (OD). METHOD We designed, pre-tested and conducted an online survey of all undergraduate medical students from Montreal, Laval and Sherbrooke universities in 2016-2017. Multivariate linear regression identified factors associated with a better knowledge score. RESULTS Twenty-two percent (750/3344) of students completed the survey. Ninety-one percent of students adequately knew that neurological death is irreversible; 76% acknowledged that someone could be neurologically deceased while his heart is still beating; 69% were not aware of circulatory determination of death. For only one knowledge item, senior students had a better answer than junior students. Total knowledge score was associated with exposure to OD during medical studies and comfort in answering patients' questions about OD (p < 0,001). Regarding attitude, 96% of respondents wished to become organ donors after death and 92% supported OD training during their medical training. CONCLUSION Despite a favourable attitude, medical students have limited knowledge of OD. Findings suggest the need for a formal curriculum about OD, as students expressed.
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Affiliation(s)
- Philippe Robert
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Faculty of Medicine, Université Laval, 1050, Avenue de la Médecine, Québec, QC, G1V 0A6, Canada.
| | - Félix Bégin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Sasha Ménard-Castonguay
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Anne-Julie Frenette
- Faculty of Pharmacy, Université de Montréal, 2940, Chemin de Polytechnique, Montréal, QC, H3T 1J4, Canada
| | - Hector Quiroz-Martinez
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - François Lamontagne
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | - Frédérick D'Aragon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
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15
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Mentzelopoulos SD, Couper K, Van de Voorde P, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. [Ethics of resuscitation and end of life decisions]. Notf Rett Med 2021; 24:720-749. [PMID: 34093076 PMCID: PMC8170633 DOI: 10.1007/s10049-021-00888-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Spyros D. Mentzelopoulos
- Evaggelismos Allgemeines Krankenhaus, Abteilung für Intensivmedizin, Medizinische Fakultät der Nationalen und Kapodistrischen Universität Athen, 45–47 Ipsilandou Street, 10675 Athen, Griechenland
| | - Keith Couper
- Universitätskliniken Birmingham NHS Foundation Trust, UK Critical Care Unit, Birmingham, Großbritannien
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | - Patrick Van de Voorde
- Universitätsklinikum und Universität Gent, Gent, Belgien
- staatliches Gesundheitsministerium, Brüssel, Belgien
| | - Patrick Druwé
- Abteilung für Intensivmedizin, Universitätsklinikum Gent, Gent, Belgien
| | - Marieke Blom
- Medizinisches Zentrum der Universität Amsterdam, Amsterdam, Niederlande
| | - Gavin D. Perkins
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | | | - Jana Djakow
- Intensivstation für Kinder, NH Hospital, Hořovice, Tschechien
- Abteilung für Kinderanästhesiologie und Intensivmedizin, Universitätsklinikum und Medizinische Fakultät der Masaryk-Universität, Brno, Tschechien
| | - Violetta Raffay
- School of Medicine, Europäische Universität Zypern, Nikosia, Zypern
- Serbischer Wiederbelebungsrat, Novi Sad, Serbien
| | - Gisela Lilja
- Universitätsklinikum Skane, Abteilung für klinische Wissenschaften Lund, Neurologie, Universität Lund, Lund, Schweden
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16
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Mentzelopoulos SD, Couper K, Voorde PVD, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation 2021; 161:408-432. [PMID: 33773832 DOI: 10.1016/j.resuscitation.2021.02.017] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
| | - Keith Couper
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Van de Voorde
- University Hospital and University Ghent, Belgium; Federal Department Health, Belgium
| | - Patrick Druwé
- Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium
| | - Marieke Blom
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gavin D Perkins
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Violetta Raffay
- European University Cyprus, School of Medicine, Nicosia, Cyprus; Serbian Resuscitation Council, Novi Sad, Serbia
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
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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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Abstract
Several authors in bioethics literature have expressed the view that a whole brain conception of death is philosophically indefensible. If they are right, what are the alternatives? Some authors have suggested that we should go back to the old cardiopulmonary criterion of death and abandon the so-called Dead Donor Rule. Others argue for a pluralist solution. For example, Robert Veatch has defended a view that competent persons should be free to decide which criterion of death should be used to determine their death. However, there is very little data on people's preferences about death determination criteria. We conducted online vignette-based survey with Latvian participants (N = 1416). The data suggest that the pluralist solution fits best with the way our study participants think about death determination-widely differing preferences concerning death determination criteria were observed. Namely, most participants choose one of the three criteria discussed in the literature: whole brain, higher brain, and cardiopulmonary. Interestingly, our data also indicate that study participants tend to prefer less restrictive criteria for determination of their own deaths than for determination of deaths of their closest relatives. Finally, the preferences observed in our sample are largely in accord with the Dead Donor Rule for organ procurement for transplantation.
