FACTORS INFLUENCING ORGAN DONATIONS 1

​ Factors Influencing the​ ​Decision Making for Organ Donations

Elena Anikeeva

Athabasca University

NURS 324

Tina Ainsworth

September 30, 2020

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Annotated Bibliography:

​ Factors Influencing the​ ​Decision Making for Organ Donations

Organ transplantation has been successful for many years now. Over time it has

improved and transformed from trials to a standard option and choice. Even though it

has been used successfully and supported by medical professionals and the majority of

the general population, there are still misconceptions, conspiracy theories, negative

publicity and lack of knowledge that create obstacles and influence the decision making

process of organ donation. Evaluating, analyzing and researching the factors that

influence the decision-making by relatives and next-of-kin can provide an insight that

could help the nurses and/or health care professionals approach such a delicate

situation.

Siminoff LA, Gordon N, Hewlett J, Arnold RM. Factors Influencing Families' Consent for

Donation of Solid Organs for Transplantation.

This article is a research study that explores and evaluates factors that influence

organ donation decisions by family members and next-of-kin. The information

was collected by conducting interviews with health care workers, organ

procurement organization (OPO) staff and family members of possible donors.

These are few examples of what the study revealed. Families were more likely to

be open to consent to organ donation when they were approached by a health

care professional other than a physician followed by a meeting with OPO staff

exceeded any other patterns. Families who anticipated or who raised the issue,
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and who showed an understanding of what brain death is, were more likely to

donate. Some other variables included in the positive decision were families of

potential donors who were younger, male, and who died from trauma as well as

families of donors who were white, and thought that the patient would make the

decision to donate. Contrarily, there are some examples of factors that would

result in refusal of organ donation. One which is shown to be how the request

was made. Families that were not expecting such a request, who felt harassed

and influenced by staff or when told that healthcare workers were required to ask

about the donation were less likely to consent. It is impossible to create a one fits

all approach, but this research study is extremely helpful in identifying major

influencing factors that could help nurses and other health care practitioners in

their assessments of the family’s initial reaction to the organ donation request.

Nurses and healthcare professionals have to learn how to ask about organ

donation in an appropriate and sensitive manner. This study can help to develop

guidelines for the nurses to make organ donation requests more successful.

Liva Jacoby, PhD, MPH; James Jaccard, PhD ​Am J Crit Care​ (2010) 19 (5):

e52–e61. Perceived Support Among Families Deciding About Organ Donation for

Their Loved Ones: Donor Vs Nondonor Next Of Kin.

This research study provides a more detailed overview compared to other

research of how specific supportive measures provided to the family by

staff during the hospital stay influences the decision about organ donation.
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Families that were provided with support elements by staff, such as

emotional support (understanding, listening, physical presence at times

when the families needed them, giving families hope to continue etc.),

instrumental support (providing physical necessities like blankets,

toiletries, food and drinks), informational support (status of the patient,

prognosis, answering questions) showed significantly a higher rate of

organ donations. Another important factor was a perceived quality of care

for the patient. When families felt that their loved ones were treated with

compassion and respect, they were more likely to agree to donation. A

very interesting finding was that non-donors’ families were more likely to

regret their decision and voiced uncertainty compared to the donors’

families. After performing multivariate analysis the strongest precursor for

organ donation is informational support. These findings are rather specific

and showed to be good predictors of consent. The supportive measures

mentioned in this study can be used as guidelines for developing training

and educational programs for nurses and health care professionals.

Manuel, A., Solberg, S., & MacDonald, S. (2010). Organ donation experiences of

family members. ​Nephrol Nurs J​, ​37(​ 3), 229-36.

