Living kidney organ donation: experiences of spousal support of donors

Aim. The purpose of this study was to explore the process of living kidney donation as experienced by husbands of donors to aid nurses and all members of the health care team in promoting informed consent for those considering living donation and to promote the well being of spouses of living donors, donors and their families. Background. The attitudes of husbands of living kidney donors may affect their decision to donate and satisfaction with recovery from donation surgery, thus it is critical to know how husbands of living kidney donors view kidney donation. Methods. Eleven male spouses of living kidney donors were interviewed three months following their wife's donation. Grounded theory methodology was used to inaugurate a substantive theory that describes living kidney donation and its impact on the spousal relationship and family, as experienced by the husband of a donor. Results. The result of the data analysis was a substantive theory pertaining strictly to the husbands’ experiences as the spouse of the living kidney donor. The process commenced with scheduling of the living donation followed by the postoperative time frame, including bringing the donor wife home. The core variable, ‘Fulfilling Your Vows’, described attitudes, behaviours and actions that guided husbands in successfully and generously caring for their wives, their families, the recipients and themselves throughout the living kidney donation process and continuing ‘to this day’. Relevance to clinical practice. The substantive theory of ‘Fulfilling Your Vows’ will guide nurses and other transplant specialists in helping to improve fully informed consent of potential donors before surgery and in developing supportive strategies to maximize spouse, donor and family outcomes throughout the transplantation process.     

Organ and tissue donation: a survey of nurse's knowledge and educational needs in an adult ITU.

The aim of this paper is to present the results of a survey that was undertaken to assess nurses' knowledge and educational needs towards organ donation within one adult general intensive care unit. The survey consists of 31 registered nurses who completed a confidential questionnaire that aimed to assess their existing knowledge and deficits in organ and tissue donation. The survey highlights the sample lacked confidence in approaching relatives for donation consent, deficits in brain stem death testing and donor criteria. It was also apparent that a significant number of nurses could not identify which tissues can be donated and the contraindications for tissue donation. A majority of the sample stated their knowledge of donation issues would improve if an educational programme were developed on organ donation. This is further supported by previous work by [Bidigare S, Oermann M, 1991. Attitudes and knowledge of nurses regarding organ procurement. Heart & lung 1:20-3; Smith-Brew S, Yanai L, 1996. The organ donation process through a review of the literature. Part 1. Accident & emergency nursing 4:5-11; Roark D, 2000. Overhauling the organ donation system. Am J Nurs 6:44-9] who suggest that educational programmes covering donation issues should enhance nurses' knowledge and confidence in the organ donation process and ultimately increase the number of potential donors.     

Organ donation: the family's right to make an informed choice.

The need for organ transplants has increased 200% over the past decade, while the number of organ donors has remained relatively constant. The family's refusal to consent to organ donation has been cited as one of the key factors in the shortage of organs. Lack of understanding about brain death and organ donation have been identified as reasons for refusal to consent. Families of potential organ donors are receiving inadequate information to make informed choices about organ donation, and their emotional needs are not consistently met. Neuroscience nurses can improve consent rates for organ donation by effectively addressing the needs of the potential donor family and offering them the option to donate their loved one's organs.     

Undergraduate nursing students' knowledge and attitudes towards organ donation in Korea: Implications for education

Organ donation from brain dead patients is a contentious issue in Korea within the cultural context of Confucian beliefs. Each year thousands of patients wait for organ donation note poor donation rates and importance of nurses in identifying potential donors. It is therefore important to identify knowledge levels and attitudes towards organ donation from brain dead patients of nursing students as future health workers. Using a 38-item instrument previously developed by the researchers, 292 undergraduate students in a Korean nursing college were surveyed in 2003 in Korea (response rate 92%). Validity and reliability of the instrument was demonstrated using a multiple analytical approach. A lack of knowledge regarding diagnostic tests and co-morbid factors of brain death were noted among students. Their attitudes toward organ donation were somewhat mixed and ambiguous, but overall they were positive and willing to be a potential donor in the future. While this study identified that an effective educational program is necessary for nursing students in Korea to improve their knowledge of brain death and organ donation, further research is also required to verify these single-site findings and improve the generalisability of results.     