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Affiliation(s)
- Ivars Neiders
- Department of Humanities, Rīga Stradiņš University, Dzirciema 16, Riga, LV 1007, Latvia.
| | - Vilius Dranseika
- Faculty of Social Sciences, Arts and Humanities, Kaunas University of Technology, Kaunas, Lithuania
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19
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Brain Death in Asia: Do Public Views Still Influence Organ Donation in the 21st Century? Transplantation 2019; 103:755-763. [DOI: 10.1097/tp.0000000000002562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keel I, Schürch R, Weiss J, Zwahlen M, Immer FF. Is there an association between consent rates in Swiss hospitals and critical care staffs' attitudes towards organ donation, their knowledge and confidence in the donation process? PLoS One 2019; 14:e0211614. [PMID: 30735508 PMCID: PMC6368376 DOI: 10.1371/journal.pone.0211614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/17/2019] [Indexed: 11/19/2022] Open
Abstract
This study investigated the critical care staff’s attitude, knowledge and involvement with donation, skills and confidence with donation-related tasks and their association with consent rates at the hospital level. In 2015, we conducted a cross-sectional survey among critical care staff of hospitals involved in organ donation using an anonymous online questionnaire with a response rate of 56.4% (n = 2799). The hospital level consent rate was obtained from the Swiss Monitoring of Potential Donors database (2013–2015). For each hospital, we calculated a mean score for each predictor of interest of the Hospital Attitude Survey and investigated the association with hospital consent rates with generalized linear mixed-effect models. In univariable analysis, one score point increase in doctors' confidence resulted in a 66% (95% CI: 45%–80%) reduction in the odds to consent, and one score point increase in nurses' attitudes resulted in a 223% (95% CI: 84%–472%) increase in the odds to consent. After simultaneously adjusting for all major predictors found in the crude models, only levels of education of medical and nursing staff remained as significant predictors for hospital consent rates. In Switzerland, efforts are needed to increase consent rates for organ donation and should concentrate on continuous support as well as specific training of the hospital staff involved in the donation process.
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Affiliation(s)
- Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Roger Schürch
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
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21
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Rodrigue JR, Luskin R, Nelson H, Glazier A, Henderson GV, Delmonico FL. Measuring Critical Care Providers' Attitudes About Controlled Donation After Circulatory Death. Prog Transplant 2018; 28:142-150. [PMID: 29558878 DOI: 10.1177/1526924818765821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Unfavorable attitudes and insufficient knowledge about donation after cardiac death among critical care providers can have important consequences for the appropriate identification of potential donors, consistent implementation of donation after cardiac death policies, and relative strength of support for this type of donation. The lack of reliable and valid assessment measures has hampered research to capture providers' attitudes. Design and Research Aims: Using stakeholder engagement and an iterative process, we developed a questionnaire to measure attitudes of donation after cardiac death in critical care providers (n = 112) and examined its psychometric properties. Exploratory factor analysis, internal consistency, and validity analyses were conducted to examine the measure. RESULTS A 34-item questionnaire consisting of 4 factors (Personal Comfort, Process Satisfaction, Family Comfort, and System Trust) provided the most parsimonious fit. Internal consistency was acceptable for each of the subscales and the total questionnaire (Cronbach α > .70). A strong association between more favorable attitudes overall and knowledge ( r = .43, P < .001) provides evidence of convergent validity. Multivariable regression analyses showed that white race ( P = .002) and more experience with donation after cardiac death ( P < .001) were significant predictors of more favorable attitudes. CONCLUSION Study findings support the utility, reliability, and validity of a questionnaire for measuring attitudes in critical care providers and for isolating targets for additional education on donation after cardiac death.
