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Rafii F, Rahimi S. Organ Donation Decision in Families With Brain-Dead Patients: An Evolutionary Concept Analysis. Prof Case Manag 2022; 27:67-84. [PMID: 35099421 DOI: 10.1097/ncm.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Organ donation decision is a complicated process for bereaved families; however, its attributes and associated factors are not clear. Accordingly, the purpose of this study was to analyze the concept of organ donation decision in families with brain-dead patients. METHODS Concept analysis was performed using Rodgers' evolutionary method. For this purpose, PubMed, OVID, Scopus, and ProQuest databases were searched in English from 1985 to 2019. In total, 54 articles were analyzed using the thematic analysis to identify the attributes, antecedents, and consequences of the concept. The validity of the data was provided by examining the analysis process by 2 independent researchers. FINDINGS/CONCLUSIONS Organ donation decision in these families is a complicated and conflicting process of vicarious decision-making that begins with an organ donation request: a difficult, painful, and critical experience that requires extensive interpersonal interactions and is ultimately influenced by various factors, leading to the acceptance or refusal. The antecedents include deceased-related factors, family-related factors, the quality of organ donation request, and the quality of health care professionals' interactions. The consequences include the positive outcomes (grief solace, gift of life, and promoting human values) and negative outcomes (ambiguity, doubt and regret, and psychological inconsistency). The results of this concept analysis led to a better understanding of the complexity of an organ donation decision in these families. In this way, in addition to knowledge development, it assists the health care staff to support families in making the organ donation decision. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Although case managers rarely participate in organ donation, they definitely need to understand the concepts related to organ donation decision while advocating for the patients or families. The results of this concept analysis can broaden the case managers' and other health care professionals' knowledge about families' organ donation decision and help them take more effective interventions for management of this process. Case managers and the health care team can use the information of this article for informing families about brain death, negotiating with families for organ donation, preparing information, and caring and facilitating the families in making the clear and unconflicted decision.
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Affiliation(s)
- Forough Rafii
- Forough Rafii, PhD, MSN , is a Professor, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Sara Rahimi, MSN , is a PhD student, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Rahimi
- Forough Rafii, PhD, MSN , is a Professor, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Sara Rahimi, MSN , is a PhD student, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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2
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Luo A, He H, Xu Z, Deng X, Xie W. Social Support of Organ Donor Families in China: A Quantitative and Qualitative Study. Front Public Health 2021; 9:746126. [PMID: 34869161 PMCID: PMC8637885 DOI: 10.3389/fpubh.2021.746126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Donor families experienced a difficult time during and after the process of organ donation. There is a necessity to understand the support they received and what they need to help them get through a painful time. This study aimed to investigate the social support level and social support needs of the donor families in China. Methods: A cross-sectional study was conducted among 102 donor families using a questionnaire to investigate their demographics and social support level. To further understand their social support needs, in-depth interviews were conducted among 9 donor families. Results: Findings of the study showed that (1) Most of the family members (74, 72.6%) lacked social support, and only a small number of families (28, 27.5%) received sufficient social support (2). The coping style had an impact on the overall social support level (P = 0.014) (3). There was a lack of emotional support, information support and material support toward the donor's family members. Both emotional support and material support are significantly needed. Conclusions: The overall social support level remained insufficient and the utilization degree of social support was low. Organ donor families are in desperate need of material and emotional support. The level of social support is largely influenced by the donor familie's coping style. Compared with a negative coping style, donor families who adopted a positive coping style acquire more social support.
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Affiliation(s)
- Aijing Luo
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Haiyan He
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Zehua Xu
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,Public Health College of Central South University, Changsha, China
| | - Xuantong Deng
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
| | - Wenzhao Xie
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
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3
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Ma J, Zeng L, Li T, Tian X, Wang L. Experiences of Families Following Organ Donation Consent: A Qualitative Systematic Review. Transplant Proc 2021; 53:501-512. [PMID: 33483168 DOI: 10.1016/j.transproceed.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This systematic review synthesizes qualitative evidence on the experiences of donor families after consent to organ donation. METHODS This robust, qualitative systematic review included an exhaustive search of electronic databases, including PubMed, Scopus, EBSCO PsycINFO, and CINAHL Complete. Manual searches of reference lists and gray literature were conducted to achieve a comprehensive identification of all relevant research. A qualitative study design served to capture the experiences of donor families after organ donation consent. RESULTS A total of 6 articles that met the eligibility criteria were identified and included in this review. Three key themes emerged from the primary research: 1. family members were ambivalent about consent due to the ambiguity of brain death; 2. conversations about donation requirements proved uncomfortable; and 3. support is needed after donation. CONCLUSIONS Family members demonstrated ongoing ambivalence and distress that lasted for weeks after organ donation due to the ambiguity of brain death. Some family members were unhappy with having been approached for a conversation about organ donation. Donor families were not always able to deal with the difficulties they faced after their decision about organ donation. Health care professionals should provide ongoing care and updated information to family members. This review helped to identify family members' needs for both psychological and financial assistance.
