Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-18T16:44:22Z No. of bitstreams: 1 monicacamposdaibert.pdf: 538391 bytes, checksum: 47a7c51d6f6a323fbff0ca594606b407 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-25T12:10:35Z (GMT) No. of bitstreams: 1 monicacamposdaibert.pdf: 538391 bytes, checksum: 47a7c51d6f6a323fbff0ca594606b407 (MD5) / Made available in DSpace on 2016-10-25T12:10:35Z (GMT). No. of bitstreams: 1 monicacamposdaibert.pdf: 538391 bytes, checksum: 47a7c51d6f6a323fbff0ca594606b407 (MD5) Previous issue date: 2007-08-24 / Este estudo pretende identificar e compreender sob a ótica dos fundamentos da integralidade, os fatores determinantes da recusa familiar na doação de órgãos, a partir da percepção dos familiares de potenciais doadores, que não consentiram a doação. O referencial teórico-conceitual referente à integralidade a compreende como um eixo estruturante da política de saúde, uma imagem-objetivo, uma conquista a ser alcançada. Particularizamos os sentidos que assume nas práticas profissionais, na organização dos serviços e na própria política de doação e transplante de órgãos. Utilizamos contribuições teóricas de diversos autores a fim de qualificar nosso estudo sobre a integralidade e a política de doação e transplante de órgãos no Brasil. Realizamos um estudo qualitativo por meio de entrevistas semi-estruturadas individuais com 9 sujeitos, que recusaram a doação dos órgãos de seus familiares falecidos. Os sujeitos residem na cidade de Juiz de Fora/MG, que integra a área de referência da CNCDO/Zona da Mata e foram entrevistados sobre doação no período de 2000 a 2004. Os depoimentos obtidos nas entrevistas substantivaram a elaboração de 7 categorias: atenção à saúde; acolhimento e vínculo; informação/desinformação; comunicação; concepção religiosa; situação de classe; e percepção de corpo, que possibilitaram compreender as razões da recusa de forma articulada com a não conquista da integralidade no cotidiano das ações de atenção e cuidado no âmbito da famílias pesquisadas. As entrevistas foram apresentadas por meio da citação de trechos discursivos percebidos por nós como mais relevantes, a fim de fundamentar a análise, bem como oportunizar a proximidade com o contexto de realização da pesquisa, reconhecendo a voz e o valor das reflexões apresentadas pelos sujeitos. / This study seeks to identify and to understand, from the standpoint of integrality, the determining factors for familiy refusal to donate organs, by examining the, perceptions of potential organ donor’s families who refuse to comply with donation requests. The theoretical reference to integrality views it as a structural pivot of health policy, an objective image, a goal to be reached. Its meanings to professional practices, the organization of services and to the organ donation and transplantation policies were distinguished. We used theoretical contributions from a variety of authors to qualify this study about integrality and the organ donation and transplantation policies in Brazil. A qualitative study was made through semi-structured individual interviews with 9 subjects refused to donate their deceased relatives’ organs. These subjects live in Juiz de Fora/MG, a city located in the CNCDO/Zona da Mata reference area, and were interviewed about organ donation between 2000 and 2004. The interviews led to the establishment of 7 categories: health care, shelter and bond, information/disinformation, communication, religious concept, social situation and body perception. These categories enable us to understand the reasons behind the refusals in an articulated way with the lack of integrality in daily “attention and care actions” in the families studied. The interview were presented through quotes of parts that we judged to be more relevant, on which to base the analysis and to enable us to take advantage of the proximity with research, recognizing the voice of the subjects and the value of the reflections they presented.