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Affiliation(s)
- James R Rodrigue
- 1 Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | | | | | - Galen V Henderson
- 2 Harvard Medical School, Boston, MA, USA.,3 New England Donor Services, Waltham, MA, USA.,4 Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Francis L Delmonico
- 2 Harvard Medical School, Boston, MA, USA.,3 New England Donor Services, Waltham, MA, USA.,5 Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Resource allocations and disparities in the Brazilian health care system: insights from organ transplantation services. BMC Health Serv Res 2018; 18:90. [PMID: 29415705 PMCID: PMC5803889 DOI: 10.1186/s12913-018-2851-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background To date, few studies have assessed how Brazil’s universal healthcare system’s (SUS, Sistema Único de Saúde) systemic, infrastructural, and geographical challenges affect individuals’ abilities to access organ transplantation services and receive quality treatment. Discussion In this article we evaluated the existing literature to examine the impact that SUS has had on an increasingly important healthcare sector: organ transplantation services. We assess how equity challenges within the transplantation system can be explained by wider problems within SUS. Findings suggest stark disparities in access to transplantation services both within and across Brazil’s regions. We found that these regional differences are partially due to logistical challenges, especially in loosely populated areas but are also a consequence of disparities in resource allocations within SUS and under-capacitated health care facilities affecting transplantation services. Summary We suggest that Brazil needs to improve its health outcome measurement system for organ transplantations and epidemiological surveillance, to gain more comprehensive and comparable data. Finally, we recommend policy strategies to reduce barriers to access to transplantation services by increasing transplantation service coverage in some areas and investing in emerging technologies.
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Abstract
Although much has been written on the dead-donor rule (DDR) in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don't Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don't Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics-unlike today's critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward.
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Ríos A, López-Navas AI, Martínez-Alarcón L, Garrido G, Ayala-García MA, Ramírez P, Hernández AM, Parrilla P. Knowledge of the Concept of Brain Death Among the Latin-American Population Residing in Spain. EXP CLIN TRANSPLANT 2017; 16:473-480. [PMID: 29251586 DOI: 10.6002/ect.2017.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The knowledge of brain death is fundamental for being able to understand the organ donation process and for ensuring its acceptance or rejection. Here, we analyzed the level of knowledge of the concept of brain death among Latin-American individuals who are residents of Spain to determine the factors affecting this knowledge. MATERIALS AND METHODS Our patient group was a sample of 1314 Latin-American residents of Spain, obtained randomly and stratified according to the respondent's nationality, age, and sex. Their attitude was assessed using a validated questionnaire. The survey was self-administered and completed anonymously. RESULTS The questionnaire completion rate was 94% (n = 1237). Of total respondents, 25% (n = 313) knew the concept of brain death, which they considered to be an individual's death, 56% (n = 697) did not know the term, and 19% (n = 227) believed that it did not mean death. The variables related to knowledge of the brain death concept included (1) country of origin, with a better knowledge among those with Mexican nationality (P < .001); (2) male sex (30% vs 23%; P = .003); (3) having university-level education (35% vs 23%; P = .044); (4) having discussed the matter within the family (29% vs 23%; P = .044); (5) having a partner with a favorable attitude toward donation (39% vs 21%; P = .001); and (6) the respondent's religion (47% vs 7%; P < .001). The following factors persisted in the multivariate analysis: country of origin (odds ratio of 2.972), sex (odds ratio of 1.416), education level (odds ratio of 2.228), attitude of the respondent's partner (odds ratio of 1.835), and religion (odds ratio of 4.490). CONCLUSIONS Knowledge of the concept of brain death is limited among Latin-American residents of Spain, with marked differences among country of origin and other socio-personal factors.