Blood,organ and bone marrow donation: Reporting on the attitudes,related to socio-emotional determinants,among nursing students in Greece

Greece is one of the countries with the lowest occurrence of blood, organ, and bone marrow donors. Sociodemographic and other psycho-emotional features such as self-efficacy seem to be linked to attitudes regarding registering as a donor. The aim of this study was to explore the attitudes of nursing students regarding blood, organ and bone marrow donation and socio-emotional background. The study was conducted among the students of the Nursing Department at the University of Thessaly in Central Greece. An electronic self-administered questionnaire was distributed to 480 students and 345 students (response rate: 71.8%) completed the questionnaire. The questionnaire consisted of socio-demographic information, and six questions, concerning knowledge, attitudes and practices towards blood, organ and bone marrow donation. Emotional Discomfort Scale (EmoD), an 8-item tool was also used in order to identify if emotional discomfort through daily activities influences beliefs and responses of the participants. Only one out of five participants had donated blood voluntarily while those who had been already registered as organ and bone marrow donors were quite few, 1.4% and 6.4% respectively. Moreover, only 15.1% of the participants were aware of the legislative framework concerning organ, tissue and bone marrow donation. Multivariate analysis showed that age, nationality and routine emotional discomfort were determinants of blood and organ donation composite score. The use of EmoD Scale could help professionals in health care and social fields to better screen for emotional complexity to become donor, and act in order to positively alter people’s attitudes.     

A cross-validation study of nurses' attitudes and commitment to organ donation in Hong Kong.

This study examined the attitudes and commitment to posthumous organ donation among a group of nurses (N=314) in a teaching hospital in Hong Kong. Attitude was operationally defined by a self-report measure of favorable or unfavorable feelings and beliefs about organ donation, whereas commitment was defined by having signed a donor card. Consistent with findings reported in the West, nurses who exhibited favorable attitudes towards organ donation were of greater proportion than those who had signed a donor card. Younger and unmarried nurses were more likely to commit to posthumous organ donation. More than half (55%) of the nurses were undecided about commitment to organ donation, but most of them were likely to sign a donor card. Principal component analysis confirmed the conceptual structure of the Organ Donation Attitude Scale developed by Parisi and Katz (Health Psychol. 5 (1986) 565-580). Reliability of the factor scores (Humanitarian and moral conviction, Fears of bodily mutilation, and Fears of medical neglect) was satisfactory (Cronbach alpha ranged from 0.80 to 0.86). Fears of bodily mutilation were most significantly related to unwillingness to commit to organ donation. Implications of the findings for nursing education are discussed and suggestions for future research made.     

A study of the perception and experiences of critical care nurses in caring for potential and actual organ donors: implications for nurse education

This paper describes a research study designed to explore the knowledge, perceptions and attitudes of practising critical care nurses towards caring for 'brain stem dead' cadaver organ donors and their families The influence of formal nurse education and experiential learning were investigated together with what nurses felt could better prepare them for this role Data were collected through self-completion questionnaires from 103 critical care nurses This was instrumental in forming a semi-structured interview schedule whereby seven respondents were interviewed The findings of the study suggest that nurses are very favourable towards organ donation and this correlated with their knowledge of brain stem death (P<0 024) Nurses with between 6 and 10 years critical care experience had a significantly higher knowledge base (P<0 05) than those of less or greater experience Nevertheless, when challenged some nurses were less comfortable with the concept of brain stem death and caring for these patients A degree of cognitive dissonance was identified Discussion revealed that all nurses need to have a better understanding of their role in organ donation, no matter what nursing discipline they practice This may help to expel some of the myths that have, undeservedly, become established and given the donor process a rather sinister image     

A donation to life: organ procurement.

1. Only 15% of brain dead patients become organ donors. This is due to a lack of public education regarding the benefits of organ donation, lack of recognition of potential donors, poor donor management, and unfortunately, even the reluctance of health-care workers to approach families with the choice to donate. 2. Once the patient has been officially accepted as an organ donor and the consents have been signed, the donor goes through a thorough evaluation involving physician consultations and lab work, and the medical history is reviewed for possible complications. 3. As many as four surgical teams may be involved in organ procurement, and good communication between nurses, physicians, and coordinators is vital to promote successful recovery of donor organs.     

