Understanding the antecedents of the acceptance of donation after cardiac death by healthcare professionals.
OBJECTIVE
A 3-yr study funded by the U.S. Department of Health and Human Services was conducted to identify potential barriers to and opportunities for increasing the number hospitals with donation after cardiac death (DCD) protocols, the support of DCD by individuals involved in the donation request process, and the number DCD donors recovered. This study reports the qualitative findings.


METHODS
Methods used included an advisory committee and an extensive array of key informant interviews and focus groups.


METHODS
Hospitals and telephone contact.


METHODS
Discussions with nurses, physicians, social service staff, clergy, administrators, and organ procurement organization staff. A total of 216 people participated.


METHODS
Collection and analysis of information regarding perceptions of DCD, potential barriers and opportunities, and strategies for gaining support.


RESULTS
Key barriers included a lack of knowledge about DCD, psychological barriers for DCD vs. brain death, concerns about whether death has been reached, saving vs. killing patients, trust in the organ procurement organization, moving from saving patients to being a donation advocate, and concerns with the DCD process. Opportunities included education initiatives, well-trained requesters, a cultural shift, a consistent DCD protocol separating care from recovery, process monitoring, and a strong sense of teamwork.


CONCLUSIONS
Our findings provide a better understanding of healthcare professionals' knowledge, attitudes, and behaviors regarding DCD. Understanding these issues is critical to the implementation of strategic plans for DCD programs. One of the biggest barriers to overcome is a lack of knowledge of DCD, which leads to misperceptions, which in turn contribute to negative attitudes and/or discomfort by healthcare professionals. Communication efforts that are able to educate healthcare professionals and eliminate misperceptions will increase support for DCD. Key to future success requires confident and well-trained DCD requesters.
D'Alessandro
Anthony M
AM
University of Wisconsin School Medicine and Public Health, Madison, WI, USA.
Peltier
James W
JW
Phelps
Joseph E
JE
D026683:Advisory Committees / Q000458:organization & administration*; D001926:Brain Death / Q000175:diagnosis; D003144:Communication Barriers; D003422:Critical Care / Q000592:standards; D003643:Death; D005190:Family / Q000523:psychology*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011369:Professional-Patient Relations; D009927:Tissue and Organ Procurement