Made available in DSpace on 2016-08-18T17:27:37Z (GMT). No. of bitstreams: 1 DISSERTACAO HELOISA ROSARIO.pdf: 8090200 bytes, checksum: 47b52c85281674379ce0ebaca4796683 (MD5) Previous issue date: 2015-07-13 / FUNDAÇÃO DE AMPARO À PESQUISA E AO DESENVOLVIMENTO CIENTIFICO E TECNOLÓGICO DO MARANHÃO / In Maranhao, donation, organs and tissues transplatation process began in 2000 with the creation of Transplant Center and the execution of the first kidney and cornea transplant. However, organization, operation and evolution of this service needs new perspectives and practices to raise the number of organs and tissues donations. Before that, we asked: which instruments, tools and strategies can be used to increase the number of potential and effective donors of organs and tissues in Maranhão? The research objective was building innovative measures aimed at increasing notifications, donations and transplants in Maranhão from the active participation of the actors involved in the donation, capture and organ transplantation process. The investigation was guided by Convergent Care Research, with a qualitative approach, and it involved 50 participants between five hospitals technicians (03 public and 02 private) from services related to donation and organ transplantation process (Intra-Hospital Transplant Commissions, Eye Bank, Transplantation Center, Intensive Care and Urgent and Emergency Services). It also involved managers of these hospitals and from Secretaria Municipal de Saúde de São Luís MA (health's secretary, control superintendent, beds evaluation, audit and regulation, beds Regulation Center coordinator) and Prosecutor's Office. Wheel conversations, focus groups and individual meetings were strategies to data collection, and it had identified limitations and build strategies and interventions to donation and organ transplantation process. Interventions were product of participant s collective work and it has been organized in three dimensions: institutional; technical-professional and social mobilization. As a result of interventions, we had the following changes in organ and tissue donation s process from Maranhão: increase in deaths and brain death notifications; more hospitals closing brain death protocol; increase in closed brain death protocols; completion time s reduction in brain death protocol; greater interaction between Transplantation Center and notifiers hospitals; Intra-Hospital Transplant Commissions implementation and reactivation; cooperative and collaborative work between Central, Eye Bank and the Intra-Hospital Transplant Commission; increase in donations and transplants. The interventions produced positive results in donation and cornea and kidney s transplants. From 2013 to 2014, Maranhão occupied the 19th position in kidney transplant and 21th position in cornea transplant. Advances were achieved by research in May 2015, so the state began occupying the 17th position in the kidney transplant and the 18th position in cornea transplant. It focused effectively on Maranhão performance in national ranking of kidney and cornea transplant. The disruption of institutional borders via interventions in the process of donation and transplant of organs and tissues by social mobilization represented a significant evolution in the increase in the number of donations and, consequentely, of transplants of organs and tissues. / No Maranhão o processo de doação e transplante de órgãos e tecidos foi iniciado em 2000 com a criação da Central de Transplante e a realização do primeiro transplante de rim e córnea. Porém no ranking Nacional até 2014 o Maranhão ocupava a penúltima posição com relação ao número de transplante de córnea e o último lugar em transplante de rim. Evidenciando que a organização e a operacionalização desse serviço carece de novas perspectivas e práticas para evoluir e elevar o número de doações de órgãos e tecidos. Em face disso questionou-se: que instrumentos, recursos e estratégias podem ser utilizados para aumentar o número de doadores possíveis e efetivos de órgãos e tecidos no Maranhão? O objetivo da pesquisa foi construir, a partir da ativa participação dos atores envolvidos no processo de doação, captação e transplante de órgãos, medidas inovadoras visando o aumento das notificações, doações e transplantes no Maranhão. Guiada pela Pesquisa Convergente Assistencial com abordagem qualitativa a investigação envolveu 50 participantes entre técnicos de cinco hospitais (03 públicos e 02 privados) dos serviços ligados com o processo de doação e transplante de órgãos (Comissão Intra-hospitalar de Transplante, Banco de Olhos, Central de Transplante, terapia intensiva e serviços de urgência e emergência) assim como gestores dessas instituições hospitalares e da Secretaria Municipal de Saúde de São Luís MA (Secretária de Saúde, Superintendente de Controle Avaliação, Auditoria e Regulação de Leitos, Coordenadora da Central de Regulação de Leitos) e Promotoria da Justiça. Rodas de conversas, grupos focais e encontros individuais foram estratégias utilizadas para a coleta de dados que permitiram identificar limitações e construir estratégias e intervenções para o processo de doação e transplantes de órgãos. As intervenções foram produto do trabalho coletivo dos atores e foram organizadas sob três dimensões: institucional; técnica-profissional e de mobilização social. Como resultado das intervenções ocorreu as seguintes mudanças no processo de doação de órgãos e tecidos do Estado do Maranhão: aumento das notificações de óbitos e de morte encefálica; maior número de hospitais concluindo protocolo de morte encefálica; aumento no número de protocolos de morte encefálica concluídos; redução no tempo de conclusão de protocolo de morte encefálica; maior interação da Central de Transplante com hospitais notificadores; implantação e reativação de Comissões Intra-hospitalares de Transplantes; trabalho cooperativo e colaborativo entre a Central, o Banco de Olhos e as Comissões Intra-hospitalares de Transplantes; aumento do número de doações e transplantes. As intervenções produziram resultados positivos na doação e transplantes de córneas e rim. De 2013 a 2014 o Maranhão ocupava a 19ª posição em transplante de rim e a 21ª no transplante de córneas. Com os avanços decorridos pela pesquisa em maio de 2015 o Estado passou a ocupar a 17ª posição no transplante de rim e 18ª em transplante de córneas incidindo eficazmente no desempenho do Maranhão no ranking Nacional de transplante de rim e córnea. O rompimento das fronteiras institucionais por meio de intervenções no processo de doação e transplante de órgãos e tecidos pela mobilização social representou uma evolução significativa no crescimento dos números de doações e, consequentemente, transplantes de órgãos e tecidos.

