Attitudes towards organ donation and transplantation--a study involving Baltic physicians

The Understanding of Human Death by Polish Early Career Pre-Specialist Physicians

Despite the legal classification of cerebral death as the actual death of a human being and the continuous clarification of neurological criteria, the subject of death, particularly, when exactly it occurs, has been the subject of debate not only in the medical environment but also in other scientific communities for over sixty years. This issue is also present in social discourse. In Poland, as well as in other countries, the concepts of "death" and "cerebral death" have a legal basis. Considerations devoted to death are also important for tanatopedagogics, which focuses primarily on mortality. Indeed, the quality of relationships with other people depends to a large extent on the awareness of death. The study involved 113 pre-specialist physicians employed in various medical centers in Poland. An original questionnaire was used to study the understanding of human death in the light of legal and medical acts that came into force between 2007 and 2019. The study showed that only 7.08% of pre-specialist physicians could fully and correctly identify the basis for declaring a patient dead after diagnosing the irreversible cessation of brain function, and only 33.63% of all respondents understood death in accordance with legal acts currently in force in Poland. Moreover, nearly half of the study participants (47.79%) indicated that irreversible loss of consciousness is not adequate grounds for determining a patient's death, while 56.64% felt that cerebral death is equal to the biological death of a human being. Women were significantly more likely to understand the concept of death (p = 0.028) as defined by current documents and to perceive the irreversible loss of consciousness as an insufficient basis for determining a patient's death (p = 0.040) and also to correctly indicate on what basis cerebral death is identified with human death (p = 0.003), as expressed by current legal regulations in Poland.

Attitude of medical professionals regarding controversial issues in kidney donation/transplantation

There is a dire need to evaluate new strategies to bridge the wide kidney demand-supply gap. The current study examined the attitude of medical professionals regarding controversial issues pertaining to transplantation. A questionnaire, presenting controversial issues related to kidney transplantation, in an agree-disagree format with supporting reasons, was employed. The research was exploratory. Data were analyzed quantitatively and qualitatively. The sample comprised 140 doctors from Mumbai (mean = 38.1 years, standard deviation = 17.95; Males = 44.3%, Females = 55.7%). Whereas 47.1% of the participants felt that live donors should be given incentives for kidney donation, others (52.9%) disagreed, fearing commercialization and illegal activities. The eligibility of patients with HIV/hepatitis for a transplant was denied by 52.9% because of poor outcomes, with the others (47.1%) maintaining that these individuals too had a right to live. A substantial majority (90.7%) of the participants maintained that organ donors should be given priority in the event of a future need for an organ because their previous humane act should be rewarded (47.1%). Most of the participants (91.4%) felt that individuals from the higher socioeconomic strata should not receive preference for kidney transplantation. A majority (77.1%) of them were also against kidney selling getting legalized. Compulsory possession of a donor card elicited mixed responses, with some accepting (56.4%), but others rejecting (43.6%) this idea as donation was perceived to be a voluntary act (33.6%). While compulsory kidney donation found favor with 44.3%, it found disfavor with others (55.7%). This study will benefit transplant healthcare personnel to formulate new policies in relation to kidney donation/transplantation.

Views of health care personnel on organ donation and transplantation: A literature review

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.

A survey to determine the understanding of the conceptual basis and diagnostic tests used for brain death by neurosurgeons in Canada

OBJECTIVE

To determine the understanding of the conceptual basis and diagnostic tests used for brain death (BD) by neurosurgeons in Canada.

METHODS

Between February and June 2006, a previously developed survey was mailed to every neurosurgeon in Canada.

RESULTS

Of 223 surveys mailed, 147 (66%) were returned; of these, 128 (87%) were completed and analyzed. When asked to choose a conceptual reason to explain why BD is equivalent to death, 50 (39%) chose a higher brain concept, 50 (39%) chose a prognosis concept, and 33 (26%) chose a loss of integration of the organism concept. More than half of respondents answered that BD is not compatible with electroencephalographic activity or brainstem evoked potential activity. More than one-third of respondents answered that some cerebral blood flow or a brainstem with minimal microscopic damage was not compatible with BD. Of the 90 respondents who answered that they were comfortable diagnosing BD because the conceptual basis of BD makes it equivalent to death of the patient, in their own words, 14 (16%) used a loss of integration concept, 20 (22%) used a prognosis concept, 25 (28%) used a higher brain concept, and 39 (43%) did not articulate a concept. When asked, "Are brain death and cardiac death the same state (i.e., are both death of the patient)?," 57 (45%) answered "No."

CONCLUSION

Within the neurosurgical community, a stand-alone concept of BD does not exist. There is also significant variability in the understanding of the tests that are compatible with the criterion of BD.

Factors associated with attitude and hypothetical behaviour regarding brain death and organ transplantation: Comparison between medical and other university students

The aim of this study was to investigate the factors, including knowledge, that determine an individual's attitudes and behaviours regarding brain death and organ transplantation using questionnaires among medical and other university students. A total of 522 students (388 medical and 134 other) answered a questionnaire. The survey included the individual's knowledge about brain death, attitudes towards brain death and organ transplantation, and hypothetical behaviours assuming their willingness to donate their own or their family's organs. Medical students were more likely to have knowledge about brain death and to accept brain death and organ transplantation compared with other students, while there was no difference in their willingness to donate their own or their family's organs. Logistic regression analysis was used to assess the effects of various factors on the attitudes and behaviours. In both medical and other students, confidence in brain-death diagnosis by doctors was independently associated with their willingness to donate their own organs after the adjustment for other factors, including knowledge (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.15 to 2.97 and OR, 4.97; 95% CI, 1.01 to 24.39, respectively). An increase in knowledge may cause positive attitudes towards brain death and organ transplant. Meanwhile, reducing uncertainty about the brain-death diagnostic process might have a beneficial effect on the willingness to donate organs.

Trauma and tribulation: the experiences and attitudes of operating room nurses working with organ donors

BACKGROUND

In the past two decades, significant medical advances have resulted in remarkable success and survival rates for organ recipients. However, the rates of donation have not kept pace with the demand, resulting in a critical shortage of available healthy organs. It has been suggested that the attitudes of medical personnel towards organ retrieval is a key success factor in improving organ donation. Yet there is evidence that those closest to the process of procurement are the most negative.

AIMS AND OBJECTIVES

This study sought to examine the attitudes towards organ donation of operating room nurses and their experiences of participating in the procurement of organs for transplant, in order to unravel factors that contribute to their attitudes.

METHODS

This study relied upon in-depth qualitative interviews with 14 operating room nurses who participated in organ procurement in a large urban trauma centre.

RESULTS

The results of this study suggest that the process of organ procurement is highly stressful and raises many concerns for operating room nurses. Factors, which added to participants' distress, include organizational factors such as strained relationships within surgical teams, concerns about the dignity of the patient and the well-being of the family and exposure to death and trauma.

CONCLUSIONS

Experiences of nurses participating in surgical removal of organs for transplantation resulted in personal feelings of distress and negative attitudes to the issue of organ donation which may be transmitted to others and undermine organ procurement efforts.

RELEVANCE TO CLINICAL PRACTICE

The concerns of these vital members of the organ procurement team should be heeded and actions taken to reduce their distress and improve their attitudes towards donation.