Understanding the sex disparity in living kidney donation

Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end‐stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex‐based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality. A plausible medical explanation for the sex‐based disparity in living kidney donation includes an uncompromising emphasis on preserving donor health, with less emphasis placed on organ quality, which is the main criterion in deceased donor selection. On the other hand, consent to deceased donation is also greater in women, indicating their greater desire to donate even though fewer women actually become deceased donors. Therefore, nonmedical reasons for the sex disparity in living donation must be sought. Increased empathic distress or emotional memory; a greater sense of responsibility, urgency, and impulsiveness with increased reaction to empathy; a different body image; and a different social status may all contribute to greater living kidney donation in women. Economic inequity may be the singular explanation when personal worth links to economic worth. To better understand the sex disparity in living kidney donation, we need better data on the reasons behind both nondonation and donor rejection after evaluation in clinical practice. Nondirected living kidney donation provides unique opportunities to minimize factors such as emotional distress, empathy, and impulsiveness. More liberal acceptance criteria for donors with isolated medical abnormalities and testing legitimate donor reimbursement strategies based on actual income levels rather than a fixed amount can assist in both ascertaining the reasons behind the sex disparity in living kidney donation and increasing overall living kidney donation rates.     

Contribution of attitudinal factors to blood donation in African American church attendees

BACKGROUND: Historically, African Americans have a general mistrust for the health care system that has contributed to significant health disparities. The goal of this study was to evaluate whether this distrust among African Americans affects attitudes toward blood donation. STUDY DESIGN AND METHODS: Fifteen African American churches in metropolitan Atlanta participated in an 81‐item self‐administered survey. The questionnaire assessed barriers and motivators for, and knowledge and beliefs about, blood donation in African Americans. Bivariate analysis and logistic regression models were performed. RESULTS: A total of 930 individuals responded to the survey. This group was 99% African Americans, 71% female, and 84% college educated, 54% with a household income of at least $50,000 and mean age of 47 ± 14 years. Donation history was 3% current donors, 46% lapsed donors, and 40% nondonors. Respondents who trusted versus distrusted hospitals had more knowledge of the blood supply and less fear of donation and were more likely to respond to blood needs of the community. In a multivariate logistic regression model, donors were more likely to trust hospitals (p = 0.003) and were more likely to have participated in research (p < 0.001) than nondonors. CONCLUSION: African American distrust of the health care system is associated with decreased likelihood of previous blood donation. This may be secondary to donor centers being viewed as a component of the health care system. Building trust between donor centers and African American community by ensuring the safety of donation may increase African American blood donation rates.     

Psychosocial factors influencing nurses' involvement with organ and tissue donation

This paper focuses on the first phase of a 3-year study that explored the psychosocial factors that influence nurses' willingness to discuss post-mortem donation intentions with relatives of potential organ and tissue donors. The United Kingdom's donation system is dependent upon such discussions taking place. A cross-sectional survey of 776 randomly selected nurses, from two health regions in the United Kingdom, found that personal negative attitudes to aspects of donation and transplantation, fears and misconceptions about the donation process, clinical area of work, past experience, and socio-historical factors influence discussion behaviour. Knowledge deficits were discovered, together with requests for general information about the donation process and specific information about the organ and tissue donor exclusion criteria.     

Vasovagal symptoms mediate the relationship between predonation anxiety and subsequent blood donation in female volunteers

BACKGROUND: Although not universal, a certain amount of predonation anxiety is common and not surprising among inexperienced blood donors. Variations in predonation anxiety, however, may influence the donor's experience in several respects and might be related to the likelihood of subsequent donation even among those who do not report particularly high levels of anxiety. STUDY DESIGN AND METHODS: A total of 671 inexperienced blood donors (zero or one prior donation) enrolled in a treatment study and completed questionnaires assessing anxiety before and after giving blood. Ratings of pain and blood donation-related symptoms were obtained after giving blood, as well as information from the nurses about the blood donation procedure. Follow-up information on number of additional visits to a blood collection clinic during the subsequent year was also obtained for most participants. RESULTS: Predonation anxiety was positively related to ratings of blood donation-related symptoms and chair reclining by the nurses and negatively related to the donor's rating, obtained at the end of the procedure, of the likelihood that he or she would give blood again. Women, but not men, with higher predonation anxiety were significantly less likely to return to a blood clinic in the following year. The results of mediation analyses suggest that this was due to the association between anxiety and donation-related symptoms. CONCLUSION: The results do not indicate whether or not it is feasible or useful to modify predonation anxiety, but highlight the relationships between the emotional state of inexperienced donors and several aspects of the donation experience, including subsequent donor return. Further study of the psychosocial aspects of blood donation and examination of related research (e.g., treatment of dental anxieties) may be worthwhile.     

