Organ procurement from the perspective of perioperative nurses

AORN Journal, Sept, 2004 by Dianne Carter-Gentry, Cynthia McCurren

During the past 35 years, organ donation and transplantation have become life-saving procedures for thousands of people with irreversible organ disease, in the years since the first transplantations were performed, medical technology has improved, and transplantation now is in great demand. The success of these procedures has led to a supply and demand mismatch for all transplantable organs. (1) It is important, therefore, to consider any potential barriers to the success of the overall donation process.

One possible barrier to successful donation is the potentially negative reaction of nursing personnel to experiences surrounding organ procurement after a donor has been secured. Nurses have the opportunity to initiate positive interventions in all phases of the organ procurement process, but use of these interventions depends on an individual nurse's attitude about donation (2)

Organ procurement is the process of removing (ie, harvesting) organs from a donor who is brain dead in anticipation of implanting them into a waiting recipient. It involves determining a patient's brain-dead status, obtaining permission from the patient's family members to remove organs and donate them to individuals in need, and initiating removal and transplantation procedures.

Little research in the area of organ transplantation has focused on how nurses who frequently participate in the procurement process are affected. Perioperative nurses involved in organ procurement may experience a variety of feelings as they participate in the removal of organs from a body that physically appears the same as that of any other surgical patient. These patients are being ventilated and medically managed in the same way as live patients, even though they are clinically dead. Perioperative nurses have described their participation in organ procurement as disrespectful, mutilating, traumatic, and emotionally draining.

The purpose of this study is to explore challenges associated with the organ procurement process from the perspective of perioperative nurses experienced in organ procurement. The goal was to develop a description of the lived experience of perioperative nurses involved in organ procurement in an effort to understand the personal impact and perceived needs associated with the experience.

PROBLEM

The death of a patient can be a major source of stress for nurses who work in specialized areas, such as the OR. (6) Research reveals that it is difficult for nurses to acknowledge emotional distress because they believe it may be misinterpreted as weakness, incompetence, or interference with progress. (7) Emotional reactions to organ procurement surgery and the events surrounding it have been only minimally researched. The long-term effects on individuals who frequently participate in the procurement process are unknown.

One OR nurse manager suggested that incidences of increased absenteeism and turnover in the perioperative area might be directly related to a stressful situation in the OR, such as a recent organ and tissue procurement procedure. Efforts to decrease absenteeism and turnover prompted the exploration of these issues. Additionally, it was important to find ways to help staff members cope more effectively with their roles in the procurement process.

REVIEW OF LITERATURE

In an attempt to overcome barriers to organ donation, most research has focused on nurses' knowledge, attitudes, and perceptions regarding organ procurement. (8) Many nurses seem to support organ procurement, but they may lack knowledge about the correct criteria for determining brain death. Inadequate knowledge regarding donor eligibility criteria and a lack of awareness of hospital policy can have a detrimental effect on organ procurement. Most research studies, however, show that nurses have a moderate to high level of understanding of the criteria. (9,10) One researcher found that critical care nurses who were more experienced in working with the procurement population were more knowledgeable about the process. (2) This increased knowledge, however, did not necessarily translate to an increased degree of comfort with the procurement process.

Other research has focused on how nurses' attitudes toward organ donation affect their likelihood of approaching a patient's family members about donation. (8) Additionally, research shows that if a nurse feels dissonant about organ donation, he or she may be less willing to discuss the donation option with a potential donor's family members (2,8,11) Although nurses may respect and support the donation process, they often report ambivalence about the nature of the organ recovery process. Unfortunately, research regarding the feelings of perioperative nurses participating in organ procurement is severely lacking. The research reported here was conducted to address this knowledge gap.

METHOD

A qualitative, phenomenological approach was used for this descriptive study. (12) The purpose of a phenomenological study is to explore the lived experience of study participants. The qualitative approach provided an in-depth description of the lived experience of perioperative nursing personnel participating in the organ procurement process.