Esta pesquisa teve por objetivos conhecer a percepção de enfermeiros sobre conflitos éticos no processo de doação de órgãos e tecidos para transplante, como são tomadas as decisões e o que é levado em consideração para a tomada de decisão frente a conflitos éticos. Foi realizado um estudo exploratório, descritivo e de abordagem qualitativa, sendo utilizada a análise de conteúdo proposta por Bardin. Foram realizadas onze entrevistas com enfermeiros que prestaram assistência a potenciais doadores na prática profissional, há pelo menos um ano, lotados nas seguintes unidades: UTI adulto e pediátrica, Pronto socorro, Centro cirúrgico, Unidades de internação e na Comissão Intra Hospitalar de Doação de Órgãos e Tecidos para Transplante. Após a análise emergiram cinco categorias: 1. Dificuldade em aceitar a morte encefálica; 2. Não aceitação da equipe multiprofissional de desconectar o ventilador mecânico do paciente em morte encefálica não doador de órgãos; 3. Dificuldades da equipe multiprofissional durante o processo de doação de órgãos; 4. Situações que podem interferir no processo de doação de órgãos e 5. Tomada de decisão frente a conflitos éticos no processo de doação de órgãos. Os resultados mostraram que os enfermeiros identificam conflitos éticos no processo de doação de órgãos, gerados por diversos fatores como: a dificuldade em aceitar a morte encefálica como morte do individuo, a resistência em aceitar a suspensão do suporte terapêutico no paciente em morte encefálica, a falta de conhecimento e comprometimento durante o processo de doação, o descaso e assistência inadequada ao potencial doador de órgãos, a dificuldade com a alocação de recursos humanos e materiais incluindo a liberação de leitos de UTI para o potencial doador; as crenças religiosas e as falhas de comunicação. Além disso, para tomar decisão frente aos conflitos éticos, eles levam em conta o princípio da beneficência, o dever legal e, principalmente, o diálogo com os colegas. Assim, ficou evidenciado que o processo de doação de órgãos está permeado por conflitos éticos, demonstrando uma necessidade de reflexão e discussão sobre o tema, incluindo as situações geradoras e as tomadas de decisão frente aos conflitos éticos / This research aimed to know the perception of nurses on ethical conflicts in the process of donating organs and tissue for transplantation, as decisions are made and what is taken into account in decision-making in the face of ethical conflicts. We conducted an exploratory, descriptive and qualitative approach, using the content analysis proposed by Bardin. Eleven interviews were conducted with nurses who provided assistance to potential donors in professional practice for at least one year, allocated in the following units: adult and pediatric ICU, First Aid, surgical center, inpatient units and the Commission Intra Hospital Organ Donation and Tissues for Transplantation. After analyzing five categories: 1. Difficulty accepting brain death, 2. Non-acceptance of the multidisciplinary team to disconnect the ventilator patient\'s brain-dead organ donor is not 3. Difficulties of the multidisciplinary team during the process of organ donation 4. Situations that may affect the process of organ donation and 5. Decision making in the face of ethical conflicts in the process of organ donation. The results showed that nurses identify ethical conflicts in the process of organ donation, generated by several factors: the difficulty in accepting brain death as death of the individual, the resistance to accept the suspension of therapeutic support in brain death, the lack of knowledge and commitment during the donation process, neglect and inadequate care of the potential organ donor, the difficulty with the allocation of human and material resources including the release of ICU beds for the potential donor, religious beliefs and failures communication. Moreover, to make decisions in the ethical conflicts, they take into account the principle of beneficence, the legal duty, and especially the dialogue with colleagues. Thus, it became evident that the process of organ donation is permeated by ethical conflicts, demonstrating a need for reflection and discussion on the topic, including generating situations and decision making in the face of ethical conflicts

