Attitudes of Australian Emergency Department Clinicians toward Organ and Tissue Donation: An Analysis of Cultural and Religious Influences

Barriers and facilitators of deceased organ donation among Muslims living globally: An integrative systematic review

AIM

To identify the barriers and facilitators of deceased organ donation among the Muslim community living globally.

METHOD

A systematic search was undertaken in databases such as CINAHL, Medline with full text, Global Health and PsycINFO via EBSCO; Scopus via Elsevier; Web of Science via Clarivate; and PubMed via US National Library of Medicine National Institute of Health were used to retrieve the studies on the 31st of December 2023. Apart from these databases two other journals, the Saudi Journal of Kidney Diseases and Transplantation, and the Journal of Experimental and Clinical Transplantation were also used to search for relevant studies. Quantitative and qualitative studies that addressed the aim of the present review published from the 30th of April 2008 were included.

RESULTS

Of the 10,474 studies, 95 studies were included in the review. The following five themes were generated based on narrative synthesis: 1) knowledge of organ donation, 2) willingness to donate, 3) community influence, 4) bodily influence, and 5) religious influence. While individuals view organ donation as a noble act, societal influences significantly impact their decision to register. Concerns include religious permissibility, potential misuse for commercial purposes, and the dignity and respect given to the deceased donor's body.

CONCLUSIONS

This review finds deceased organ donation decisions in this population are collective, influenced by religious views, and hindered by uncertainty. Interventional studies on strategies to address uncertainty could help us identify best practices for this population to improve deceased organ donation. Rather than an individual approach among this population, a whole-system approach, tailored-made evidence-guided community engagement could improve donation rates.

Identifying the barriers to kidney transplantation for patients in rural and remote areas: a scoping review

BACKGROUND

Populations in rural and remote areas have higher rates of chronic kidney disease and kidney failure than those in urban or metropolitan areas, and mortality rates for chronic kidney disease are almost twice as high in remote areas compared to major cities. Despite this, patients residing in regional, rural, or remote areas are less likely to be wait-listed for or receive a kidney transplant. The objective of this scoping review is to identify specific barriers to kidney transplantation for adult patients residing in rural and remote areas from the perspectives of health professionals and patients/carers.

METHODS

Studies were identified through database (MEDLINE, CINAHL, Emcare, Scopus) searches and assessed against inclusion criteria to determine eligibility. A descriptive content analysis was undertaken to identify and describe barriers as key themes.

RESULTS

The 24 selected studies included both quantitative (n = 5) and qualitative (n = 19) methodologies. In studies conducted in health professional populations (n = 10) the most prevalent themes identified were perceived social and cultural issues (80%), burden of travel and distance from treatment (60%), and system-level factors as barriers (60%). In patient/carer populations (n = 14), the most prevalent themes were limited understanding of illness and treatment options (71%), dislocation from family and support network (71%), and physical and psychosocial effects of treatment (71%).

CONCLUSIONS

Patients in regional, rural, and remote areas face many additional barriers to kidney transplantation, which are predominantly associated with the need to travel or relocate to access required medical testing and transplantation facilities.

Utilizing a Hospital-based Setting to Increase Organ Donor Registrations

BACKGROUND

Shortages of organs for transplantation are a concern for many countries. In Australia's "opt-in" system, people register their donation decision on the Australian Organ Donor Register (AODR) in their own time, yet <30% of the population have done so. Consent registrations are honored by the next-of-kin in 90% of cases, so increasing registrations will increase donated organs for transplantation. This study investigated the efficacy of offering an immediate registration opportunity in 2 hospitals, and the role that beliefs about organ donation play in registration behavior.

METHODS

An immediate registration opportunity was offered at a public and a private hospital in New South Wales, Australia. Participants (N = 168) categorized as medical/healthcare (eg, doctor and nurse) and nonhealthcare (eg, teacher and chef) completed a measure of beliefs about organ donation, were encouraged to discuss their fears and concerns about organ donation, and given an immediate opportunity to register on the AODR.