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Affiliation(s)
- Antonio Ríos
- From the Proyecto Colaborativo Internacional Donante (International Collaborative Donor Project), and Surgery Service, IMIB-Virgen de la Arrixaca University Hospital, Murcia Health Service, Murcia, Spain
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25
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Syversen TB, Sørensen DW, Foss S, Andersen MH. Donation after circulatory death - an expanded opportunity for donation appreciated by families. J Crit Care 2017; 43:306-311. [PMID: 28968526 DOI: 10.1016/j.jcrc.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Torgunn Bø Syversen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Dag Wendelbo Sørensen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Stein Foss
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Marit Helen Andersen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
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Smith Z, Leslie G, Wynaden D. Experiential learning not enough for organ procurement surgery: implications for perioperative nursing education. Prog Transplant 2015; 25:339-50. [PMID: 26645929 DOI: 10.7182/pit2015689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Mercado-Martínez FJ, Padilla-Altamira C, Díaz-Medina B, Sánchez-Pimienta C. Views of health care personnel on organ donation and transplantation: A literature review. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015003842014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to review the empirical studies on health personnel's views towards organ donation and transplantation. A scoping review was carried out in English, Portuguese and Spanish. The search was conducted in eight databases, and two search engines. Four groups of descriptors were used. The period covered was 1985 to 2013. Frequency and content analysis was performed. Two hundred forty-eight articles were selected, out of 316 identified. The literature is temporally and geographically clustered. Quantitative studies predominate. The studies prioritized the perspective of medical and nursing personnel over other actors, such as directors and organ donation coordinators. Health personnel's attitudes toward deceased organ donation was the most examined topic. In conclusion, a growing quantitative literature analyzes the perspective of physicians and nurses with regard to deceased organ donation and transplantation.
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Shah SK, Kasper K, Miller FG. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy. JOURNAL OF MEDICAL ETHICS 2015; 41:291-6. [PMID: 24769621 DOI: 10.1136/medethics-2013-101930] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Vital organ transplantation is premised on 'the dead donor rule': donors must be declared dead according to medical and legal criteria prior to donation. However, it is controversial whether individuals diagnosed as 'brain dead' are really dead in accordance with the established biological conception of death-the irreversible cessation of the functioning of the organism as a whole. A basic understanding of brain death is also relevant for giving valid, informed consent to serve as an organ donor. There is therefore a need for reliable empirical data on public understanding of brain death and vital organ transplantation. We conducted a review of the empirical literature that identified 43 articles with approximately 18,603 study participants. These data demonstrate that participants generally do not understand three key issues: (1) uncontested biological facts about brain death, (2) the legal status of brain death and (3) that organs are procured from brain dead patients while their hearts are still beating and before their removal from ventilators. These data suggest that, despite scholarly claims of widespread public support for organ donation from brain dead patients, the existing data on public attitudes regarding brain death and organ transplantation reflect substantial public confusion. Our review raises questions about the validity of consent for vital organ transplantation and suggests that existing data are of little assistance in developing policy proposals for organ transplantation from brain dead patients. New approaches to rigorous empirical research with educational components and evaluations of understanding are urgently needed.
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Affiliation(s)
- Seema K Shah
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Kenneth Kasper
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Franklin G Miller
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
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Iltis AS. Organ Donation, Brain Death and the Family: Valid Informed Consent. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:369-382. [PMID: 26242960 DOI: 10.1111/jlme.12254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
I argue that valid informed consent is ethically required for organ donation from individuals declared dead using neurological criteria. Current policies in the U.S. do not require this and, not surprisingly, current practices inhibit the possibility of informed consent. Relevant information is withheld, opportunities to ensure understanding and appreciation are extremely limited, and the ability to make and communicate a free and voluntary decision is hindered by incomplete disclosure and other practices. Current practices should be revised to facilitate valid informed consent for organ donation.
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Affiliation(s)
- Ana S Iltis
- Director of the Center for Bioethics, Health and Society and a Professor of Philosophy at Wake Forest University. She holds a Ph.D. in Philosophy from Rice University
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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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Abstract
Remarkable advances in the technological capacity of modern medicine now permit the use of mechanical organ failure support deployed primarily to save life. Such technology serves as a bridge to either recovery or, when feasible, organ transplantation. However, when effective treatment options are exhausted, technological advances can be burdensome bridges to death. This paper briefly reviews the principles of management of life-threatening critical illness and the corresponding biological aspects of life, death, and organ donation, which are both informed and complicated by these technological and scientific achievements.
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Affiliation(s)
- Sam D Shemie
- Division of Critical Care and Extracorporeal Life Support Program, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada; The Bertram Loeb Chair in Organ and Tissue Donation, Faculty of Arts, University of Ottawa, Ottawa, Ontario, Canada; Deceased Donation, Canadian Blood Services, Ottawa, Ontario, Canada
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Weiss J, Coslovsky M, Keel I, Immer FF, Jüni P. Organ donation in Switzerland--an analysis of factors associated with consent rate. PLoS One 2014; 9:e106845. [PMID: 25208215 PMCID: PMC4160222 DOI: 10.1371/journal.pone.0106845] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions.
