Idag väntar många patienter på transplantation av ett eller flera organ. Med nuvarande lagstiftning identifieras inte alla potentiella organdonatorer och därför kan inte dessa organ tas tillvara. Regeringen har därför tillsatt en utredning om det kan bli aktuellt med organdonation efter hjärtdöd. Detta uttrycks internationellt som Donation after Cardiac Death (DCD). Denna studiens syfte var att beskriva intensivvårdssjuksköterskors uppfattningar, tankar och känslor, samt förbereddhet kring begreppet donation efter hjärtdöd. Sju intervjuer av intensivvårdssjuksköterskor på två sjukhus i västra Sverige genomfördes och data analyserades med kvalitativ innehållsanalys. Resultatet presenteras som fyra kategorier: Upplevda farhågor och potentiella konsekvenser av DCD, Mötet med anhöriga, Tankar och känslor kring organisatoriska svårigheter och Tankar och känslor kring etiska dilemman. Slutsatser var att de intervjuade intensivvårdssjuksköterskorna ställde sig positiva till DCD och tidigare forskning visar att det kan vara en källa till ökning av organtillgång förutsatt att det är organisatoriskt genomförbart. / Today there are many patients on the waiting list to receive one or more organ transplants. With the current Swedish legislation not all potential organ donors are identified and therefore these organs are omitted as potential transplants. The government is in the process of investigating the possibility to implement organ donation after cardiac death, i.e. DCD. The aim of the study was to describe ICU nurses’ understanding, thoughts and emotions, as well as their preparations regards to DCD. Seven ICU nurses at two hospitals in western Sweden were interviewed and data were processed through qualitative content analysis. The results are presented as four categories: Perceived fears and potential consequences regarding DCD, the meeting with relatives, Thoughts and emotions regarding organizational difficulties and Thoughts and emotions regarding ethical dilemmas. Conclusions derived from the findings in the interviews with ICU nurses were a fully positive perception of DCD and that DCD could mean an increase in the amount of available organ donors given that legalisation and organisation processes are clear and possible to carry out.

Bakgrund: Donationsprocessen är en del av intensivvården som ställer stora krav på de närstående, som förutom att ha drabbats av plötslig förlust, också har ett beslut om donation att ta ställning till. Intensivvårdssjuksköterskor har en stor roll i denna process men upplever ofta det svårt att veta hur de ska bemöta de närstående på ett bra sätt. Syfte: Att identifiera och sammanställa hur närstående till potentiella organdonatorer upplever transitionerna de genomgår under donationsprocessen. Metod: Studien utfördes som en litteraturöversikt med kvalitativ design. En deskriptiv innehållsanalys utfördes av 17 stycken studier som baserats på intervjuer med närstående kring deras upplevelser av donationsprocessen. Resultat: De närståendes transitioner sammanfattades i tre huvudkategorier: från liv till död, insikt och acceptans och från död till liv. Beskrivningarna av deras upplevelser kretsade i huvudsak kring bemötande från vården, samtyckesprocessen och förståelse för situationen. De flesta upplevde ett gott empatiskt bemötande men många hade svåt att ta till sig och förstå information kring framför allt hjändödsbegreppet. Att ta ett beslut om samtycke till donation upplevdes för vissa som en tröst då det gav förlusten en mening, medan andra upplevde det som ett omöjligt och fruktansvärt beslut att ta. Slutsats: Viktiga områden för näståendes upplevelser under donationsprocessen var bemötandet, det emotionella stödet, informationen och beslutsfattandet. Kunskapen om närståendes upplevelser är relevant för intensivvården och intensivvårdssjuksköterskan för att vården skall kunna ge den omvårdnad som behövs under processen. / Background: The process of organ- and tissue donation is a part of the critical care that puts a lot of pressure on the next of kin who as well as being victims of a sudden loss, need to make a decision about donation. Intensive care nurses play a major role within this process and often experience it difficult to know how to respond to the next of kin in a good way. Aim: To identify and compile how next of kin to potential organ donors experience the transitions they go through during the donation process. Method: This study has been conducted as a review of previous literature and with a qualitative design. A descriptive content analysis was performed of 17 studies which were based on interviews with next of kin and their experiences with the donation process. Results: The next of kin transitions were compiled into three main categories: from life to death, insight and acceptance and from death to life. The description of their experiences through these transitions mainly focused on reception from hospital staff, the decision-making process and their perception of the situation. The reception in the majority of the cases was considered good and empathetic. A number of them had a difficult time understanding the information given to them, in particular about the meaning of brain death. Some of the next of kin did experience making the decision about donation as a comfort that gave them a deeper meaning to their loss, while others experienced it as an impossible and dreadful decision to make. Conclusion: Important aspects recognized by the next of kin during the donation process were; the personal treatment, the emotional support, the received information and the decision-making. The knowledge surrounding experiences of the next of kin, is relevant to the intensive care and the intensive care nurse, to reassure that they provide the care needed during the process.