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Affiliation(s)
- Juanjuan Ma
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Li Zeng
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China.
| | - Tingjun Li
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Xiaofei Tian
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Wang
- Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
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4
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Wang PY, Tseng WC, Fu CM, Wu MH, Wang JK, Chen YS, Chou NK, Wang SS, Chiu SN, Lin MT, Lu CW, Chen CA. Long-Term Outcomes and Prognosticators of Pediatric Primary Dilated Cardiomyopathy in an Asian Cohort. Front Pediatr 2021; 9:771283. [PMID: 34796157 PMCID: PMC8593174 DOI: 10.3389/fped.2021.771283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Dilated cardiomyopathy (DCM) is the most common childhood cardiomyopathy. The epidemiological profiles and prognosticators of clinical outcomes in Asian populations are not well elucidated. Methods: Data of 104 children aged <18 years with a diagnosis of primary DCM from January 1990 to December 2019 in our institutional database were retrospectively investigated. Relevant demographic, echocardiographic, and clinical variables were recorded for analysis. A P <0.05 was considered statistically significant. Results: The median age at diagnosis was 1.4 years (interquartile range = 0.3-9.1 years), and 52.9% were males. During a median follow-up duration of 4.8 years, 48 patients (46.2%) were placed on the transplantation waitlist, and 52.1% of them eventually received heart transplants. An exceptionally high overall waitlist mortality rate was noted (27.1%), which was even higher (43.5%) if the diagnostic age was <3 years. The 1-, 5-, and 10-year transplant-free were 61.1, 48.0, and 42.8%. Age at diagnosis >3 years and severe mitral regurgitation at initial diagnosis were independent risk factors for death or transplantation (hazard ratios = 2.93 and 3.31, respectively; for both, P <0.001). In total, 11 patients (10.6%) experienced ventricular function recovery after a median follow-up of 2.5 (interquartile range = 1.65-5) years. Younger age at diagnosis was associated a higher probability of ventricular function recovery. Conclusions: Despite donor shortage for heart transplantation and subsequently high waitlist mortality, our data from an Asian cohort indicated that transplant-free long-term survival was comparable with that noted in reports from Western populations. Although younger patients had exceptionally higher waitlist mortality, lower diagnostic age was associated with better long-term survival and higher likelihood of ventricular function recovery.
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Affiliation(s)
- Po-Yuan Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shoei-Shen Wang
- Department of Cardiovascular Surgery, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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5
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Dicks SG, Burkolter N, Jackson LC, Northam HL, Boer DP, van Haren FM. Grief, Stress, Trauma, and Support During the Organ Donation Process. Transplant Direct 2020; 6:e512. [PMID: 32047840 PMCID: PMC6964929 DOI: 10.1097/txd.0000000000000957] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022] Open
Abstract
The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.
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Affiliation(s)
- Sean G. Dicks
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
| | | | | | - Holly L. Northam
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Douglas P. Boer
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Frank M.P. van Haren
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
- School of Medicine, Australian National University, Canberra, ACT, Australia
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6
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Ahmadian S, Khaghanizadeh M, Khaleghi E, Hossein Zarghami M, Ebadi A. Stressors experienced by the family members of brain-dead people during the process of organ donation: A qualitative study. DEATH STUDIES 2019; 44:759-770. [PMID: 31058581 DOI: 10.1080/07481187.2019.1609137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
More is known about organ donor recipients than donor families. We explored the stressors experienced by family members of brain-dead people during the process of organ donation. Seventeen family members and five organ procurers were interviewed and the data analyzed through conventional qualitative content analysis. Stressors experienced by family members fell into six themes-perceived threat of loss, decision making under conflict, painful corrosive farewell, feeling of insecurity, complexity of grief, and seeking relief. Findings highlight the necessity of developing and using standard protocols for supporting brain-dead people's family members throughout the process of organ donation and following bereavement.
