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Peetz A, Kuzemchak M, Hammack C, Guillamondegui OD, Dennis BM, Eastham S, Meador K, Beskow L, Patel M. Trauma Surgeons' Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation. Am Surg 2021; 88:663-667. [PMID: 34962834 DOI: 10.1177/00031348211065100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trauma surgeons face a challenge when deciding whether to resuscitate lethally injured patients whose organ donor status is unknown. Data suggests practice pattern variability in this setting, but little is known about why. MATERIALS AND METHODS We conducted semi-structured interviews with trauma surgeons practicing in Level 1 or 2 trauma centers in Tennessee. Interviews focused on ethical dilemmas and resource constraints. Analysis was performed using inductive thematic analysis. RESULTS Response rate was 73% (11/15). Four key themes emerged. All described resuscitating patients to buy time to collect more definitive clinical information and to identify family. Some acknowledged this served the secondary purpose of organ preservation. 11/11 participants felt a primacy of obligation to the patient in front of them even after it became apparent, they could not personally benefit. For 9/11 (82%), the moral obligation to consider organ preservation was secondary/balancing; 2/11 (18%) felt it was irrelevant/immoral. Resource allocation was commonly considered. All participants expressed some limitation to resources they would allocate. All participants conveyed clear moral agency in determining resuscitation extent when the goal was to save the patient's life, however this was less clear when resuscitating for organ preservation. Across themes, perceptions of a "standard practice" existed but the described practices were not consistent across interviewees. DISCUSSION Widely ranging perceptions regarding ethical and resource considerations underlie practices resuscitating toward organ preservation. Common themes suggest a lack of consensus. Despite expressed beliefs, there is no identifiable standard of practice amongst trauma surgeons resuscitating in this setting.
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Affiliation(s)
- Allan Peetz
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Surgical Services, 20106Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Marie Kuzemchak
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine Hammack
- Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oscar D Guillamondegui
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley M Dennis
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shannon Eastham
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keith Meador
- Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Psychiatry and Behavior Sciences, 6339Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura Beskow
- Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Health Policy, 6339Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mayur Patel
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Surgical Services, 20106Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, 213918Vanderbilt Center for Health Services Research, Nashville, TN, USA
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DiBrito SR, Bowring MG, Holscher CM, Haugen CE, Rasmussen SV, Duncan MD, Efron DT, Stevens K, Segev DL, Garonzik-Wang J, Haut ER. Acute Care Surgery for Transplant Recipients: A National Survey of Surgeon Perspectives and Practices. J Surg Res 2019; 243:114-122. [PMID: 31170553 PMCID: PMC6773475 DOI: 10.1016/j.jss.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/13/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Transplant recipients are living longer than ever before, and occasionally require acute care surgery for nontransplant-related issues. We hypothesized that while both acute care surgeons (ACS) and transplant surgeons would feel comfortable operating on this unique patient population, both would believe transplant centers provide superior care. METHODS To characterize surgeon perspectives, we conducted a national survey of ACS and transplant surgeons. Surgeon- and center-specific demographics were collected; surgeon preferences were compared using χ2, Fisher's exact, and Kruskal-Wallis tests. RESULTS We obtained 230 responses from ACS and 204 from transplant surgeons. ACS and transplant surgeons believed care is better at transplant centers (78% and 100%), and transplant recipients requiring acute care surgery should be transferred to a transplant center (80.2% and 87.2%). ACS felt comfortable operating (97.5%) and performing laparoscopy (94.0%) on transplant recipients. ACS cited transplant medication use as the most important underlying cause of increased surgical complications for transplant recipients. Transplant surgeons felt it was their responsibility to perform acute care surgery on transplant recipients (67.3%), but less so if patient underwent transplant at a different institution (26.5%). Transplant surgeons cited poor transplanted organ resiliency as the most important underlying cause of increased surgical complications for transplant recipients. CONCLUSIONS ACS and transplant surgeons feel comfortable performing laparoscopic and open acute care surgery on transplant recipients, and recommend treating transplant recipients at transplant centers, despite the lack of supportive evidence. Elucidating common goals allows surgeons to provide optimal care for this unique patient population.
