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Exploring staff perceptions of organ donation after circulatory death

Version 2 2024-06-03, 08:18
Version 1 2019-06-14, 14:11
journal contribution
posted on 2024-06-03, 08:18 authored by LA Milross, TG O'Donnell, Tracey BucknallTracey Bucknall, DV Pilcher, JF Ihle
BACKGROUND AND OBJECTIVE: Solid organ donation remains low in Australia; however, donation after circulatory death (DCD) bolsters rates and is associated with good short- and long-term clinical outcomes among recipients, especially in lung and kidney recipients. However, its reintroduction is met with resistance within hospitals. The aim of the present study was to develop a greater understanding of DCD perceptions among staff involved. METHODS: This descriptive exploratory study incorporated open-ended and scaled questions with intensive care staff at a public tertiary teaching hospital in Australia. Interviews were digitally recorded and transcribed verbatim before thematic analysis. Quantitative responses were assessed using a 10-point Likert scale. RESULTS: Twelve participants were interviewed. Responses to the Likert scale questions were averaged. Donation after brain death was unanimously accepted (average = 10.0), whereas DCD acceptance was lower but remained supported (average = 8.8). Interview responses generated five themes, each containing subthemes. Respondents had concerns with DCD where perceptions existed that DCD would increase family distress, from either timeframes not being met or logistical delays. A second major source of concern stemmed from personal conflict relating to their role. There was difficulty transitioning from primarily sustaining life or facilitating palliation alone to advocating for DCD, especially where there was perceived potential for deviations from standard palliation in analgesia, sedation, and investigations. Overall, concerns were overcome by reliance on a supportive work environment, rationalisation of concerns over time, and reliance on protocols. CONCLUSIONS: Supportive leadership within the hospital's intensive care unit meant DCD occurred with minimal institutional resistance. However, some individual concerns surrounding DCD were identified. These may be present and amplified in other centres. More study is required in centres where institutional resistance to DCD is identified so that DCD may be further promoted to expand the donor pool.

History

Journal

Australian Critical Care

Volume

33

Pagination

175-180

Location

Australia

ISSN

1036-7314

eISSN

1878-1721

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2019, Australian College of Critical Care Nurses Ltd.

Issue

2

Publisher

ELSEVIER SCIENCE INC