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Affiliation(s)
- Shamsa Ahmadian
- Behavioral Sciences Research Center, Life style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Life style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ebrahim Khaleghi
- bOrgan Procurement and Transplant Center, Mashhad University of Medical Sciences, Montaserieh Hospital, Mashhad, Iran
| | - Mohammad Hossein Zarghami
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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7
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Dicks SG, Ranse K, Northam H, van Haren FM, Boer DP. A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study. Health Psychol Open 2018; 5:2055102917753706. [PMID: 29399367 PMCID: PMC5788101 DOI: 10.1177/2055102917753706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of ‘communication’ between researchers contributes to information being ‘lost’ and then later ‘rediscovered’. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.
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Affiliation(s)
| | | | | | - Frank Mp van Haren
- University of Canberra, Australia.,Australian National University, Australia
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8
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Dicks SG, Northam H, van Haren FMP, Boer DP. An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis. Health Psychol Open 2018; 5:2055102918782172. [PMID: 30083368 PMCID: PMC6069040 DOI: 10.1177/2055102918782172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.
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Affiliation(s)
| | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University,
Australia
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9
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Dicks SG, Ranse K, Northam H, Boer DP, van Haren FM. The development of a narrative describing the bereavement of families of potential organ donors: A systematic review. Health Psychol Open 2017; 4:2055102917742918. [PMID: 29379629 PMCID: PMC5779939 DOI: 10.1177/2055102917742918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.
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Affiliation(s)
| | | | | | | | - Frank Mp van Haren
- University of Canberra, Australia.,Australian National University, Australia
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10
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"Effective" Requesting: A Scoping Review of the Literature on Asking Families to Consent to Organ and Tissue Donation. Transplantation 2017; 101:S1-S16. [PMID: 28437367 DOI: 10.1097/tp.0000000000001695] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Families are often asked to consent to the donation of their deceased relative's organs or tissues. These end-of-life conversations are important because they affect consent rates as well as the psychological impact of the decision for families. This scoping review of the literature on requesting family consent was prepared to support of the development of leading practice recommendations for end-of-life conversations with families of potential donors. A scoping review maps research activity in a field across a range of commentary and empirical study designs but does not attempt meta-synthesis of empirical data or quality assessment. METHODS We performed a scoping review of the peer-reviewed literature from January 2000 to February 2015 on the questions of what constitutes an "effective" request and the factors that affect consent rates and family satisfaction with their decision and the process. This review includes a final set of 168 articles addressing (a) whether, when, and how to ask families for consent to donation or (b) characteristics of families or decedents that affect families' decisions or family satisfaction with their decisions. RESULTS Six main themes were identified: (1) the objectives of requesting and encouraging family consent to donation, (2) the effect of the donation decision on family well-being, (3) the process of requesting family consent, (4) the impact of the quality of the care for the deceased and for the family, (5) the content and manner of the request for family consent, and (6) the characteristics of the family and deceased that affect the request for family consent. CONCLUSION This scoping review found that there is a large literature on how to modify the process and manner of the request to increase family consent rates. Another important line of inquiry focuses on the psychological impact of the decision on the family. Although a scoping review does not attempt to synthesize results or draw evidence-based conclusions, the literature generally supports the intuitive expectations that compassionate and respectful care for the deceased and family, listening for and addressing family concerns, and an attitude to donation that is positive (but not solely procurement-focused) and is best for both consent rates and family well-being. Although the presumption is often that the primary objective of asking for family consent is to secure consent and donation, some ethical commentary on requesting consent emphasizes that this objective must be balanced with the parallel obligation to protect the psychological well-being of families. This places some constraints on the approaches used in family consent discussions.
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11
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Ahmadian S, Rahimi A, Khaleghi E. Outcomes of organ donation in brain-dead patient's families: Ethical perspective. Nurs Ethics 2017; 26:256-269. [DOI: 10.1177/0969733017703696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. Objective: The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. Methods: This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. Findings: The main category of the data was “Decision to organ donation: a challenge from conflict to transcendence.” This main category consisted of 10 subcategories and 3 general categories. The general categories were “challenging outcomes,” “reassuring outcomes,” and “transcending outcomes.” Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Conclusion: Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.
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12
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Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors. Transplantation 2016; 100:2006-9. [DOI: 10.1097/tp.0000000000001198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Abstract
This project was undertaken to ascertain the perceptions of a group of Taiwan’s fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because little is known about how Taiwan’s nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students’ reported needs during the dying process were directed towards three main goals: (1) help in reaching the ‘triple targets of individual life’; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife.