Attitudes of critical care nurses toward organ donation

In October, 1987, federal legislation requiring hospitals to develop protocols to encourage organ and tissue donation went into effect. Despite required request legislation, a lack of donors still exists. The attitudes of the critical care nurses caring for potential organ donors may have an effect on the actual donation of organs. This author describes how knowledge level and experience with organ donors and recipients affected the attitudes of two groups of critical care nurses towards organ donation.     

What's New in the Transplant OR?

Advancements in transplantation offer promising treatment options for a variety of diseases. Organ donation, an essential part of organ transplantation, may be performed at hospitals even if the facility is not a transplant center; therefore, perioperative nurses should be aware of developments in transplantation and the implications for patient care at their facilities. Considerations for organ transplant protocols include the type of documentation required, the elements of the transplant OR time out, and the use of intraoperative anti-rejection medications. Considerations for organ donation protocols include issues specific to a deceased donor, a living donor, or a donation after cardiac death. Newer developments in the transplant OR include laparoscopic kidney donation and transplantation, kidney paired donation transplantation, other living donor procedures, and transplantation procedures using robotic technology.     

Organ donation: a nursing perspective

The frequency and success rate of organ donation and transplant surgery has dramatically increased over the past several years. Since organ donors are drawn primarily from the traumatically brain-injured population this increase has a direct impact on neuroscience nurses. This article addresses the organ procurement process, nursing care of the organ donor and the interrelationship of organ donation and neuroscience nursing.     

Organ donation and neuroscience nursing: your role in the process.

The death of a patient is seen by many nurses as the end of their interaction with the patient and family. However, the option of organ donation may extend that interaction and present another opportunity to serve as an advocate for the family, as well as for patients whom the nurse has never met. Patients who have been declared brain dead or from whom life support is going to be withdrawn following a neurological injury are potential organ donors. Although these patients and their families are frequently under the care of neuroscience nurses, all nurses need a thorough understanding of their responsibilities regarding identification and referral of potential organ donors to the designated Organ Procurement Organization (OPO). In addition, it is essential for nurses to understand the clinical presentation and determination of brain death in order to provide patient care and family education. Understanding how consent for organ donation should be obtained from families and how the organ recovery process works enables the nurse to collaborate with OPO staff and support the family in their decision regarding organ donation.     

儿童心脏死亡器官捐献与肾脏移植1例报告

背景：器官短缺是全球移植界共同面临的难题,为扩大供者来源,缓解日益紧张的器官短缺,回避因脑死亡立法及诊断标准缺位造成的困惑,卫生部和中国红十字会联合推动心脏死亡器官捐献。目的：探讨开展儿童心脏死亡器官捐献的可行性。方法：回顾性分析解放军南京军区福州总医院1例儿童心脏死亡肾脏捐献案例,结合文献进行分析。结果与结论：4岁男孩,心肺复苏后脑死亡,经过2次两组专家时隔24h按脑死亡判定标准（儿童）和脑死亡判定技术规范,以及阿托品试验结果独立作出判定。捐献者父母对捐献方案知情同意,书面表达捐献意愿,且得到医院伦理委员会批准。按中国心脏死亡器官捐献工作指南逐步完成捐献申请、审批、转运、器官维护,以及生命支持治疗撤除、器官切取过程,热缺血时间13min。按年龄、体质量和组织配型结果选择受者,2只肾脏分别植入2例尿毒症受者体内,左肾接受者为13岁女性,右肾接受者为35岁女性,术后未发生肾功能延迟恢复,无移植肾血管栓塞、尿瘘、输尿管梗阻等并发症。术后1年内移植肾由术前7cm增大至10cm,尿蛋白阴性,血肌酐≤60μmol/L,估算肾小球滤过率70-150mL/min。术后至今均未发生严重感染事件,血压正常,无糖尿病、高脂血症、肝功能损害等并发症,现生活自理,精神状态好,遵医行为佳。提示儿童心脏死亡器官捐献是过渡时期解决器官来源的方向之一。必须严格遵守患者救治利益高于一切的基本原则,积极探索儿童心脏死亡器官捐献规范化操作程序。     