Bakgrund: Behovet av organ är större än antalet utförda transplantationer i Sverige. Att som anhörig få beskedet o m ett plötsligt dödsfall kan vara en utlösande faktor till att hamna i kris. Hur hanterar de anhöriga att ta beslut om organdonation och vilka är deras erfarenheter och upplevelser av situationen på en intensivvårdsavdelning. Syfte: Att beskriva anhörigas erfarenheter av att ta beslut om organdonation på en intensivvårdsavdelning. Metod: En systematisk litteraturstudie genomfördes, resultatet grundas på 17 vetenskapliga artiklar varav tolv kvalitativa respektive tre kvantitativa samt två med mixad metod. Resultat: I resultatet framkom olika aspekter på anhörigas erfarenheter om att ta beslut om en organdonation. Resultatet sammanfattades i sju kategorier; viljan om donation, organdonationsprocessen kan skapa lidande, kommunikation och information, kunskap om anhöriges vilja, relationen med vårdpersonal, från fråga till beslut, från beslut till donation, samt efter donation. Slutsats: Litteraturstudien resulterade i en djupare insikt i anhörigas erfarenheter och kunskaper om faktorer som påverkar hens beslut om organdonation. Att som anhörig behöva ta beslut om organdonation i en kris kan generera lidande samt att hitta en mening genom organdonationen. / Background: The need for organs is greater than the number of transplants performed in Sweden. Familiarizing a relative with a sudden death can be a trigger for ending a crisis. How do relatives deal with organ donation decisions and what are their experiences of the situation on an intensive care unit. Purpose: To describe relatives' experiences in deciding on organ donation in an intensive care unit. Method: A systematic literature study was conducted, the result is based on a total of 17 scientific articles, of which twelve qualitative and three quantitative as well as two by mixed method. Result: The results revealed different aspects of the relatives' experience of deciding on organ donation. The result was summarized in seven categories; The desire for donation, the organ donation process can create suffering, communication and information, knowledge of the family's will, the relationship with healthcare professionals, from question to decision, from decision to donation, and after donation. Conclusion: The literature study resulted in a deeper insight into the relatives' experiences and knowledge of factors that influence decisions on organ donation. Being able to decide on organ donation in a crisis as a relative can cause suffering and find an opinion through organ donation.

The donation of organs and tissues for transplantation is being used to treat a wide range of diseases. The structure of the Brazilian transplant system is based on the search for potential donors and in this context, the Commissions Intra-hospital Donation of Organs and Tissues for Transplantation (CIHDOTT) play an important role in obtaining organs through active search potential donors. Among the members of CIHDOTT, is the nurse who has great importance in the donation process and organ transplantation. This study aimed to know the nurse's role as a member of Intra-hospital Committee on Organ Donation and Transplantation fabrics - CIHDOTT. This is a qualitative research, exploratory and descriptive. Was performed with nurses working in CIHDOTT five hospitals in Porto Alegre, the state capital of Rio Grande do Sul, Brazil. Data were collected through semi-structured interview, during the first half of 2014. The data were analyzed based on thematic content analysis framework proposed by Minayo. The results highlight four categories related to the role of the nurse in CIHDOTT: The insertion of nurses in CIHDOTT; Nurses work in CIHDOTT: Facilities and difficulties faced by nurses in the course of work in CIHDOTT. The work of nurses with relatives, particularly with respect to the reception and bond and the centrality of nurses who work in CIHDOTT. We conclude that the CIHDOTT nurse is fundamental, and is seen as crucial for a donation program and successful transplant. Is a professional to perform their role, appropriates technological, logistical and human resources in order to develop mainly the activities of coordination / management CIHDOTT, and direct and indirect assistance throughout the donation and transplantation process actions and attitudes aimed at the donor, to the care team and family. / A doação de órgãos e tecidos para transplante está sendo utilizada para o tratamento de uma ampla gama de afecções. A estrutura do sistema brasileiro de transplante fundamenta-se na procura por potenciais doadores e, neste contexto, as Comissões Intra-hospitalares de Doação de Órgãos e Tecidos para Transplantes (CIHDOTT) desempenham um papel importante na obtenção de órgãos por meio da busca ativa de potenciais doadores. Entre os