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Affiliation(s)
- Fu-Jin Shih
- National Yang-Ming University School of Nursing, Taipei, Taiwan
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14
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Kim JR, Elliott D, Hyde C. The Influence of Sociocultural Factors on Organ Donation and Transplantation in Korea: Findings From Key Informant Interviews. J Transcult Nurs 2016; 15:147-54. [PMID: 15070497 DOI: 10.1177/1043659603262485] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although brain death was formally recognized in Korea in 2000 for the purpose of organ donation, traditional Confucian-based thought still prevails. The aim of this study was to explore sociocultural perspectives that influence health professionals’ attitudes and perceptions regarding organ donation. Semistructured interviews were conducted with nine key informants from three major hospitals providing transplant services in South Korea. Several themes were identified as barriers to organ donation: Confucianism, misunderstandings and myths, organs as spare for selling, lack of clarity in the definition of death in the new legislation, and limited medical insurance coverage. It remains difficult for brain death to be accepted as true death, and there is currently a poor rate of organ procurement. Findings of the study will help identify socioculturally appropriate strategies to promote acceptance and accessibility of organ transplantation among South Koreans.
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15
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Community preferences for the allocation of donor organs for transplantation: a discrete choice study. Transplantation 2015; 99:560-7. [PMID: 25700169 DOI: 10.1097/tp.0000000000000365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Demand for organs for transplant exceeds supply. There is an ongoing debate about the relative weighting that should be given to different allocation criteria. Little is known about the relative weight the community places on various allocation criteria. This study aims to determine community preferences for organ allocation. METHODS Community respondents recruited from a web-based panel chose which patient received a transplant in 30 scenarios presenting two hypothetical patients. Patients were described in age, sex, previous transplants, whether they or family were registered donors, had caring responsibilities, adherence, time on waiting list, estimated survival and quality of life (QOL) with and without transplant, comorbidities, and lifestyle factors, such as smoking. Analyses were conducted in NLOGIT 5.0, using a mixed-logit model. RESULTS Two thousand fifty-one respondents aged 18 to 83 years completed the survey. All attributes significantly influenced recipient choice except sex and having diabetes. Younger patients were preferred over older patients. Family member donor registration, having caring responsibilities, and longer time on waiting list increased priority. Pretransplant life expectancy was valued more highly than posttransplant life expectancy; 1 year less of pretransplant life expectancy required an increase of 1.49 years in posttransplant life expectancy to compensate. Posttransplant QOL was valued more highly than pretransplant QOL. CONCLUSION Lower pretransplant life expectancy (need) was more important than higher posttransplant life expectancy (utility). Although current allocation algorithms are consistent with community preferences for prioritizing children and time on the waiting list, favoring patients with high predicted posttransplant survival as potential recipients may not be aligned with community preferences.
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16
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Chen HM, Shih FJ, Pan YJ, Shih FJ, Wang SS. The needs and expectations of overseas liver transplant recipients' families in Taiwan: across different transplantation stages. Transplant Proc 2014; 46:782-4. [PMID: 24767348 DOI: 10.1016/j.transproceed.2013.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022]
Abstract
AIMS This study explored the needs and expectations of Taiwanese overseas liver transplant recipients' families (OLTRFs) across three liver transplantation stages. PATIENTS AND METHODS An exploratory qualitative method was applied to a purposive sample of OLTRFs who received guided face-to-face, semi-structured interviews. Data were subjected to content analysis. RESULTS Nineteen OLTRF members (15 females, 4 males) aged between 29 and 71 years (mean, 55.1 years) for 19 patients who had end-stage liver diseases were interviewed regarding overseas liver transplantation (OLT) across three stages: pre-departure (first stage), stay in mainland China (second stage), and re-entry into Taiwan (third stage). Five types of needs across OLT stages were reported: (a) knowing precise operation schedule in advance (first to second stages); (b) sharing the caring burdens (second to third stages); (c) knowing the updated health status if possible (all stages); (d) obtaining timely psychological support (all stages); and (e) effective communications between health professionals in Taiwan and mainland China to ensure the caring quality (all stages). Furthermore, five expectations were reported: (a) more donor sources (first stage); (b) comprehensive caring strategies for OLT (first stage); (c) a comprehensive consultation system and timely assistance channels for OLT recipients and their families (second to third stages); (d) a legal and accessible therapy process (all stages); and (e) the cooperation with foreign countries and allowed experience sharing for better quality of patient care (all stages). CONCLUSIONS Most ethnic Chinese believe that family is an integrated system; moreover, there is close attachment between OLT recipients and their families. The needs and expectations of the recipients' family across three transplantation stages were first reported in this project. With this knowledge, the health providers of related countries are empowered by a better understanding of the family's needs and expectations of these OLT recipients at different stages.
