Organ procurement in forensic deaths: A retrospective analysis of the Italian context with a focus on the Puglia Region virtuous experience

Organ transplantation is one the most important contributions of modern medicine to society since it provides a unique therapy for terminal organ failure. However, the development of this therapeutic approach is hindered by the limited organ supply. In Italy, organ procurement requires a multidisciplinary medical-surgical approach in which legal medical doctors (LMDs) are generally tasked with ascertaining the reality of death. Sometimes, a medico-legal report is required when the deceased's family deny their consent to the organs and tissues removal from a potential deceased donor. LMDs can also be appointed by law to carry out post-mortem examinations of potential deceased donors. In these cases, the public prosecutors' interest in preserving the corpse integrity for forensic purposes seems to conflict with the ethical-humanitarian interest in promoting, at most, the opportunity to donate; however, a LMD can act as a mediator and allow both goals. This paper aims to illustrate the Apulia Region experience in reconciling the justice interests with those of a culture promoting deceased organ and tissue donation. It has been pursued by analyzing the virtuous regional organ procurement trend in forensic deaths before and after a crucial 2015 initiative, comparing the results with the national ones, and contextualizing them in the relevant literature to show systemic strengths and weaknesses and inform future Italian policy development.

The healthcare professionals' support towards organ donation. An analysis of current practices, predictors, and consent rates in Apulian hospitals

INTRODUCTION

The paper investigates the critical care staff's support towards organ donation by analysing how their attitude, knowledge, confidence, engagement, and training can act as predictors of donation consent rates. Our study focused on hospitals in the Apulia Region, Italy.

MATERIAL AND METHODS

The study employs a quantitative methodology based on a survey of healthcare professionals. The rate of consent to organ and tissue donation at the hospital level, given as a ratio of the permissions received to the proposals performed, was extracted from GEDON software related to the year 2019 report. For each Apulian participating hospital, we calculated a median score for each of the five predictors (namely, attitude, knowledge, confidence, engagement, and training) and investigated the association with hospital consent rates.

RESULTS

The results highlight that the engagement of the intensive care units' healthcare personnel stands as the only influential predictor of the consent rate.

DISCUSSION

In Italy's Apulia Region, efforts are needed to increase consent rates for organ donation. Strategies should concentrate on continuous support, as well as specific training of hospital staff involved in the donation process.