RESULTS

A total of 81.5% of medical/healthcare participants who were eligible registered, and 71.5% of all eligible participants registered on the spot. Beliefs about the negative consequences of donation and concerns over the medical care given to potential donors predicted (non)registration. Medical/healthcare participants reported lower levels of fears and concerns than nonhealthcare participants. Although both groups reported strong positive beliefs about donation, these did not predict registration.

CONCLUSIONS

Offering an immediate registration opportunity in 2 hospitals notably increased the number of registrations on the AODR, suggesting this is a strategy that could potentially increase registrations in opt-in donation systems.

Barriers to Brain Death Notifications From Emergency Departments

PURPOSE

Emergency departments (EDs) are a new focus of interest in recent years as a possible solution for increasing organ donations, as, EDs are full of missed opportunities. In this study, we aimed to determine the barriers to the identification and referral by emergency medicine physicians (EMPs) of potential brain death (BD) cases.

MATERIALS AND METHODS

The participants of the study consist of 252 EMPs who had answered the questionnaire sent via e-mail.

FINDINGS

The following causes were found in the questionnaire: (1) negative attitudes and lack of knowledge about organ donation in society (63.1%); (2) religious beliefs (57.5%); (3) family refusal (57.1%); (4) disruption of bodily integrity (45.6%); (5) inadequate knowledge of doctors (50.4%); (6) difficulties in predicting the prognosis of the patient and diagnosing BD in EDs (40.1%); (7) fear of negative reactions from relatives of patients (37.7%); (8) the absence of an organ procurement unit (OPU) (36.5%); (9) lack of ideal candidates (27%); (10) increased workload in EDs (23.8%); and (11) fear of legal problems arising (23.8%). Of the participants, 42.9% stated that there was an OPU in their hospital. Of the participants, 15.8% reported that they have good communication with the OPU.

CONCLUSIONS

Negative attitudes and lack of knowledge about organ donation in society, religious beliefs, inadequate knowledge of EMPs, and the absence of an OPU in hospitals are important barriers to organ donor notification from EDs. Increasing social awareness and increasing of the level of knowledge of EMPs and close cooperation between OPU and EDs will significantly contribute to the increase of organ donor notifications from EDs.

Attitudes of intensive care and emergency physicians in Australia with regard to the organ donation process: A qualitative analysis

Specialized hospital physicians have direct capacity to impact Australia’s sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians’ attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians’ conflicts of interest in maintaining patients’/next-of-kin’s best interests and a sense of duty-of-care in this context. Two sub-themes related to this main theme were identified as follows: (1) discussions about organ donation and who is best to carry these out and (2) determining whether organ donation is part of end-of-life care; including the avoidance of non-therapeutic ventilation; and some reluctance to follow clinical triggers in the emergency department. Overall, participants indicated strong support for organ donation but would not consider it part of end-of-life care, representing a major obstacle to the support of potential donation opportunities. Findings have implications for physician education and training. Continued efforts are needed to integrate the potential for organ donation into end-of-life care within intensive care units and emergency departments.

Training, work, and lifestyle of transplant physicians and surgeons in Germany

BACKGROUND

International data on training, work, and lifestyle of transplant physicians and surgeons are scarce. Such data might help in development of uniform education paths and provide insights for young clinicians interested in this field. This study aimed at the evaluation of these data in all transplant-associated medical disciplines.

METHODS

A survey on professional and academic training, workload, and lifestyle was generated. The questionnaire was distributed to all members of the German Transplant Association (DTG), utilizing the tool SurveyMonkey(®) .

RESULTS

A total of 127 members of the DTG responded (male/female 66.1%/33.9%, 45.8±10.3 years). The majority had been working in transplant medicine for more than 10 years (61.9%). Fifteen respondents (11.8%) obtained an official European certification (European Union of Medical Specialists). A total of 57 (48.3%) respondents worked full time on research during training. The research focus was clinical for most respondents (n=72, 61.5%). An average working time of 62±1.5 h/wk was reported. Fifty-eight percent of all respondents complained of inadequate remuneration and 50% reported inadequate acknowledgment of their professional performance.

CONCLUSION

This is the first study reporting characteristics of training, work, and lifestyle in an interdisciplinary cohort of German transplant physicians and surgeons. Enormous efforts in clinical and research work were reported, associated with high rates of professional and financial dissatisfaction.