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Affiliation(s)
- Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah V Rasmussen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark D Duncan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David T Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kent Stevens
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Elliott R Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Roza BDA, Garcia VD, Barbosa SDFF, Mendes KDS, Schirmer J. Doação de órgãos e tecidos: relação com o corpo em nossa sociedade. ACTA PAUL ENFERM 2010. [DOI: 10.1590/s0103-21002010000300017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo, de revisão bibliográfica, objetivou tecer considerações teóricas sobre doação de órgãos e tecidos e sua relação com o corpo em nossa sociedade. O aumento da taxa de doação depende de um olhar ampliado além das questões técnicas do processo de doação de órgãos e tecidos. Vários países, com larga experiência temporal e, que trabalham sistematicamente nesse processo, incorporaram a abordagem social e a perspectiva ética, baseadas no voluntarismo das famílias e no respeito ao direito de autonomia dos potenciais doadores. O acompanhamento do corpo, pós-doação, solicitado pelas famílias, representa o início do luto pela morte de um parente, parte da prática de ritual fúnebre cultuada em nossa sociedade. As ações que asseguram uma sequência ético-legal, definida na legislação dos transplantes, pressupõem compromisso com a qualidade e segurança do processo de doação de órgãos e tecidos, que deve ser rigorosamente perseguida pelos profissionais que trabalham na área. Espera-se, assim, que essas atitudes construam uma cultura positiva sobre a doação no país, contribuindo, a longo prazo, para o aumento nas taxas de doação.
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Affiliation(s)
- Bartira De Aguiar Roza
- Câmara Técnica Nacional de Doação de órgãos e Tecidos; Sociedade Beneficente Israelita Brasileira Albert Einstein, Brasil
| | | | | | | | - Janine Schirmer
- Escola Paulista de Enfermagem; Universidade Federal de São Paulo, Brasil
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Ríos A, Ramírez P, Martínez L, Montoya MJ, Lucas D, Alcaraz J, Rodríguez MM, Rodríguez JM, Parrilla P. Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program. Clin Transplant 2007; 20:743-54. [PMID: 17100725 DOI: 10.1111/j.1399-0012.2006.00562.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program. MATERIALS AND METHODS The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis. RESULTS The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2). CONCLUSIONS Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.
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Affiliation(s)
- A Ríos
- Coordinación Regional de Trasplantes de la Comunidad Autónoma de Murcia, Consejería de Sanidad, Murcia, Spain.
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Sanner MA, Nydahl A, Desatnik P, Rizell M. Obstacles to organ donation in Swedish intensive care units. Intensive Care Med 2006; 32:700-7. [PMID: 16550371 DOI: 10.1007/s00134-006-0126-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 02/21/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify obstacles to organ donation in Swedish intensive care units. DESIGN A survey exploring attitudes and experiences of organ donation activities was sent to half of all anaesthetists and all neurosurgeons in Sweden (n=644). Total response rate was 67%; 69% from the anaesthetists and 54% from the neurosurgeons. RESULTS Neurosurgeons had more experiences of caring for potential donors and requesting donation than anaesthetists. Twenty-seven percent of the anaesthetists were not confident with clinical neurological criteria for brain incarceration. Nine per cent found donation activities solely burdensome, and 14% wanted an external team to take over the donation request. A quarter regarded the request definitely as an extra load on the family, and more than half of the respondents had refrained from asking in emotionally strained situations. Forty-nine per cent had a neutral approach to relatives when requesting donation while 38% had a pro-donation approach. Thirty-six per cent terminated ventilator treatment for a potential donor without waiting for total brain infarction. Lack of resources in the ICUs resulted in not identifying a possible donor according to 29% of respondents. Knowing the prior wish of the deceased was regarded as the single most important factor that facilitated the work with organ donation for the intensivists. CONCLUSIONS The identified obstacles (neutral approach of donation request, ethical problems concerning the potential donor and the relatives, varying competence in diagnosing total brain infarction, and lack of intensive care bed resources) require tailored efforts in order to increase organ donation. Checking these factors can be used as a quality control when analysing donation activities at hospitals.
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Affiliation(s)
- Margareta A Sanner
- Department of Public Health and Caring Sciences, Unit of Health Services Research, Uppsala University, and Department of Anaesthesiology and Intensive Care, Orebro University Hospital, Sweden.
