Mandell M Susan, Zamudio Stacy, Seem Debbie, McGaw Lin J, Wood Geri, Liehr Patricia, Ethier Angela, D'Alessandro Anthony M
Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, CO, USA.
Crit Care Med. 2006 Dec;34(12):2952-8. doi: 10.1097/01.CCM.0000247718.27324.65.
Organ donation after cardiac death will save lives by increasing the number of transplantable organs. But many healthcare providers are reluctant to participate when the withdrawal of intensive care leads to organ donation. Prior surveys indicate ethical concerns as a barrier to the practice of organ donation after cardiac death, but the specific issues that characterize these concerns are unknown. We thus aimed to identify what barriers healthcare providers perceive.
We conducted a qualitative analysis of focus group transcripts to identify issues of broad importance.
Healthcare setting.
Participants included 141 healthcare providers representing critical care and perioperative nurses, transplant surgeons, medical examiners, organ procurement personnel, neurosurgeons, and neurologists.
Collection and analysis of information regarding healthcare providers' attitudes and beliefs.
All focus groups agreed that increased organ availability is a benefit but questioned the quality of organs recovered. Study participants identified a lack of standards for patient prognostication and cardiopulmonary death and a failure to prevent a conflict between patient and donor interests as obstacles to acceptance of organ donation after cardiac death. They questioned the practices and motives of colleagues who participate in organ donation after cardiac death, apprehensive that real or perceived impropriety would affect public perception.
Healthcare providers are uncomfortable at the clinical juncture where end-of-life care and organ donation interface. Our findings are consistent with theories that care providers are hesitant to perform medical tasks that they consider to be outside the focus of their practice, especially when there is potential conflict of interest. This conflict appears to impose moral distress on healthcare providers and limits acceptance of organ donation after cardiac death. Future research is warranted to examine the effect of standardized procedures on reducing moral distress. The hypothesis generated by this qualitative study is that use of neutral third parties to broach the subject of organ donation may improve acceptance of organ donation after cardiac death.
心源性死亡后的器官捐赠将通过增加可移植器官数量挽救生命。但当重症监护撤除导致器官捐赠时，许多医疗服务提供者不愿参与。先前的调查表明伦理问题是心源性死亡后器官捐赠实践的障碍，但构成这些问题的具体事项尚不清楚。因此，我们旨在确定医疗服务提供者察觉到的障碍。
我们对焦点小组记录进行了定性分析，以确定具有广泛重要性的问题。
医疗环境。
参与者包括141名医疗服务提供者，代表重症监护和围手术期护士、移植外科医生、法医、器官获取人员、神经外科医生和神经科医生。
收集和分析有关医疗服务提供者态度和信念的信息。
所有焦点小组都认为增加器官可用性是一项益处，但对获取器官的质量表示质疑。研究参与者指出，缺乏患者预后和心肺死亡的标准，以及未能防止患者与捐赠者利益冲突，是接受心源性死亡后器官捐赠的障碍。他们对参与心源性死亡后器官捐赠的同事的做法和动机提出质疑，担心实际或被认为的不当行为会影响公众认知。
医疗服务提供者在临终护理与器官捐赠交汇的临床关头感到不安。我们的研究结果与以下理论一致，即护理人员不愿执行他们认为超出其执业重点的医疗任务，尤其是在存在潜在利益冲突时。这种冲突似乎给医疗服务提供者带来了道德困扰，并限制了心源性死亡后器官捐赠的接受度。有必要进行未来研究，以检验标准化程序对减少道德困扰的影响。这项定性研究产生的假设是，使用中立第三方提及器官捐赠主题可能会提高心源性死亡后器官捐赠的接受度。