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Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
| | - Peter Jüni
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Knowledge of the Brain Death Concept by Personnel in Spanish and Latin-American Healthcare Centers. Int J Artif Organs 2014; 37:336-43. [DOI: 10.5301/ijao.5000305] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2013] [Indexed: 12/14/2022]
Abstract
Background The knowledge and acceptance of the concept of brain death (BD) among health care personnel is fundamental. Objective To analyze the level of understanding of the BD concept among personnel in Spanish and Latin American healthcare centers and to determine the factors affecting this attitude. Material and methods Data from 12 hospitals and 32 primary care centers in 4 countries within the International Collaborative Donor Project were selected (Spain, Mexico, Cuba and Costa Rica (n = 4378)). Results 62% of the personnel (n = 2714) understood BD and believed that this was the death of an individual. Of the rest, 30% (n = 1 333) did not understand it and the remaining 8% (n = 331) believed it did not mean the death of a patient. 83% (n = 931) of physicians understood BD, compared to 75% (n = 895) of nurses, 55% (n = 299) of healthcare assistants, 53% (n = 108) of non-healthcare university-educated personnel and 36% (n = 481) of those without a university education (p<0.001). 68% (n = 1084) of Mexicans understood BD compared to 66% (n = 134) of Cubans, 58% (n = 1411) of Spaniards, and 52% (n = 85) (p<0.001) of Costa Ricans. There were significant relationships between knowledge of the concept and the following: type of healthcare center (p<0.001), clinical service (p<0.001), having spoken about organ donation within the family (p<0.001) and one's partner's attitude to the subject (p<0.001). A direct relationship has been found between understanding the concept and attitude toward deceased donation (p<0.001). Conclusions The understanding of BD by personnel from healthcare centers was not as good as expected. There were marked differences depending on job category.
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Donor and procurement related issues in vascularized composite allograft transplantation. Curr Opin Organ Transplant 2013; 18:665-71. [DOI: 10.1097/mot.0000000000000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Iriarte J, Palma J, Kufoy E, de Miguel M. Brain death: Is it an appropriate term? NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2010.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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DuBois JM. Dead tired of repetitious debates about death criteria. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2011; 11:45-47. [PMID: 21806440 DOI: 10.1080/15265161.2011.583327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Jacoby L, Jaccard J. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of kin. Am J Crit Care 2010; 19:e52-61. [PMID: 20810408 DOI: 10.4037/ajcc2010396] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Families' experiences in the hospital influence their decisions about donating organs of brain-dead relatives. Meeting families' support needs during this traumatic time is an obligation and a challenge for critical care staff. OBJECTIVES (1) To elicit family members' accounts of various types of support received and perceived quality of care for themselves and their loved ones when they made the donation decision, and (2) to examine the relationship between these factors and the families' donation decision. METHODS Retrospective telephone interviews of 199 families from different regions of the country were completed. Aside from demographic data, the survey addressed perceptions of informational, emotional, and instrumental support and quality of care. RESULTS One hundred fifty-four study participants consented to donation; 45 declined. White next of kin were significantly more likely than African Americans to consent. Specific elements of reported support were significantly associated with consent to donate. Donor and nondonor families had differing perceptions of quality care for themselves and their loved ones. Receiving understandable information about organ donation was the strongest predictor of consent. CONCLUSIONS Specific supportive behaviors by staff as recounted by family members of potential donors were significantly associated with consent to donation. These behaviors lend themselves to creative training and educational programs for staff. Such interventions are essential not only for next of kin of brain-dead patients, but also for staff and ultimately for the public as a whole.
