Challenges in facing organ donation request of the family of brain-dead patients: a qualitative analysis

Document Type: Original Quantitative and Qualitative Research Paper

Authors

1 Assistant professor, Department of medical- surgical, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate Professor of Nursing, Department of Nursing, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

3 Associate Professor of Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: The sudden nature of confrontation with brain death complicates organ donation request and makes the understanding difficult  for the family. Understanding the experience of these families with inductive approach provides a better understanding of their problems and explains the approaches to help families in this difficult and complex situation.
Aim: To discover mental concerns and challenges in brain-dead patients’ families while confronted with organ donation request
Methods: This qualitative study was conducted with content analysis approach. Data were collected using 24 unstructured, in-depth interviews and 14 supplementary interviews with 14 brain-death patient's families consented to organ donation, as well as 12 families who refused organ donation. Individuals were enrolled in the study using the information obtained from center of organ transplantation of Mashhad University of Medical Science from July 2009 to October 2011. Data analysis was carried out simultaneously as they were collected using content analysis with the conventional approach.
Results: Analysis of the data resulted in 680 codes, 12 categories, and 3 themes. The themes included doubt, fear, and hope, which the “Triangle of decision making purgatorial” was extracted as central theme.
Conclusion: Facing brain death and organ donation request is a complicated process that its acceptance is difficult and decision-making is full of challenges. Therefore, it seems that it is essential to support the family and pay attention to their mental challenges when requesting for organ donation.

Keywords

Main Subjects


  1. Levy CR, Ely EW, Payne K, Engelberg RA, Patrick DL, Curtis JR. Quality of Dying and Death in Two Medical ICUs: Perceptions of Family and Clinicians. Chest 2005; 127:1775–83.
  2. Heyland DK, Rocker GM, O’Callighan CJ, DodekPM, Cook DJ. Dying in the ICU: Perspectivesof Family Members. Chest 2003; 124(1):392–7
  3. Corr CA, Coolican MB.Understanding Bereavement, Grief and Mourning: Implications for Donation and Transplant Professionals.Prog Transplant 2010; 20(2):169-77.
  4. Siminoff LA, Mercer MB, Arnold R. Families’understanding of Brain Death. Prog Transplantation 2003; 13(3):218–24.
  5. Randell TT. Medical and Legal Considerationsof Brain Death. ActaAnaesthesiol Scand2004; 48:139–144.
  6. Karcioglu O, Aryik C, Erbil B. The brain-dead patient or a flower in the vase? The Emergency Department Approach to the Preservation of the Organ Donor. Eur J Emer Med 2003; 10:52–7
  7. Sque M. Researching the Bereaved: An Investigator’s Experience.Nurs Ethic2007; 7 (1):23-34.
  8. Baumrucker SJ, Stolick M, Morris GM, Carter GT, Sheldon JE. Brain Death and Organ Transplantation. Am J HospPalliat Care 2007; 24(4): 325-30.
  9. Evans D. Brain Death: The Family in Crisis.Intensive Crit Care Nurs 1995; 11(6): 318-21.
  10. Rocheleau C. Increasing Family Consent for Organ Donation: Findings and Challenges. Prog Transplant2001; 11(3):194-200.
  11. Long T, Sque M, Payne S. Information Sharing: Its Impacton Donor and Nondonor Families’ Experiences in the Hospital.Prog Transplant 2006; 6(2):144-9.
  12. Daly BJ. End-Of-Life Decision Making, Organ Donation, Andcritical Care Nurses. Crit Care Nurse 2006; 26(2):78-86.
  13. Phillips Riley L, Coolican MB. Needs of Families of Organdonors: Facing Death and Life. Crit Care Nurse 1999; 19(2):53-9
  14. Linosa K, Frasera J, Freemanb WD, Foota C. Care Of the Brain-Dead Organ Donor.
    CurrAnaesthCrit Care 2007; 18(5): 284–94.
  15. Eckenrod EL. Psychological-Emotional Trauma of Donor Families.Transplant Proc 2008; 40:1061–3
  16. Sque M, Long T, Payne S, and Allardyce D.Why Relatives Do Not Donate Organs for Transplants: 'Sacrifice' Or 'Gift of Life'.J Adv Nurs 2008; 61(2):134-44.
  17. 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 2004; 15: 147-54.
  18. Frutos M, Ruiz P, Requena M, Daga D. Family Refusal In Organ Donation: Analysis Of Three Patterns.Transplant Proc 2002; 34: 2513–4
  19. Einollahi B, Nourbala1 MH, Bahaeloo-HorehS, Assari SH, Lessan-Pezeshki M, SimforooshN. Deceased-Donor Kidney Transplantation in Iran: Trends, Barriers and Opportunities. Indian J Med Ethics 2007; IV(2): 70-2
  20. Streubert H and Carpenter D. Qualitative Research in Nursing: Advancing the Humanistic Imperative. Philadelphia, PA: Lippincot, Williams &Wilkins, 2007.
  21. Krippendorff K. Content Analysis: An Introduction to Its Methodology. Thousand Oaks, CA: SAGE, 2004.
  22. Manuel A, Solberg S, MacDonald S. Organ Donation Experiences Of Family Members. NephrolNurs J 2010; 37(3):229-36.
  23. Pearson IY, Bazeley P, Spencer-Plane T, Chapman JR, Robertson P. A Survey of Families Of Brain Dead Patients: Their Experiences, Attitudes To Organ Donation And Transplantation. Anaesth Intensive Care 1995; 23(1): 88-95
  24. Warren N.A. Critical Care Family Members’ Satisfaction with Bereavement Experiences. Crit Care Nurs Q 2002; 25(2): 54-60.
  25. BellaliT, Papazoglou I, Papadatou D. Empirically Based Recommendations to Support Parents Facing the Dilemma of Pediatric Cadaverorgan Donation. Intensive Crit Care Nurs 2007; 23: 216-25
  26. Farsides B. Respecting Wishes and Avoiding Conflict: Understanding the Ethical Basis for Organ Donation and Retrieval.Br J Anaesth 2012; 108( Suppl)1:i73-9
  27. Blok GA, van Dalen J, Jager KJ, Ryan M, Wijnen RM, Wight C, Morton JM, Morley M, Cohen B.The European Conor Hospital Education Programme(EDHEP): Addressing The Training Needs Of Doctors And Nurseswho Break Bad News, Care For The Bereaved, And Requestdonation. Transpl Int 1999; 12(3):161-7.
23.    Franz H.G, Delong W,Wolfe S.W, Nathan H,Payne D,Reitsma W,Beasly C.Explaining Brain Death: A Critical Feature Of The Donation Process. J Transpl Coord 1997; 7(1): 14-21.
29.    Douglass G.E, Daly M. Donor Families’ Experience Of Organ Donation.Anaesth Intensive care 1995; 23:96-8
30.    Floden A, Kelvered M, Frid I, Backman L. Causes Why Organ Donation Was Not Carried Out Despite The Deceased Being Positive To Donation. Transplant Proc 2006; 38: 2619–21