The purpose of this study is to identify and explore issues and challenges that impact on transplant coordinators and their practice. Such identification enhances understanding of their role, provides evidence for decision-makers to facilitate the positive aspects of the coordinators' practice, highlights their professional needs and contributions and provides baseline data for future research, education and policy development. The study used both qualitative and quantitative data. Data collection methods involved focus group interviews and Delphi surveys. Participants were coordinators who were employed on a full-time, part-time or relieving basis. Recruitment of participants was done by purposive and snowball sampling. There were 112 coordinators in the study and each was randomly assigned to the focus groups or Delphi survey phases of the research. The analysis of the focus group data together with the literature, informed the development of the first Delphi survey. The second Delphi survey was developed using the data from the focus groups, literature and the first survey. Four categories emerged from the data. The first involved 'knowledge and experience', which explored the education needs of coordinators and the issue of nursing qualification requirements. The work environment, demands and conditions, together with role attributes were discussed in the next category - 'the role'. Recipient, donor family and transplant coordinator outcomes were addressed in the 'outcomes’ category. The basic social process – building relationships - explored the relationships that coordinators have with the health team and their client groups. Four types of relationships emerged which were supportive, non-supportive, aggressive and virtual relationships. The emergent theory of the challenges that transplant coordinators face relates to the building of relationships. The theory also discovers how knowledge and experience, the role and outcomes impact on the building of these relationships in an interdependent manner. This study also emphasises that the transplant coordinators' role is complex, demanding and distinctly unique in terms of the context within which coordinators practice. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1311520 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

Brain death has adverse effects on the organ donor, increasing organ dysfunction and affecting transplantation outcomes. It can also render organs unsuitable for transplantation. Another determinant of organ quality is ischaemia-reperfusion injury, which limits ischaemic storage time for hearts to six hours. The aim of this thesis was to investigate the effectiveness of hormone resuscitation (HR) of the donor to ameliorate the effects of brain death. Another aim was to develop a donor management and organ preservation strategy to ameliorate the effects of ischaemia-reperfusion injury on the heart, thereby extending ischaemic preservation times. A porcine model of the brain-dead multi-organ donor with orthotopic cardiac transplantation was utilised. Donor HR was shown to improve cardiac contractility and haemodynamics, thereby reducing inotrope requirements. A follow-up study investigating the effects of three different donor management protocols demonstrated that donor haemodynamics, renal arterial flow and creatinine clearance were superior in HR animals compared with animals treated with noradrenaline or intravenous fluid alone. Noradrenaline was associated with a significant deterioration in pulmonary function (PaO2 and alveolar-arterial oxygen gradient) and a decline in donor pH. HR was not associated with any detrimental effects on the lungs, liver or pancreas compared with the other two groups. Preservation strategies incorporating glyceryl trinitrate (GTN) and cariporide, a Na+-H+ exchange inhibitor, were investigated to safely extend cardiac ischaemic preservation times. Pre-treatment with intravenous cariporide prior to heart explantation (donor) and reperfusion of the transplanted heart (recipient) was shown to effectively extend ischaemic time to 14 hours, evidenced by weaning off cardiopulmonary bypass. GTN and cariporide-supplemented Celsior, used as a cardioplegic/storage solution, was also effective in extending preservation time to 14 hours, with superior cardiac contractility compared with cariporide pre-treated hearts. Both treatments also ameliorated reperfusion injury, stabilising haemodynamics for up to three hours post-bypass. This thesis has demonstrated the effectiveness of HR to ameliorate the negative effects of donor brain death. It also provides evidence that combined GTN and cariporide-supplemented Celsior improves long-term preservation of the donor heart. These strategies offer the potential to increase the proportion of transplantable organs, to improve donor organ quality, and thereby improve transplantation outcomes.