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Roth BJ, Sher L, Murray JA, Belzberg H, Mateo R, Heeran A, Romero J, Mone T, Chan L, Selby R. Cadaveric organ donor recruitment at Los Angeles County Hospital: improvement after formation of a structured clinical, educational and administrative service. Clin Transplant 2004; 17 Suppl 9:52-7. [PMID: 12795670 DOI: 10.1034/j.1399-0012.17.s9.10.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS There remains a critical shortage of cadaveric organs. At a large inner city level one trauma centre, several strategies were devised and combined to (a). optimize the physiologic status of potential donors, (b). promote awareness of the donation process among health care professionals and (c). perform quality control on the organ donation system - all in an effort to improve organ donation rates. Resuscitative and maintenance protocols were devised and implemented through a multidisciplinary team approach for patients diagnosed with brain death. We report the effect this approach has had on organ donation in a single centre. METHOD A death record review (DRR) by the local organ procurement agency (OPO) was used to identify the number of patients diagnosed with brain death at Los Angeles County Hospital each year from 1995 through 2001. Data were collected to determine the number of these potential donors that eventually underwent organ donation. Data were collected for two time intervals: Phase I (1995-98) and Phase II (1999-2001). During Phase I, there was no focused institutional programme for the approach to potential donors. During Phase II, an institutional programme including the following characteristics was implemented: 1). donor resuscitation protocol, 2). assignment of a dedicated OPO coordinator liaison to interact with families, hospital personnel and the coroner's office, 3). assignment of the primary role of stabilization and care of potential donors and the integration of all medical services to the trauma service, and 4). biweekly conferences to review policies, protocols, and outcomes of donor management strategies. RESULTS From 1995 to 2001 there was a large increase in patient referrals for donor evaluation from 86 (Phase I) to 124 (Phase II). There was a smaller increase in the number of suitable donors: Phase I (mean: 51/year) and Phase II (mean: 63/year). There was, however, an increase in the mean number of actual organ donors from 14.2/year to 25.7/year from Phase I to Phase II and an increase in organs donated from 29 to 49. Organ donor declines decreased from 53% (Phase I) to 39% (Phase II). CONCLUSIONS Strategies to increase the number of cadaveric organs available for organ transplantation are crucial. A strategy combining prompt identification of potential organ donors, institution of resuscitative protocols, a multidisciplinary team approach, educational activities and utilization of personnel expert in organ procurement led to a marked increase in the number of organ donors and the number of organs donated at a single institution. Wider application of this approach should prove successful in increasing organ donation in a similar fashion in other institutions.
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Affiliation(s)
- Bradley J Roth
- Division of Trauma Surgery/Critical Care Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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McCunn M, Mauritz W, Dutton RP, Alexander C, Handley C, Scalea TM. Impact of culture and policy on organ donation: a comparison between two urban trauma centers in developed nations. THE JOURNAL OF TRAUMA 2003; 54:995-9. [PMID: 12777916 DOI: 10.1097/01.ta.0000022461.76930.4e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The similarities and differences in organ donation policies, consent rates, and number of organs transplanted from patients declared "brain dead" after traumatic injury in different countries has not been previously reported. METHODS An international trauma survey questionnaire was developed. Analysis of two responding centers with regard to organ donation practices between urban, free-standing adult trauma hospitals is presented: the R Adams Cowley Shock Trauma Center (STC) in Baltimore, Maryland, and the Lorenz Böhler Hospital (LBH) in Vienna, Austria. RESULTS Hospital admissions resulting from traumatic brain injury (TBI) account for a significantly greater number of admissions at the STC than at the LBH (761 vs. 276), and the STC has a higher number of patients admitted with severe TBI (Glasgow Coma Scale score < 8). Of 39 medically suitable brain-dead patients at the STC, 18 went to organ donation. At the LBH, 16 patients were declared brain-dead, 7 were considered to be medically suitable, and all 7 went to donation. A "presumed consent" organ donation policy in Austria resulted in 100% of medically suitable patients going to donation at the LBH. With a volunteer donation policy at the STC, 46% of patients went to donation. Of those families who refused donation at the STC, 9 of 16 eligible African Americans (56%), 10 of 21 eligible Caucasians (48%), 1 Hispanic, and 1 Native American Indian family declined donation. CONCLUSION "Presumed" organ donation in Austria led to 4 organs transplanted per trauma brain-death at the LBH, as compared with 3.8 organs per brain-death at the STC. The greater number of patients with severe TBI at the STC accounts for a similar organ donation rate compared with the LBH, despite the fact that the consent at the STC is voluntary and at the LBH is "presumed." A higher organ donation rate in the United States would result in a greater number of organ transplants from patients who die after traumatic injury and a resultant increase in potential lives saved. There does not appear to be a significant difference in ethnicity between families who accept and those who refuse organ donation after traumatic brain death declaration at the STC.
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Affiliation(s)
- Maureen McCunn
- Department of Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, 21202, USA.
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Aldridge A, Guy B, Roggenkamp S. From attitude formation to behavioral response in organ donation: using marketing to increase consent rates. Health Mark Q 2003; 20:21-35. [PMID: 15018000 DOI: 10.1300/j026v20n03_03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This article presents a theoretical analysis of attitude formation and the relationship to stated behavioral intentions as it relates to the decision to donate organs. This analysis reveals the presence of three distinct paths to behavior of potential donors, groups differing in their involvement with organ donation. Promotional objectives and campaign strategies designed to influence attitudes and behaviors should differ according to the behavioral path in operation and the involvement of the audience. Mass media campaigns are likely to reach high involvement groups only. Therefore, personal selling, underutilized in previous donation campaigns, should be brought into the donation strategy to appeal to low involvement groups. By recognizing differences in audience involvement and implementing different strategies, overall donation rates could substantially increase.
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