integrantes da CIHDOTT, encontra-se o enfermeiro, que tem suma importância no processo de doação e transplante de órgãos. O presente estudo teve como objetivo geral conhecer o papel do enfermeiro como membro de Comissão Intra-hospitalar de Doação de Órgãos e Tecidos para Transplantes CIHDOTT. Trata-se de uma pesquisa de abordagem qualitativa, de caráter exploratório e descritivo. Foi realizada com enfermeiros atuantes em CIHDOTT de cinco hospitais em Porto Alegre, capital do Estado do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de entrevista semiestruturada, durante o período primeiro semestre de 2014. Os dados foram analisados com base no referencial de análise de conteúdo temático proposto por Minayo. Dos resultados emergiram quatro categorias, relacionadas ao papel do enfermeiro em CIHDOTT: A inserção do enfermeiro em CIHDOTT; O trabalho do enfermeiro em CIHDOTT: Facilidades e dificuldades, enfrentadas pelo enfermeiro no decorrer do trabalho na CIHDOTT. A atuação do enfermeiro junto aos familiares, particularmente no que tange ao acolhimento e vinculo e a centralidade do enfermeiro atuante em CIHDOTT. Conclui-se que o enfermeiro de CIHDOTT é fundamental, e é tido como elemento crucial para um programa de doação e transplante de sucesso. É um profissional que para desempenhar seu papel, apropria-se de meios tecnológicos, logísticos e humanos no intuito de desenvolver, principalmente, as atividades de coordenação/gestão em CIHDOTT, além de assistência direta e indireta durante todo o processo de doação e transplante com ações e atitudes voltadas para o doador, para a equipe assistencial e para a família.

Organ donation is traditionally based on the notion of making a gift based on altruism. An important aspect of ‘altruistic gifting’ is commitment to a solidaristic approach to meeting transplant needs. In line with this, people are encouraged to donate their organs at death to a common pool for collective provision, or donate a live organ to another freely. Given a chronic organ shortage, proposals have been made to change this system to increase donation. Proposals include introducing some organ market or payment in the form of a reward to incentivise live or deceased donation. However, these proposals have been opposed because of the grip of ‘altruistic gift’ as the only ethically acceptable way to procure and distribute organs. To support the ethical acceptability of other systems, ‘altruistic gift’ has been subject to various criticisms. One criticism is the moral relevance of altruism: people may donate on other motives other than altruism; or, altruism is not the motive that underpins most deceased organ donations. Another criticism is the moral value of altruism: even if deceased organ donations are in general altruistic, altruism does not express communal virtues like generosity that support solidarity. A third criticism is the value of the concept of altruism when understood in the pure sense: ‘pure altruism’ fashions an unnecessary or false dichotomy – gift versus sale – in the way people can ethically relate and help each other. Consistent with or following this criticism, it has been argued that use of a financial reward to incentivise donation can be compatible with preserving donation as altruistic albeit in a ‘non-pure’ sense. ‘Altruism’ and reward can co-exist as motives for donation. This thesis concerns itself centrally with the third criticism. It argues that the concept of altruism delineates a distinctive moral ‘perspective’ of a common humanity that engenders a devotion to others’ interests. Accordingly, as I argue, ‘non-pure’ definitions of altruism are misleading as to how a financial reward can be compatible with altruism. From this, the thesis argues that introduction of a financial reward for organ donation would not preserve donation as altruistic. Based on an understanding of altruism as also a motive for ‘creative’ relationships, the thesis counters criticisms of its relevance and value to deceased organ donation under a gift model. As part of its legal analysis, the thesis considers the antithesis of ‘altruistic gift’: the idea of organs as property which places individual control on their disposition at its moral centre. It has been argued that organs should be owned as property so that individuals can sell them, or transmit them to relatives so that relatives can claim payment from donation. To provoke thought on whether organs should be owned as private property like any other, the thesis proposes an inheritance regime for organs with family as default successor.