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Affiliation(s)
- H-M Chen
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan; School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - F-Jong Shih
- Departments of Information Management and Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Y-J Pan
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan
| | - F J Shih
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chayi, Taiwan.
| | - S-S Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Irving MJ, Jan S, Tong A, Wong G, Craig JC, Chadban S, Rose J, Cass A, Allen RD, Howard K. What factors influence people's decisions to register for organ donation? The results of a nominal group study. Transpl Int 2014; 27:617-24. [DOI: 10.1111/tri.12307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/08/2014] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle J. Irving
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Stephen Jan
- The George Institute for Global Health; Camperdown Sydney NSW Australia
| | - Allison Tong
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Germaine Wong
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Jonathan C. Craig
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Steven Chadban
- Central Clinical School; Bosch Institute; The University of Sydney; Sydney NSW Australia
- Department of Renal Medicine; Royal Prince Alfred Hospital; Camperdown Sydney NSW Australia
| | - John Rose
- Institute for Transport and Logistics Studies; The University of Sydney; Sydney NSW Australia
- Institute for Choice; University of South Australia; Adelaide Australia
| | - Alan Cass
- The George Institute for Global Health; Camperdown Sydney NSW Australia
- Menzies School of Health Research; Casuarina NT Australia
| | - Richard D. Allen
- Department of Renal Medicine; Royal Prince Alfred Hospital; Camperdown Sydney NSW Australia
| | - Kirsten Howard
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
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Ralph A, Chapman JR, Gillis J, Craig JC, Butow P, Howard K, Irving M, Sutanto B, Tong A. Family perspectives on deceased organ donation: thematic synthesis of qualitative studies. Am J Transplant 2014; 14:923-35. [PMID: 24612855 DOI: 10.1111/ajt.12660] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 01/25/2023]
Abstract
A major barrier to meeting the needs for organ transplantation is family refusal to give consent. This study aimed to describe the perspectives of donor families on deceased donation. We conducted a systematic review and thematic synthesis of qualitative studies. Electronic databases were searched to September 2012. From 34 studies involving 1035 participants, we identified seven themes: comprehension of sudden death (accepting finality of life, ambiguity of brain death); finding meaning in donation (altruism, letting the donor live on, fulfilling a moral obligation, easing grief); fear and suspicion (financial motivations, unwanted responsibility for death, medical mistrust); decisional conflict (pressured decision making, family consensus, internal dissonance, religious beliefs); vulnerability (valuing sensitivity and rapport, overwhelmed and disempowered); respecting the donor (honoring the donor's wishes, preserving body integrity) and needing closure (acknowledgment, regret over refusal, unresolved decisional uncertainty, feeling dismissed). Bereaved families report uncertainty about death and the donation process, emotional and cognitive burden and decisional dissonance, but can derive emotional benefit from the "lifesaving" act of donation. Strategies are needed to help families understand death in the context of donation, address anxieties about organ procurement, foster trust in the donation process, resolve insecurities in decision making and gain a sense of closure.
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Affiliation(s)
- A Ralph
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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19
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Hogan NS, Coolican M, Schmidt LA. Making Meaning in the Legacy of Tissue Donation for Donor Families. Prog Transplant 2013; 23:180-7. [DOI: 10.7182/pit2013862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context Individuals needing lifesaving (heart valves, skin grafts for repair of critical burn injuries) and life-enhancing (corneas, bone and tendon grafts, skin, and veins) tissue donations outnumber the tissues available for transplant. Objective To describe the grief family members experienced 6 months after donation and to learn how family decision makers gained meaning from the decision to donate a loved one's tissues. This is phase 1 of a longitudinal study in which family decision makers will be surveyed again at 13 and 25 months after donation. Design Qualitative descriptive. Participants One hundred seven family decision makers whose family member died a traumatic sudden death and who authorized donating tissues for transplant. Data Collection and Analysis Data were written responses to the questions, “If you could ask or tell your dead family member something, what would it be” and “What meaning does donating tissue to others have for you” Data were analyzed by using content analysis procedures. Results Concepts derived from the first question represent the context of family members grieving the sudden death of a loved one. Concepts were (1) feeling empty, (2) missing and loving, (3) being grateful, and (4) having regrets. The concepts derived from the second question were (1) fulfilling their family member's wish, (2) doing the right thing, (3) believing something good came from the death, (4) helping others, and (5) living on. Reasons for donating were based, in part, on honoring the legacy of their loved ones who had given of themselves to others in life and now continued to give to others after death. Conclusion The results of this study provide a basis for health professionals and donation staffs to better understand the context within which families grieve and give meaning to tissue donation.