Organ transplantation is a method of treatment of damaged or missing organ by replacement by a new one that is removed from a donor. Donors may be not only living people but also dead people after cardiac arrest or people with brain death. The aim of the study was to assess the attitude of laymen to organ transplantation. The quantitative research used questionnaires which were distributed since 25th October - 31st December 2017 to non-medical adults older than 18 years living in the Czech Republic. The results demonstrated that the laymen have basic knowledge which organs and tissues can be used for transplantation in humans. Total 110 respondents answered that organs can be removed from people with diagnosed brain death. Knowledge of legislation was a surprise. Over one half of respondents knew about implied consent with organ removal after death and knew at least one possibility how to deny post-mortem organ harvesting. Generally, the public lacks interest in organ donation. People dislike registration unless necessary and dislike discussion concerning death which is a symbol of pain and suffering. Majority of public agree that there is need for more education in the field of organ transplantation and donation. They would prefer a specialised lecture or discussion with medical professionals....

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Background: Organ donation is crucial for the survival of many patients that are waiting for a transplant. Considering that the need for organs is often greater than the supply, it is important that the intensive care providers identify and diagnose potential donors. The intensive care nurse has a central role in the donation process. Caring for a potential donor involves respecting the donor's will and preserving the dignity that the body possesses. It is of great importance that the intensive care nurse feels familiar with the donation process and feels secure in their professional role.  Purpose: The purpose of this study was to describe the nurses' experiences of caring for a potential organ donor in an intensive care unit.  Method: A literature review with a qualitative approach is conducted. 13 scientific articles from two different databases were reviewed and analyzed. The data was analyzed according to Bettany-Saltikov and McSherry's (2016) model in nine steps.  Results: The results show that caring for a potential organ donor can result in experiences of emotional stress. Emotions such as sadness, anxiety, stress, fear, anger and hopelessness arise in connection with caring for a potential organ donor. Trusting the diagnosis brain death was very difficult for the intensive care nurses, this made the work more difficult and ethically challenging. In addition, interprofessional collaboration and training around (donation after brain death) DBD were essential in care. Although the donation process could be experienced as emotionally stressful, the intensive care nurse can experience feelings of meaning.  Conclusion: From the results of this study it can be concluded that the donation process is perceived as complex. The intensive care nurses describe the donation process as a stressful task that challenges their professional role and competence. Despite care in this capacity being characterized by emotional and existential challenges, the nurses care for the donor's body and preserve its dignity.