Comment le visage est-il devenu un organe, objet de don et de transplantation ? En partant de ce questionnement, cette thèse investit le milieu de celles et ceux qui ont porté et débattu des projets de transplantation faciale au cours des années 2000 et 2010 en France et au Royaume-Uni. Elle éclaire les conditions sociales selon lesquelles la transplantation faciale a été rendue acceptable, pour les patients opérés et les équipes chirurgicales, les coordinateurs du don d’organes et les proches des donneurs défunts qui permettent le prélèvement. L’enquête a impliqué un investissement approfondi de l’ensemble de la chaîne de la transplantation,reposant sur la collecte d’archives (scientifiques, institutionnelles, médiatiques), sur la réalisation d’entretiens (avec les chirurgiens, les patients, les acteurs du don d’organes et de la régulation médicale, les membres d’associations de personnes défigurées), ainsi que sur une ethnographie des services hospitaliers qui réalisent ces opérations (du bloc jusqu’aux réunions de service). En suivant au plus près ces acteurs, l’enquête éclaire les tensions quel’expérimentation révèle sur son passage.Cette recherche aborde la greffe comme un objet qui articule des questionnements au croisement des institutions, des mouvements associatifs et des expériences du don. La greffe du visage bouscule, tout d’abord, les prétentions des chirurgiens à s’autoréguler. La confrontation des équipes chirurgicales aux institutions sanitaires et éthiques, qui évaluent l’opportunité de cette expérimentation, révèle des rapports distincts à l’objectivité médicale e tà l’encadrement des pratiques hospitalières. L’émergence de la greffe du visage travaille,ensuite, les collectifs de personnes défigurées qui oscillent entre soutien au progrès médical et dénonciation de la chirurgie comme oppression. Les réactions des associations françaises et anglaises sont révélatrices de conceptions distinctes de la défiguration, et contribuent à façonner la trajectoire de la greffe du visage. La greffe du visage interroge, enfin, les conditions sociales de disponibilité des corps des défunts et les tensions à l’oeuvre dans la réception d’un don anonyme d’organes. Les patients greffés au visage sont soumis à une double contrainte qui peut-être vécue comme contradictoire : d’un côté, celle de remercier le donneur, de l’autre, celle de l’oublier pour accepter la greffe. La thèse révèle ainsi l’assemblage hétérogène, mais néanmoins cohérent, de ces niveaux d’analyse, qui est en jeu dans chaque déplacement d’une partie de corps d’une personne à une autre. Elle éclaire, en d’autres termes, ce que charrie la chair. / How has the face become an organ, object of donation and transplantation? Starting from thisquestioning, this thesis invests the environment of those who have carried facial transplantprojects, and those who have debated about them, during the years 2000 and 2010 in Franceand the United Kingdom. It illuminates the social conditions according to which facialtransplantation has been made acceptable, for transplanted patients and surgical teams, organdonation coordinators and relatives of deceased donors who allow the retrieval. The enquiryinvolved an in-depth investment of the whole chain of transplantation, based on the collectionof archives (scientific, institutional, media), on conducting interviews (with surgeons, patients,organ donation and medical regulation’s actors, members of associations of disfigured people),as well as doing an ethnography of hospital services that carry out these operations (from theoperating rooms to the service meetings). By closely following these actors, the surveyilluminates the tensions that experimentation reveals in its passage.This research addresses face transplant as an object that articulates questions at the crossroadsof institutions, social movements and experiences of donation. Face transplant upsets, first ofall, the claims of the surgeons to self-regulate. The confrontation of surgical teams with healthand ethical institutions, which evaluate the appropriateness of this experiment, reveals distinctrelationships to medical objectivity and to the supervision of hospital practices. The emergenceof face transplant, then, poses a challenge to the collectives of disfigured people who oscillatebetween support for medical progress and denunciation of surgery as oppression. The reactionsof the French and English associations are indicative of distinct conceptions of disfigurement,and help to shape the trajectory of face transplant. Lastly, face transplant questions the socialconditions of the dead bodies' availability and the tensions at work in the reception of ananonymous donation of organs. Transplanted patients are subject to a double constraint that canbe experienced as contradictory: on the one hand, that of thanking the donor, on the other, thatof forgetting the donor in order to accept the transplant. The thesis thus reveals theheterogeneous – and at the same time coherent – assembly of these levels of analysis, which isat stake every time a body part is transferred from one person to another. It illuminates, in otherwords, what the flesh carries.