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Affiliation(s)
- Nancy S. Hogan
- Loyola University Chicago, Illinois (NSH, LAS), Musculoskeletal Transplant Foundation, East Hampton, Connecticut (MC)
| | - Maggie Coolican
- Loyola University Chicago, Illinois (NSH, LAS), Musculoskeletal Transplant Foundation, East Hampton, Connecticut (MC)
| | - Lee A. Schmidt
- Loyola University Chicago, Illinois (NSH, LAS), Musculoskeletal Transplant Foundation, East Hampton, Connecticut (MC)
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20
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Manzari ZS, Mohammadi E, Heydari A, Sharbaf HRA, Azizi MJM, Khaleghi E. Exploring families' experiences of an organ donation request after brain death. Nurs Ethics 2013; 19:654-65. [PMID: 22990425 DOI: 10.1177/0969733011423410] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative research study with a content analysis approach aimed to explore families' experiences of an organ donation request after brain death. Data were collected through 38 unstructured and in-depth interviews with 14 consenting families and 12 who declined to donate organs. A purposeful sampling process began in October 2009 and ended in October 2010. Data analysis reached 10 categories and two major themes were listed as: (1) serenity in eternal freedom; and (2) resentful grief. The central themes were peace and honor versus doubt and regret. The findings indicated that the families faced with an organ donation request of a brain-dead loved one experienced a lasting effect long after the patient's demise regardless of their decision to donate or refusal to donate. In conclusion, this study highlights the importance of family support and follow-up in an efficient healthcare system aimed at developing trust with the families and providing comfort during and after the final decision.
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21
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Chen HM, Hu RH, Shih FJ, Shih FJ. Dilemmas Across Different Overseas Liver Transplant Stages: Taiwan Transplant Recipient Families' Perspectives. Transplant Proc 2012; 44:539-43. [DOI: 10.1016/j.transproceed.2012.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Cinque VM, Bianchi ERF. [Stressor experienced by family members in the process of organ and tissue donation for transplant]. Rev Esc Enferm USP 2011; 44:996-1002. [PMID: 21337782 DOI: 10.1590/s0080-62342010000400020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of the present study is to identify the stressors experienced by family members during the process of organ donation, evince the most distressful moment of the process and verify the association of variable with the family members' experience. The sample consisted of 16 family members that were making the donation through a Organ Search Organization, in São Paulo, in 2007. A structured instrument was used, containing question addressing the family members' experience and their evaluation of the donation process. The main stressors reported were: dissatisfaction with the service (31.25%); receiving a harsh notification about the individual's brain death (62.50%); and the wait to release the body (62.50%), which was considered the most distressful moment of the process. Using the phi coefficient, it was found that there was a moderate association between the variables of interest with the family's experience. In conclusion, the donation process is stressful on the family and nursing care is necessary in each stage of the process to offer support and reduce the distress on the family members.
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Affiliation(s)
- Valdir Moreira Cinque
- Escola de Enfermagem da Universidade de São Paulo, Enfermeiro do Hospital das Clinicas da Faculdade de Medicina, São Paulo, SP, Brasil.
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23
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Weng HJ, Niu DM, Turale S, Tsao LI, Shih FJ, Yamamoto-Mitani N, Chang CC, Shih FJ. Family caregiver distress with children having rare genetic disorders: a qualitative study involving Russell-Silver Syndrome in Taiwan. J Clin Nurs 2011; 21:160-9. [DOI: 10.1111/j.1365-2702.2010.03583.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Caring For Overseas Liver Transplant Recipients: Taiwan Primary Family Caregivers' Experiences in Mainland China. Transplant Proc 2010; 42:3921-3. [DOI: 10.1016/j.transproceed.2010.09.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 09/16/2010] [Indexed: 11/23/2022]
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25
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Shih F, Wang S, Hsu R, Weng H, Chu S. Concerns Regarding Organ Donation From Prisoners With Death Penalties: Perspectives of Health Professionals in Taiwan and Mainland China. Transplant Proc 2009; 41:20-2. [DOI: 10.1016/j.transproceed.2008.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 10/02/2008] [Indexed: 11/28/2022]
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26
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Comparative Study of Depression and Consent Among Brain Death Families in Donor and Nondonor Groups From March 2001 to December 2002 in Tehran. Transplant Proc 2008; 40:3299-302. [DOI: 10.1016/j.transproceed.2008.08.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 08/12/2008] [Indexed: 11/20/2022]
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27
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Shih SN, Gau ML, Tsai JC, Li IC, Liou YM, Shih FJ. A Health Need Satisfaction Instrument for Taiwan's single-living older people with chronic disease in the community. J Clin Nurs 2008; 17:67-77. [DOI: 10.1111/j.1365-2702.2007.02124.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Kesselring A, Kainz M, Kiss A. Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU. Am J Transplant 2007; 7:211-7. [PMID: 17227569 DOI: 10.1111/j.1600-6143.2006.01594.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Little is known about the memories of relatives after they have been confronted with the brain death of a loved one and the request for organ donation. We conducted this study, guided by Grounded Theory, to explore relatives' experiences, their interactions with health care providers and what influenced their memories. We interviewed 40 relatives (31 consenting to and 9 refusing organ donation) of 33 brain-dead individuals. Relatives described their experiences as a difficult process composed of several stages spanning from the initial encounter to the final decision about donation. Long-term memories of bereaved relatives were influenced by the characteristics of their decision-making style (clear vs. ambivalent) and the perceived quality of the interaction with professionals on the intensive care unit. Organ-focused behavior of professionals and an ambivalent decision-making style of relatives appear to be risk factors for traumatic memories.
