National evaluation of healthcare provider attitudes toward organ donation after cardiac death.
OBJECTIVE
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.


METHODS
We conducted a qualitative analysis of focus group transcripts to identify issues of broad importance.


METHODS
Healthcare setting.


METHODS
Participants included 141 healthcare providers representing critical care and perioperative nurses, transplant surgeons, medical examiners, organ procurement personnel, neurosurgeons, and neurologists.


METHODS
Collection and analysis of information regarding healthcare providers' attitudes and beliefs.


RESULTS
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.


CONCLUSIONS
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.
Mandell
M Susan
MS
Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, CO, USA.
Zamudio
Stacy
S
Seem
Debbie
D
McGaw
Lin J
LJ
Wood
Geri
G
Liehr
Patricia
P
Ethier
Angela
A
D'Alessandro
Anthony M
AM
D001291:Attitude of Health Personnel; D016265:Conflict of Interest; D003643:Death; D017144:Focus Groups; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D036301:Qualitative Research; D013727:Terminal Care / Q000941:ethics / Q000523:psychology; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000592:standards*