This research article gives an insight into the experiences the donors’

families had , their perception and understanding of the medical condition

and diagnosis of their loved ones, and some of their thought process
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during the decision-making about organ donation. The authors’ goal is to

help nurses to gain a better understanding of what the families go through

when they are approached about the organ donation and to help develop

strategies to assist families during this process. Nurses describe their role

in the organ donation process as physically and emotionally stressful, due

to lack of clarity is attached to the definition of brain death, the lack of

knowledge of the organ donation process, a discord between guidelines

for clinical practice and policies for organ procurement, ethical conflicts

between providing the best care for the patient with brain injury versus

preserving organs for harvesting and the lack of confidence in their

preparedness to provide adequate support to the donors’ families.

Participants of this study expressed difficulty understanding the medical

criteria for diagnosing brain death. The authors suggest that the nurses

should be able to recognize the knowledge deficit of the families and

provide necessary information. In order to do so, clear policies and

procedures about the criterias of brain death diagnosis need to be

developed. If the nurse takes part in the organ donation process they

should actively participate in developing such policies and procedures.

Verheijde, J. L., Rady, M. Y., & McGregor, J. L. (2009). Brain death, states of

impaired consciousness, and physician-assisted death for end-of-life organ donation

and transplantation.
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This article gives an overview of the challenges, debates and ethical

conflicts surrounding the concepts of altered consciousness state, brain

death criteria in heart-beating donors, and the controversy of

non-heart-beating organ donations. The adopted Harvard clinical criteria

based on irreversible coma and apnea was used as a primary guideline

for brain death declaration and permitted the organ procurement from

heart-beating donors. This article argues the validity of these criterias

because there is insufficient evidence of irreversibility of loss of

neurological functions in donors. Later on, The American Academy of

Neurology updated the clinical guidelines but critics have still been

disputing the efficacy of these guidelines, and point out the major flaws.

This uncertainty in determining the exact state of brain death has never

been disclosed to the general public, nor broadly discussed by the

medical community. This fact is an ongoing ethical issue, whether by

following questionable clinical guidelines medical professionals pressured

by initiatives to increase the number of organ donors rush into early

declaration of brain death of patients whose condition may be still

reversible. Organ procurement based on unsubstantiated criteria of death

is also questionable from the criminal legislation point of view. It raises a

question whether by signing a consent for organ donations donors also

agree to the physician-assisted death as a result of organ procurement.

The authors recognize the fact that it will be very difficult to change the

process of organ donation because it is deeply integrated in the public

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mindset. Society must decide if it is ethical to allow physician assisted

death as a consequence of organ harvesting to decrease a gap between

demand and supply of organ donors.

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References

Liva Jacoby, PhD, MPH; James Jaccard, PhD ​Am J Crit Care​ (2010) 19 (5):

e52–e61. Perceived Support Among Families Deciding About Organ

Donation for Their Loved Ones: Donor Vs Nondonor Next Of Kin.

Retrieved from

https://aacnjournals.org/ajcconline/article/19/5/e52/5857/Perceived-Suppo

rt-Among-Families-Deciding-About

Manuel, A., Solberg, S., & MacDonald, S. (2010). Organ donation experiences of

family members. ​Nephrol Nurs J​, ​37​(3), 229-36. Retrieved from

https://scholar.googleusercontent.com/scholar?q=cache:NBgjnG5XRXwJ:

scholar.google.com/+Organ+Donation+Experiences+of+family+members

&hl=en&as_sdt=0,5&as_vis=1

Siminoff LA, Gordon N, Hewlett J, Arnold RM. Factors Influencing Families'

Consent for Donation of Solid Organs for Transplantation. ​JAMA.

2001;286(1):71–77. doi:10.1001/jama.286.1.71 . Retrieved from

https://jamanetwork.com/journals/jama/fullarticle/193976

Verheijde, J. L., Rady, M. Y., & McGregor, J. L. (2009). Brain death, states of

impaired consciousness, and physician-assisted death for end-of-life

organ donation and transplantation. ​Medicine, health care, and

philosophy​, ​12(​ 4), 409–421. Retrieved from

https://doi.org/10.1007/s11019-009-9204-0
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