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Affiliation(s)
- A Kesselring
- Institute of Nursing Science, University Hospital Basel, Switzerland
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29
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Schulz PJ, Nakamoto K, Brinberg D, Haes J. More than nation and knowledge: cultural micro-diversity and organ donation in Switzerland. PATIENT EDUCATION AND COUNSELING 2006; 64:294-302. [PMID: 16859863 DOI: 10.1016/j.pec.2006.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 03/03/2006] [Accepted: 03/05/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation. METHODS We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings. RESULTS The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs--differences that persist even in the context of strong national identity, relatively homogeneous cultural background, and the public good nature of organ donation. CONCLUSION The results demonstrate a need to consider and address cultural factors and barriers when designing organ donation campaigns. PRACTICE IMPLICATIONS Centrally designed organ donation campaigns are not likely to be effective and efficient. Message strategies should rather be tailored to different (micro-) cultural groups.
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Affiliation(s)
- Peter J Schulz
- University of Lugano, Via G. Buffi 13, 6900 Lugano, Switzerland.
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30
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Bellali T, Papadatou D. Parental grief following the brain death of a child: does consent or refusal to organ donation affect their grief? DEATH STUDIES 2006; 30:883-917. [PMID: 17024783 DOI: 10.1080/07481180600923257] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved parents who consented to, and 11 parents who declined organ donation. Findings suggest that the core themes that characterize their grief and the main variables that affect their grieving process are similar for both donor and non-donor parents. Consent or refusal of organ donation per se does not seem to affect the overall grieving process. It is the meaning attributed to the act of donation that affects how parents perceive the child's death and subsequently facilitate or hinder their adjustment to loss.
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Affiliation(s)
- Thalia Bellali
- Paculty of Nursing, University of Athens, 123 Papadiamadopoulou Str., Athens, 11527, Greece.
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31
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Hsu HT, Hwang SL, Lee PH, Chen SC. Impact of Liver Donation on Quality of Life and Physical and Psychological Distress. Transplant Proc 2006; 38:2102-5. [PMID: 16980013 DOI: 10.1016/j.transproceed.2006.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Our objectives were to assess the characteristics of donors for living-donor liver transplantation (LDLT) and to examine the impact of donation on LDLT donor quality of life (QOL) regarding physical and psychological distress. METHODS Data were collected from a mailed survey or an interview using a cross-sectional prospective study design. We used the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF), Physical Symptom Disturbance Scale, and Psychological Distress Scale. LDLT donors were recruited from a teaching hospital located in a metropolitan area of northern Taiwan. RESULTS The 35 LDLT donors have a mean age 34.0 +/- 8.6 years and were recruited at a median of 25.9 months after donation (range, 0.6-92 months). The average scores in the four domains of the WHOQOL-BREF scale ranged from 13.5 to 14.9. LDLT Donors reported higher QOL scores in social and environment domains but lower scores in physical and psychological domains than healthy adults. Numbers of physical symptoms experienced by each donor ranged from one (n = 4) to 27 (n = 2). Feeling throbbing, itching or numbness around the wound was the most common physical symptom disturbance reported by donors (n = 26, 74%). Approximately 40% of the donors reported having one to three metrics of psychological distresses. "Easily feel distress and angry" was the most common psychological distress reported by 57% (n = 20) of donors. CONCLUSIONS This study indicated that liver donation had a mild negative impact on donors physical and psychological facets of QOL. These results may assist professionals to provide appropriate clinical management.
