Importantly, the community needs clarity about what to expect when a decision to donate tissue or organs is made on behalf of a relative. People need to be confident that strict regulatory processes are in place. And an important first step is to know what tissue donation is. In the context of therapeutic organ and tissue donation, tissue is specialised cellular structures that can survive without blood flow and oxygen , for periods up to 24 hours, and are transplantable.
This tissue can then be preserved for future use.
To Consent or Not: Stewards of the “Gift”
Tissue includes corneas membrane on the surface of the eye , heart valves and vessels, tendons, skin, bone, pancreatic islets. But organs heart, lungs, liver, kidneys, pancreas, intestines perform specialist processes and their cells require a constant flow of oxygenated blood. Without circulation, the cells die and organs stop functioning within a very short time minutes.
This is why organ donation is rare. With family agreement, the deceased is then transported with the technology still preserving respiration, heart beat and organ function to the operating theatre. This allows the organs to be recovered within minutes of the heart stopping. Unambiguous information about what happens when a decision to donate is made is vital for public confidence. And transparency protects the interests of deceased donors, their families and recipients. When the needs of patients waiting for transplantation are subverted by distrust about donation practices, our society is damaged.
Knowing what to expect before making the decision will increase confidence in and consent for organ and tissue donation. See more Explainer articles on The Conversation. A contemporary Robinsonade — York, York. The polar oceans and global climate — Milton Keynes, Buckinghamshire. Edition: Available editions United Kingdom. Holly Northam , University of Canberra. The researcher also took detailed notes about the part not recorded or the parts which were not recordable after each interview. After the primary codes were defined, they were categorized into unique groups with similar context, and next, subthemes and main themes were formed.
These themes were checked by primary codes. Main themes were again reviewed, and appropriate abstract names were selected for them. Eventually, a final and comprehensive report based on the research question and major and minor goals was provided, and the results were described. For rigor of the data, the researcher took advantage of consultation with her supervisor and counselor.
The data were approved by participants during transcription and by the researcher's supervisor and counselor at the time of coding. Data collection and analysis were concurrently conducted through Aronson, a method described earlier. Data analysis led to extraction of primary codes of which were for prohibiting factors and for facilitating factors.
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Finally, their reduction yielded 11 themes and 24 subthemes, which were divided into two groups of prohibiting and facilitating factors. Prohibiting factors included 5 main themes that emerged from 12 subthemes, and facilitating factors included 6 main themes that emerged from 12 subthemes [ Table 1 ]. The five themes of prohibiting factors were shock, hope for recovery, unknown process, conflict of opinions, and worrying association. There are explained subsequently. Shock: Shock refers to a situation when the family members have just faced an unexpected situation and crisis and are imbalanced.
This theme emerged from two subthemes of disbelief and shortage of time. Disbelief is a manner when the family has just faced the crisis. The family finds itself in a miserable situation and is in shock and disbelief and tries to escape from reality. They told me I did not have much time. First, I did not accept, I was in shock I was out of my mind. On the other hand, when the families are in this dilemma and have not accepted the reality, they are asked for organ donation of their deceased one while there is a short time interval between brain death and making a decision on organ donation.
Finally, we made up our mind in just one night.
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We did not realize anything at that time. Hope for recovery: From three subthemes of healthy appearance, patient's condition, and prayer, the theme of hope for recovery emerged. Families hoped their patient would get cured and return to family. In most of the cases, healthy appearance of the patient was one of the reasons which reinforced the hope for recovery of the brain dead in families. The position of the brain dead in the family reinforced the hope for recovery. It was too hard to accept.
Praying, especially in difficult life situations, exists in all humans, especially in Iran, where there are deep and firm religious beliefs. Unknown process: This theme emerged from three subthemes of unknown death, shortage of information, and distrust, and reveals the unknown process of brain death and its roots in families and society.
Another obstacle was improper manner of informing the families by the health team. This defect embarrassed the families and made them agree with health and transplantation team. If I actually knew there was no hope, I would have eagerly signed the form, but I gave consent with crying.
My two sons brought a doctor from out of hospital, but he said the same thing as other doctors.
While the family tries to accept organ donation of their deceased beloved, at the time of decision making, disagreement of the relatives and friends can put the family in confusion, nervous breakdown, and conflict of opinions. They objected why we gave consent for organ donation. Some relatives and people think that the family has sold the organs or have monetary expectations from the recipient's family.
They always expressed their concern about the public opinion. As we had to change our house, they were more convinced that we had sold our son's organs.
Experiences of the families concerning organ donation of a family member with brain death
Do they recipient's family deserve? What family are they? Are they believers and religious? Some families need respect from others, especially from the side of the recipient. Meanwhile, ignoring the value of organ donation in the society either from the side of recipients or by other people, mass media, and related organizations can slow down the process of making the culture of donation among these social groups. Mass media did not contact us. Nobody asked how we would make ends meet now that our bread winner is gone. They left us. Six themes of facilitating factors included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor.