COVID-19 related callback in blood donors; Outcomes in blood donors and patients

Call back as a procedure to report post donation symptoms or illness by donors has been established since 2009 in Iranian Blood Transfusion Organization (IBTO). During the first phase of COVID-19 outbreak, all blood donors were requested to report any respiratory infection symptoms after donation. The study investigated the callback data of COVID-19 in Tehran Blood Center during the first 3 months of the outbreak in Iran. The purpose of this study was to estimate the frequency of post donation COVID-19 related call back reports and determine its implications for blood donors and patients.A telephone interview was conducted with donors who had reported COVID-19 symptoms. Some questions were asked to evaluate donor′s health at the time of blood donation. The donors categorized into three groups: laboratory-confirmed, suspected, and COVID-19 irrelevant based on their answers. In cases that the blood component obtained from a laboratory-confirmed donor had been released, the hospital was notified and asked to follow up the recipient for COVID-19.The results showed 30 donors (0.08 %) had callback related to COVID-19 and 76.63 % of the obtained component was disposed. The results also showed that only one donor had a laboratory-confirmed result with the RBC unit processed from her whole blood released for transfusion. The RBC unit recipient did not show any signs or symptoms of infection during a 46-day follow-up.Concluded that callback system was effective to remove most of the components obtained from the donors who reported to be COVID-19 suspected or confirmed. Moreover, the result did not support virus transmission through blood transfusion.     

Safety of donating multiple products in a single apheresis collection: Are we expecting too much?

Modern blood separators rapidly process many liters of donor blood and efficiently collect vast quantities of blood components from donors, who may be stimulated with potent recombinant hematopoietic growth factors or cytokines. Accordingly, the potential risks of modern multiple product/unit apheresis donations and recombinant growth factors is analyzed in this report. As is true for all medical procedures, risks are associated with apheresis donations. Risks of a "standard" apheresis donation, in which one unit of PLTs or plasma is collected, are comparable to the risks of whole blood donation. Risks of multiple unit apheresis donations, in which either vast quantities of a single blood component or multiple units of various components are collected, are incompletely understood, particularly, when donors are stimulated with recombinant hematopoietic growth factors to increase component yields. To minimize donor risks and to increase knowledge of multiple component apheresis donations, both short-term problems (e.g., donor reactions accompanying apheresis procedures and pre- vs. post-procedure changes in results of donor laboratory studies) and long-term problems (e.g., medical diagnoses/problems and abnormalities of donor blood counts and laboratory test results) should be monitored, ideally, by a repeat donor registry. When recombinant hematopoietic growth factors are prescribed, donors should give informed consent, and blood center professionals must be aware of 1) the effects of these drugs given at pharmacologic, rather than physiologic, doses; 2) the differences between the molecular structure of recombinant vs. natural/endogenous growth factors; 3) the fact that recombinant growth factors have both narrow/focused and broad biological activities; and 4) the probability that results of studies in sick/immunosuppressed patients may not be applicable to healthy/immunocompetent donors.     

Organ donation: a university hospital experience

To define the size of the donor pool among nontrauma patients and the role of physicians in the limited supply of organs available for transplantation, we reviewed the 1293 nontrauma deaths that occurred in Vanderbilt University Medical Center during a 31-month period. Computerized discharge abstracts showed that 111 adults died without contraindications to organ donation. Manual review of these 111 medical records yielded 68 records suitable for review by Tennessee Donor Services. From this group 10 eligible donors were identified. Physicians failed to ask the families of three patients, families of three patients refused organ donation, and one patient had cardiovascular collapse before the donation process could be completed. Organs were successfully donated from three patients. All eligible donors died of intracerebral hemorrhage or drug overdose. Failure of physicians to approach families for donation was not based on medical criteria, and it resulted in organ wastage. As a result of this study, we have developed a simplified audit process for hospitals to use in evaluating compliance with required request legislation.