Ethical challenges to care in donor situations
The need for organ donations can create ethical challenges for healthcare professionals.
Do we treat individuals as patients or as potential donors? A phenomenological study of healthcare professionals' experiences
Aud Orøy, Kjell Erik Strømskag and Eva Gjengedal(Authors in bold from the Department of Global Health and Primary Care, (UiB)).
Nurs Ethics April 2014
Approaching families on the subject of organ donation: A phenomenological study of the experience of healthcare professionals
Aud Orøy, Kjell Erik Strømskag, Eva Gjengedal(Authors in bold from the Department of Global Health and Primary Care, (UiB)).
Intensive and Critical Care Nursing 2013
Miracle to modern medicine
A ‘miracle of modern medicine’, “organ donation and transplantation have made it possible to both save life and improve the quality of life for a large number of patients”. However, in Norway, as in most other countries, there are increasingly growing organ shortages and lengthening waiting lists. Authors Aud Orøy and Eva Gjengedal report from studies investigation the ethical challenges involved for healthcare professionals.
While physicians are responsible for both the timing and raising of the issue of organ donation, all healthcare professionals are implicated in the ethical challenges involved in caring for patients, potential donors and their families. The 2 papers explore the experiences of healthcare professionals involved in situations where brain death is an inevitable outcome of a patient’s condition, and they must broach the issue of organ donation with the families.
Organ donation a national priority
While national policies on organ donation and transplantation vary in different countries, the authors highlight that, in Norway, organ donation is a national priority. In addition, the Norwegian ‘Transplant Act (1973)’ assumes presumed consent. However, the regulations stipulate that, if medical conditions allow, the next-of-kin should be informed and asked. Clinical practice is that next-of-kin always is asked whether they are familiar with the deceased's attitude to organ donation. Donation practice involves routines, specified in the ‘Protocol for Organ Donation’. Unlike many countries, Norway does not have an organ donation registry. It is considered sufficient if donation wishes have been expressed to close relatives.
The study used participant observations and in-depth interviews to explore healthcare professionals’ experiences during end-of-life decision-making and care. It is a situation where “professional ethics may be threatened by [the] more pragmatic and utilitarian arguments contained in [Norwegian] regulations and the Norwegian Transplant Act”. In addition, “caring for organ donors requires skills that are in conflict with traditional  care.”
Ethical issues should be openly discussed
The authors’ comprehensive analyses of this sensitive area led to some conclusions and implications for healthcare practice. They state that “caring by healthcare professionals means more than simply maintaining life; it is about supporting a dignified life.” Among other things, they stress the need to facilitate the development of reflection and moral reasoning through open discussion and exploration. They also suggest the mentoring of less experienced personnel by more experienced ones.
Some links relating to Norwegian regulations (in Norwegian)