Humanistic traits: This theme emerged from two subthemes of sacrifice, and altruism and spiritual motives. Having traits of sacrifice, forgiveness, and altruism is one of the factors, and perhaps the most important factor in organ donation. When his healthy organs are to decay in grave, why not to donate.
Spiritual and religious beliefs and motives are among the facilitating factors in organ donation. In fact, they help them cope with the sorrow more easily. In all interviews, the families claimed to have donated the organ for the sate of God and for the peace of the deceased person's ghost. We dealt with God. There is a high desire to communicate with the recipient's family from the side of organ donor's family.
We liked them to call us once in a while; this is a solace for us.
One of the important issues about brain death is culture making in relation with organ donation. Propaganda and informing the public, especially through mass media, plays an important role in this regard. In Iran, in recent years, production and broadcasting of TV series on the subject of brain death has increased. It can act as a facilitating factor. Now, we watch such movies and they seem ordinary to us. Relatives and, especially, immediate family members play a key role in decision making.
The positive role of relatives and friends in provision of a peaceful atmosphere and relaxing the family facing the disaster, as well as provision of psychological and mental help to make them take a decision is so important and effective. Now, all of them have organ donation card.
The Dark Side Of Organ Donation - CBS News
It is good for us. Some emphasized on the necessity of receiving financial help from related organizations based on their financial status after their beloved passed away. I wish the authorities could hear us to do something. I think families like us should be known more in the society and people should hear us more. Assurance: This theme emerged from five subthemes of trust, accepting the fact, visiting the patient, appropriate informing, and awareness. I went to his bed, he had a pulse but his eyes were not live and his body was cold. With regard to the reality of brain death and irreversibility of patient's condition, losing hope to go on with treatment and acceptance of the situation that had happened can act as an efficient factor for organ donation.
When families knew the fact, they made their decision for organ donation more easily. Eternal glory: Brain death followed by an organ donation was counted as death with glory by the families. This issue is more notable in Iranian society in which humanistic and spiritual values are more prevailing. Participants considered organ donation as an eternal glory which is reflected in donor's resurrection. We are happy, we finished it, and thank God, he the deceased had a glorious death and got immortal like a martyr.
The results of the present study showed that families experience some perceptions and emotions and show various reactions in the process of decision making when they are informed about diagnosis of brain death of their patients, and their organ donation, which can be divided into two groups of prohibiting and facilitating factors in the trend of organ donation.
Shock indicated the conditions that are deeply stressful in which the family receives the bad news of their patient's brain death and remains in distress and confusion. This theme is consistent with the theme of trial to accept death obtained by Manuel et al. Khoddami Vishteh et al. In such conditions, families start praying and seek for a more magnificent power God. Sadock et al. Consequently, they are vulnerable concerning psychological status. In the phase of knocking off or dealing which is one of the steps in crisis, one deals with God through vow and worship.
From the viewpoint of participating families in the present study, the sorrow of missing a young member is more than that of an older member through brain death.
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Dejong et al. Manuel et al. Most of them did not know the difference between coma and brain death. Long et al. The decision to donate an organ is a very tough decision for the family members of the brain dead. In this relation, Tavakohi et al. Therefore, through supporting these humanistic motives and valuing them, donation is somehow spread in the society. In Iranian society, sacrifice and altruism are highly dominating among the people and, consequently, positively affect organ donation and can be considered as facilitating factors.
In addition, religious beliefs are counted as a very effective factor in organ donation. Ahmadian et al. Willson et al. The theme of immortality in the present study concords with the term of dominance in the study of Abedi et al. Some were after attention to transfer their own message and some others wanted to make culture among people. Roza et al. Tavakoli et al. Routasalo et al. Manual et al. Trusting the treatment staffs and approval of diagnosis are among the assuring elements. On the other hand, accepting the reality assures the family that their patient is in an irreversible condition.
Visiting their patients and seeing their critical condition can help the families accept the fact. The participants counted organ donation as a glorious death and remembered the deceased with wellness and considered them as the honor of the family.
They believed that participating families believed organ donation to be effective in their gaining peace and consolation. They stated that the decision to donate an organ is the reflection of an internal desire and wish through which they changed a miserable event to something better and positive. The addressee group of our results is the public, related organizations, and supportive NGOs. Nursing personnel should also attain necessary skills to attend a dynamic interaction with brain dead member families, and the public should be driven toward organ donation and getting organ donation card through their better and higher perception of brain death and organ donation process.
The study shows that there is ambiguity and different interpretations on brain death. Using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and remember to the health care system for more attention to these families.
This is to thank and appreciate the cooperation and assistance of all those who participated in this study, particularly the family members who gave consent to organ donation, and the staff of the transplantation team. Conflict of Interest: None. National Center for Biotechnology Information , U. Iran J Nurs Midwifery Res.