Introduction: The three ways of making a wish for organ donation known are donor registration, donation card and telling the relatives. The relatives always have to be consulted to know the last expressed wish. If the wish was unknown there is a presumed consent, but the relatives have veto and can refuse organ donation. A new proposal suggests that the veto should be removed.Aim: To identify and analyse the ethical considerations concerning decision making on organ donation with an emphasis on the role of relatives.Methods: A search for literature was made. Scientific articles, debate articles, constitutional texts, reports and other texts were selected. The selection of sources was performed on the basis of relevance for the aim of the study which means for answering the research questions.Results: Recurrent themes were identified in studies with an emphasis on the experiences of relatives who have been part of decision making on organ donation. The themes identified were: “incompetence to decide”, “disagreement”, “lack of information and support”, “comprehension of brain death” and “protection”. The themes, together with the reading of debate articles and other texts, formed the basis of arguments in favour of and against relatives’ right to veto.Conclusions: There are many factors influencing relatives in their decision concerning organ donation. There are strong arguments against the relatives’ right to veto. Donor registration and a sensitive approach in the conversation with relatives are important factors to increase the consent rate and fulfil the wish of the deceased.

Bakgrund: Organtransplantation är en behandling som räddar liv på personer med organsvikt. För att detta ska vara möjligt krävs en organdonator, antingen levande eller avliden. Som avliden donator utförs en uttagsoperation efter medgivande till donation. Perioperativa sjuksköterskor deltar tillsammans med transplantationsteamet vid uttagoperationerna för att tillvarata organ och tillgodose donatorns önskan om donation. Syfte: Att beskriva anestesi- och operationssjuksköterskors upplevelser av att delta vid uttagsoperationer hos avlidna organdonatorer. Metod: En kvalitativ metod genomfördes, där åtta perioperativa sjuksköterskor intervjuades med öppna frågor som var fenomenorienterade. Datamaterialet analyserades med innebördsanalys. Resultat: Den essentiella innebörden är Värdighet och Respekt, som är en tydlig kärna i studiens fyra innebördsteman: Dubbelbottnade känslor, Känslan av att göra gott för andra, Samarbete i teamet skapar en känsla av trygghet och Professionellt bemötande. Konklusion: Resultatet visar att de perioperativa sjuksköterskorna upplevde värdighet och respekt som en central del vid uttagsoperationer hos avlidna donatorer. Uttagsoperationerna erfars av känslor som glädje, meningsfullhet och sorg. Samarbete i teamet upplevs som viktigt och gav en känsla av trygghet. Återkopplingen om mottagarna till organens tillstånd upplevdes som hjälp i den känslomässiga hanteringen. / Background: Organ transplantation is a treatment that saves the lives of people with organfailure. For it to be possible, an organ donor is required, either alive or dead. A donors’operation is performed after consent to donation. Perioperative nurses participate togetherwith the transplant team in the removal operations to remove organs and to pursue the donor'sdesire for donation.The aim: To describe the anesthesia- and operating theatre nurses' experiences ofparticipating in deceased organ donors' operations.Methods: A qualitative method, where eight perioperative nurses were interviewed throughopen-ended questions that were phenomenon-oriented. The data was analyzed with meaninganalysis.Results: The essential meaning is Dignity and Respect, which is a clear core of the study'sfour clusters of meanings: Double-edged emotions, The feeling of doing good for others,Cooperation in the team creates a feeling of security and Professional treatment.Conclusions: The perioperative nurses experienced dignity and respect as a central part indonors’ operations for deceased donors. The operations were experienced by emotions asjoy, meaning and sadness. Cooperation in the team is perceived as important and gives afeeling of security. Feedback about recipients of the organs condition was perceived ashelpful in emotional management.

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