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Affiliation(s)
- H-T Hsu
- Chang Gung Institute of Technology, 261 Wen-hua 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan
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32
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Tong YF, Holroyd EA, Cheng B. Needs and Experiences of Hong Kong Chinese Cadaveric Organ Donor Families. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1561-5413(09)60226-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The refusal to donate an organ is a phenomenon in need of exploration and explanation. This article refers to the major fear of becoming an organ donor in relation to a global culture perspective and to the Halacha (Jewish law). A theoretical critique about the ambivalence demonstrated by health care providers and families will discuss these concepts in relation to brain death, from the stages of hospitalization, through the period prior to the assertion of brain death, ending with brain death, and its perspective as a liminal situation.Finally, we conclude that nursing practices during the care of the "brain dead" patient, and toward the patient's family, should convey an unequivocal message. That is, brain death describes irreversible cessation of all brain function, and therefore, the patient becomes a dead body and can be treated as a potential organ donor.
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Affiliation(s)
- Michal Rassin
- Nursing Research Unit, Assaf Harofe Medical Center, Be'er-Yaakov, Israel.
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Abstract
Living-donor liver transplantation took root in Asia as a natural result of circumstances, because the supply of organs from the cadaveric pool remained scarce over the years. In contrast to Western countries, the majority of organs for liver transplantation in Asia come from live donations. As the expertise of the transplant teams grows, patient outcomes improve, and public awareness increases, the option of live donation of the liver is increasingly chosen. Although no live liver donor death has yet been reported from Asia, the risk is not eliminated and remains a major consideration in the potential donor's decision to donate. The low morbidity and mortality rate could be attributed to the extensive experience of surgeons in liver surgery, because surgical liver disease is highly prevalent in Asia. Although the donor risk is estimated to be low, live organ donation should be absolutely voluntary, with consent given on the basis of unbiased information and chosen only when the option for obtaining a cadaveric graft is practically nil. It is only under these conditions that living-donor liver transplantation should be perpetuated. Although the disease-donation-transplantation process involves a complex interplay of psychosocial and family dynamics, the potential candidate's perception will necessarily depend on the surgeon's explanation. The ethical soundness of the practice of living-donor liver transplantation rests primarily on the ones who deliver the service.
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Affiliation(s)
- Vanessa H de Villa
- Department of Surgery, Liver Transplant Program, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
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Shih FJ, Liao YC, Chan SM, Duh BR, Gau ML. The impact of the 9-21 earthquake experiences of Taiwanese nurses as rescuers. Soc Sci Med 2002; 55:659-72. [PMID: 12188470 DOI: 10.1016/s0277-9536(01)00194-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The powerful earthquake of September 21, 1999 wrought incalculable havoc on lives and properties in Taiwan. Although the scars of the earthquake can never be erased, the calamity can lead to a more full understanding of the experiences, perceptions and reflections of nurses involved directly in post-rescue situations. The purpose of this study was to compare the impacts of rescue experiences on Taiwanese female and male nurses who worked as rescuers following the earthquake of 21 September. A purposive sample of 46 nurses (40 women, 6 men) (mean age 26) who worked in a renowned hospital with a reputation for high quality of emergency care in Northern Taiwan was obtained. Data were collected by in-depth semi-structured interviews and analyzed by a unique mode of between-method triangulation. The majority of the subjects (38 female, 6 male) reported various impacts from their rescue experiences. They are: (a) recognition of the impermanence of life and wishing to lead a more significant life (32 female, 3 male); (b) more caring relationships with others and for their homeland (19 female, 5 male); (c) a clearer concept of disaster care (19 female, 4 male); (d) a better appreciation of the value of nursing and their own self-worth (11 female, 3 male); (e) enhanced knowledge of the survivors' needs (3 female); and (f) enhanced ability to identify the factors hindering rescue operations (1 female, 2 male). However, one female nurse complained of having been bothered by feelings of fear of earthquake disasters resulting from her rescue experience. Rescue experiences help to strengthen most Taiwanese nurses' professional competency, reinforce their commitment to nursing, and lead them to have positive life goals. The relative weight of the impacts for male and female nurses were somewhat different. The vulnerability of nurses, which was manifested in the post-rescue stage, requires attention and long-term follow-up. A comprehensive and organized pre-rescue training program which recognizes the need to care for both acute and chronic post-disaster conditions, along with spiritual care for the survivors, as well as a "disaster reduction" course for health professionals are suggested.
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Affiliation(s)
- Fu-Jin Shih
- College of Medicine, School of Nursing, National Taiwan University, Taipei
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