Over the last few years, policies have been introduced in the UK which aim to improve organ transplantation rates by changing the way that potential organ donors are treated before death. Patients incapacitated due to catastrophic brain injury may now undergo ante-mortem donor optimisation procedures to facilitate deceased organ donation. As I identify in this thesis, the most significant ethical and legal problem with these policies is that they are not based on what the patient would have chosen for themselves in the specific circumstances. The policies identify and treat patients meeting certain clinical criteria as a group rather than the individuals, with their own viewpoints, that the law on best interests requires. They equate registration on the Organ Donation Register with ante-mortem donor optimisation procedures being in their best interests, despite registrants having neither been informed about nor given consent to ante-mortem interventions. The overarching claim I make in this thesis is that a system of specific advance consent is needed to provide a clear and unequivocal legal justification for ante-mortem donor optimisation procedures. The ethical foundation for this claim is autonomy, and this is the central theme running through all six chapters. I argue that autonomy should be incorporated into donor optimisation policy to promote the dignity and integrity of potential organ donors and to safeguard trust in the organ donation programme. I argue that a system of specific advance consent is needed as part of the duty of care owed to registrants on the Organ Donor Register and to facilitate the determination of the best interests of the potential organ donor. I argue that the state has not established the necessity of the current policy of non-consensual donor optimisation procedures and that they are under an ethical and legal obligation to introduce an autonomy-based framework for ante-mortem interventions to facilitate organ donation.

In this paper I examine the factors that affect the likelihood an individual is a registered organ donor. Unlike many studies which focus on subpopulations in specific regions, I utilize national data to get a broader assessment of individuals from around the country across a number of racial and religious classifications. Using a probit model and controlling for a variety of parameters, I find that some racial and religious variables are negatively and significantly associated with organ donor registration rates, while education and being female are positively associated with organ donor registration rates. I conclude by discussing the implications of my results and the potential for future research.

Bakgrund: Organtransplantation är en livräddande behandling vid terminal organsvikt men det råder en global brist på potentiella organdonatorer. Sjuksköterskan har en viktig roll i att öka medvetenheten om organdonation i samhället och hennes attityd till och kunskap om organdonation kan påverka människors beslut att donera. Syfte: Syftet med studien var att undersöka vilka faktorer som påverkar sjuksköterskans attityd till organdonation. Metod: Studien genomfördes som en allmän litteraturstudie där 15 vetenskapliga artiklar från tre olika databaser granskades och analyserades. Resultat:Analysen resulterade i fem kategorier: Kunskapens påverkan, Arbetslivserfarenhetens påverkan, Familjen och den egna donationsviljans inflytande, Religionens inflytande och Misstro mot hälso- och sjukvården och lagstiftningen. Konklusion: Kunskap om kriterier för att fastställa död, organdonation, donationsprocessen och kommunikationsmetoder hjälpte sjuksköterskorna att förmedla adekvat information. Att vårda potentiella organdonatorer skapade en emotionell stress och att lyfta frågan om donation med donatorns familj var påfrestande. Att ha diskuterat organdonation inom den egna familjen var gynnsamt för attityden. Sjuksköterskans egen tolkning av sin religions inställning till organdonation påverkade attityden. Sjuksköterskorna upplevde rädsla för att gå miste om återupplivningsåtgärder eller att dödförklaras för tidigt som registrerade organdonatorer. / Background: Organ transplantation is a life-saving treatment but there is a global shortage of potential organ donors. The nurse has an important role in increasing awareness of organ donation. Her attitude toward and knowledge about organ donation might influence people’s decision to donate. Aim: The aim was to investigate factors that influence the nurse’s attitude toward organ donation. Method: This study was carried out as a general literature study. Fifteen scientific articles from three different data bases were reviewed and analyzed. Result: The analyze resulted in five categories: The impact of knowledge, The impact of work experience, The impact of family and own willingness to donate, The influence of religion and Distrust in the health care system and legislation. Conclusion: Knowledge about death criteria, organ donation and communication skills helped the nurse’s to convey information. Caring for potential organ donors generated an emotional stress and raising the question about donation with donor families was stressful. Having discussed organ donation within the own family was favorable for the attitude. The nurse’s own interpretation of her religion’s attitude toward organ donation influenced the attitude. The nurses experienced fear of not receiving proper resuscitation of being declared dead prematurely as registered organ donors.