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Affiliation(s)
- Liva Jacoby
- Liva Jacoby is an associate professor in the Department of Medical Education and the Alden March Bioethics Institute at Albany Medical College in Albany, New York. Jim Jaccard is a professor in the Department of Psychology at Florida International University in Miami
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A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation”. Transplantation 2009; 88:S108-58. [DOI: 10.1097/tp.0b013e3181b66576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
OBJECTIVES The 2006 revision of the Uniform Anatomical Gift Act (UAGA) attempts to enhance the availability of organs in part by granting new authority to organ procurement organizations over patients who are near death and may be candidates for donation after death while limiting patients' end of life (EOL) decisional authority through advance directives or surrogates. To examine the revised UAGA that may alter the ethics and law of EOL medical care in the United States. To analyze the revised UAGA in light of established legal and ethical standards. DATA SOURCES We evaluated the 2006 UAGA and accompanying commentary. Case law and ethics literature regarding informed consent and EOL care, state laws and regulations concerning advance directives and medical licensure, and literature concerning the fiduciary obligations of physicians were reviewed and compared with the 2006 UAGA and its 2007 amendment. DATA EXTRACTION AND SYNTHESIS We examined the legal and medical ethics literature to evaluate the 2006 UAGA and its 2007 amendment. CONCLUSIONS The 2006 UAGA reflects the important public policy goal of making more organs available for transplantation. However, it transfers authority over EOL decisions from patients or surrogates to organ procurement organizations, which is inconsistent with EOL U.S. common law and the ethical and legal standards that govern medicine. The extent of informed consent transferred to organ procurement organizations at the time of signing a donor registry card is legally and ethically uncertain under the UAGA. As states consider enacting the 2006 UAGA, further revisions should be considered to balance the public policy goals of increasing the availability of donated organs with truly informed and voluntary EOL decisions for patients. Further revision of the 2006 UAGA is necessary to respect patients' civil liberties and the professional integrity of physicians who have legally and ethically recognized fiduciary duties to their dying patients.
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Respecting patients’ rights at the end of life: Problems with the 2006 Uniform Anatomical Gift Act*. Crit Care Med 2009; 37:372-3. [DOI: 10.1097/ccm.0b013e3181932d71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Linde EB. Consider the ethical issues raised by organ donation, such as how to define death. Then examine your own opinions. Nursing 2009; 39:28-31. [PMID: 19114831 DOI: 10.1097/01.nurse.0000343453.58376.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Ellen Bridget Linde
- department of biology and anatomy and physiology lab at The University of Scranton in Scranton, Pa., USA
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A Paradigm Shift in the Approach to Families for Organ Donation: Honoring Patients’ Wishes Versus Request for Permission in Patients With Department of Motor Vehicles Donor Designations. ACTA ACUST UNITED AC 2008; 65:1507-9; discussion 1509-10. [DOI: 10.1097/ta.0b013e31818a5cf0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Understanding the antecedents of the acceptance of donation after cardiac death by healthcare professionals. Crit Care Med 2008; 36:1075-81. [PMID: 18379230 DOI: 10.1097/ccm.0b013e3181691b2b] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A 3-yr study funded by the U.S. Department of Health and Human Services was conducted to identify potential barriers to and opportunities for increasing the number hospitals with donation after cardiac death (DCD) protocols, the support of DCD by individuals involved in the donation request process, and the number DCD donors recovered. This study reports the qualitative findings. DESIGN Methods used included an advisory committee and an extensive array of key informant interviews and focus groups. SETTING Hospitals and telephone contact. SUBJECTS Discussions with nurses, physicians, social service staff, clergy, administrators, and organ procurement organization staff. A total of 216 people participated. INTERVENTIONS Collection and analysis of information regarding perceptions of DCD, potential barriers and opportunities, and strategies for gaining support. MEASUREMENT AND MAIN RESULTS Key barriers included a lack of knowledge about DCD, psychological barriers for DCD vs. brain death, concerns about whether death has been reached, saving vs. killing patients, trust in the organ procurement organization, moving from saving patients to being a donation advocate, and concerns with the DCD process. Opportunities included education initiatives, well-trained requesters, a cultural shift, a consistent DCD protocol separating care from recovery, process monitoring, and a strong sense of teamwork. CONCLUSIONS Our findings provide a better understanding of healthcare professionals' knowledge, attitudes, and behaviors regarding DCD. Understanding these issues is critical to the implementation of strategic plans for DCD programs. One of the biggest barriers to overcome is a lack of knowledge of DCD, which leads to misperceptions, which in turn contribute to negative attitudes and/or discomfort by healthcare professionals. Communication efforts that are able to educate healthcare professionals and eliminate misperceptions will increase support for DCD. Key to future success requires confident and well-trained DCD requesters.
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