Facilitators and Barriers in the Organ Donation Process: A Qualitative Study among Nurse Transplant Coordinators

Religio-cultural facilitators and barriers in decision-making on organ donation: The experiences of families of brain-dead patients in Iran

This study aimed to explore the experiences of families of brain-dead patients regarding religio-cultural facilitators and barriers in decision-making for organ donation. This is a qualitative descriptive study, in which a total of eighteen families of brain-dead patients were recruited using purposive sampling. Data were collected using semi-structured face-to-face interviews. After recording and transcribing the interviews, concepts were extracted using conventional content analysis. The main theme was entitled "religio-cultural facilitators and barriers in decision-making on organ donation" and consisted of four main categories, including two facilitators of "life-giving culture" and "life-giving sacredness" and two barriers of "decision-making skepticism" and "opportunity-burning religiousization". Therefore, cultural and religious issues require further attention and a more realistic and logical cultural and religious perspective toward organ donation should be created at the societal level.

What determinants impact deceased organ donation consent in the adult intensive care unit? An integrative review exploring the perspectives of staff and families

BACKGROUND

Deceased organ donation saves lives. Donation processes in New Zealand operate under an opt-in system, which requires consent from families of patients diagnosed with brain death or circulatory death while in the intensivecare unit. The donation demand and supply mismatch is a global phenomenon.

OBJECTIVES

The objective of this study was to understand the determinants of deceased organ donation decisions in the adult intensive care setting from the perspectives of staff and families.

METHODS

An integrative review based on Whittemore and Knafl's approach searched literature through databases CINAHL Plus, SCOPUS, Proquest Medline Ovid, and manual ancestry searches. Inclusion/exclusion criteria screened for pertinent literature, which were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Selected studies were appraised using a generic scoring tool, and data were systematically extracted and coded onto spreadsheets using inductive, thematic analysis.

RESULTS

A total of 21 studies (12 qualitative, seven quantitative, two mixed methods) were included. Publication dates ranged from 1993 to 2021 from multiple countries (18 opt-in, three opt-out systems). Four overarching themes pertaining to families and staff were generated. Important knowledge related to families' knowledge deficits around brain death, the purpose of ventilation, donation procedures, patients' wishes, and staffs' lack of training. Challenging communication highlighted miscommunications due to language choices and interrupted continuity of care during staff-family interactions. Internal determinants explored the cultural, spiritual, and emotional perspectives of families, while staff faced a sense of burden and conflicting values in delivering care between donors and recipients. External determinants related to the clinical environment impacting on grieving families, while for the staff, it explained concerns around resources and organisational processes.

CONCLUSIONS

Factors underpinning deceased organ donation are multifaceted and complex. Staff actions and families' decisions are inextricably intertwined. Modifiable factors include a lack of formal training and communicational skills and environmental limitations of an intensive care setting.

Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study

Background

Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors.

Methods

In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals.

Results

A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals.

Conclusions

This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Opt-in Vs. Opt-out of Organ Donation in Scotland: Bioethical analysis

This paper looks at the ethics of opt-in vs. opt-out of organ donation as Scotland has transitioned its systems to promote greater organ availability. We first analyse studies that compare the donation rates in other regions due to such a system switch and find that organ increase is inconclusive and modest at best. This is due to a lack of explicit opt-out choices resulting in greater resistance and family override unless there are infrastructures and greater awareness to support such change. The paper then looks at the difference between informed consent of the opt-in vs. presumed consent in the opt-out approaches. Patient autonomy and dignity are better reflected with informed consent. Eighteen months have passed since the new organ donation policy has come into effect, this paper recommends more research into organ donors' psychological motivations to help governments and the healthcare profession obtain more organs for transplantation.

Concerns and Challenges of Living Donors When Making Decisions on Organ Donation: A Qualitative Study

Background

Mental concerns of living donors can be a solid barrier to logical and informed decision-making for organ donation. The present study explores living donors' mental concerns and problems during the process of decision-making for organ donation.

Materials and Methods

present study was performed using qualitative content analysis. Twenty-one participants were selected by purposive sampling. The data were collected and recorded through semistructured interviews and analyzed by MAX Qualitative Data Analysis software 12, based on Graneheim and Lundman's contractual content analysis method.

Results

Data analysis extracted 425 codes, 13 subcategories, 3 main categories, and 1 core theme (conflict between doubt and certainty). The three main categories were individual barriers and concerns (faced by the donor), interpersonal concerns and barriers (experienced by the family), and socio-organizational concerns and barriers (at the community).

Conclusions

Based on the results, donors have significant concerns and face major problems when deciding on organ donation. Therefore, health-care professionals should take into account organ donors' concerns, raise awareness of donor associations, and formulate policies to increase living donors' satisfaction.

Edgework emotion management: A constructivist grounded theory of organ donation nurses' experiences and practices

AIMS AND OBJECTIVES

To explore nurses' experiences when approaching families for organ donation authorisation to guide nursing practice.

BACKGROUND

Organ donation after brainstem death implies that bereaved families are approached to discuss organ donation authorisation, and in many countries, specialist nurses do this approach. The literature describes the social, psychological and emotional challenges of health professionals in this role. However, lack of conceptual clarity regarding nurses' experiences on approaching families to guide nursing practice was found.

DESIGN

Constructivist grounded theory.

METHODS

Between October 2017 and July 2019, seven months of observations were conducted across two large public hospitals in Chile. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) with 71 participants (51 healthcare professionals and 20 bereaved families) were included. Data collection and analysis followed the principles and practices of Charmaz' constructivist grounded theory. The COREQ checklist was followed in reporting the study.

RESULTS

Edgework emotion management of organ donation nurses was developed as a threefold process: 1) being present to recognise inner and family emotions, 2) being on an emotional edge when approaching families and 3) extending the emotional edge to make sense of their experiences. The grounded theory was conceptualised using edgework emotion management by Lois (2003), which allowed to elucidate organ donation nurses' experiences and practices on managing their emotions.

CONCLUSIONS

Organ donation nurses develop a sophisticated and complex emotional regulation process to approach and care for families when negotiating organ donation authorisation for transplantation.

RELEVANCE TO CLINICAL PRACTICE

The experiences of specialist organ donation nurses entail a sophisticated emotion management process, which may explain the complexities of a critical role within healthcare institutions. Findings can be locally and internationally used to understand, educate and guide nursing practice, in an area of increasing specialisation and staffing shortages such as organ donation and transplantation.