Accounting for organ donation decision-making: Analyzing interview discourse of the donors’ relatives and intensive care unit physicians in Greece

Abstract

The study casts light on the organ donation decision-making process by exploring the experiences of families and physicians involved. Specifically, semi-structured interviews were conducted with 11 family members of 11 different donors and with 13 intensive care unit physicians. Data collection and analysis draws on the principles of Grounded Theory Methodology. Analysis indicated that in the accounts of both groups, organ donation is represented as a multi-faceted process that includes various social and ideological dilemmas. Overlap and mutual influence was found connecting the experiences of family members and those of physicians, highlighting the need for further education and training for physicians and aftercare for families.

Organ Donation Decision in Families With Brain-Dead Patients

“…These antecedents can facilitate or limit the OD decision; hence, they are further categorized into two categories of facilitators and barriers (see Table 1). Among the deceased-related factors, the age and the deceased's prior wishes about donation were the most important antecedents for the OD decision; hence, the deceased person's age range (i.e., child and elderly) (López et al, 2018;Mojtabaee et al, 2018;Rodrigue et al, 2006;Siminoff et al, 2001) and the ambiguity of the deceased's wishes (Brown et al, 2010;de Groot et al, 2012;Ghorbani et al, 2011;Kentish-Barnes, Cohen-Solal, et al, 2019;Kentish-Barnes, Siminoff, et al, 2019;López et al, 2018;Miller & Breakwell, 2018;Podara et al, 2021;Sarti et al, 2018;Vincent & Logan, 2012) were barriers to the OD decision. Among the family-related factors, ethnicity and race were mentioned, whereby the level of consent was lower among ethnic and racial minorities (Brown et al, 2010;Exley et al, 2002;Ghorbani et al, 2011;Kentish-Barnes, Siminoff, et al, 2019;Mojtabaee et al, 2018;Rodrigue et al, 2006;Siminoff et al, 2001).…”

“…de Moraes et al, 2019;Ghorbani et al, 2011;Holman et al, 2013;Kentish-Barnes, Cohen-Solal, et al, 2019;Kentish-Barnes, Siminoff, et al, 2019;Lira et al, 2012;Long et al, 2008;López et al, 2018;Miller & Breakwell, 2018;Mojtabaee et al, 2018;Ralph et al, 2014;Santiago & Gomez, 1997;Vincent & Logan, 2012 Expectation for a miracle Ghorbani et al, 2011;Lira et al, 2012;Mojtabaee et al, 2018;Yousefi et al, 2014 Religious prohibition of cutting deceased body Brown et al, 2010;Burroughs et al, 1998;de Moraes et al, 2019;Exley et al, 2002;Holman et al, 2013;Huang et al, 2019;Kentish-Barnes, Siminoff, et al, 2019;Podara et al, 2021;Sanner, 2007 Concerns over funeral/burial arrangements Gironés et al, 2018;Huang et al, 2019;Siminoff et al, 2013;Siminoff et al, 2001;Simpkin et al, 2009;Vincent & Logan, 2012 Fear and suspicion of family…”

“…Knowing the deceased's prior wishes or having prior discussions about donation in the family was the most important factor that facilitated the decision and prevented family disagreement and instability in the decision (de Groot et al, 2012; Miller & Breakwell, 2018;Rodrigue et al, 2008;Sarti et al, 2018). Families' fears and suspicions about OD were other barriers to decision making; hence, distrust in the diagnosis of brain death and the OD process, fear of being responsible for death, being accused of selling organs, and fear of disfiguration of the deceased's body negatively affected the OD decision (Ahmadian et al, 2019;Huang et al, 2019;Podara et al, 2021;Ralph et al, 2014). The quality of the OD request had a significant impact on families' decision.…”

“…Family conflictsAhmadian et al, 2019;de Groot et al, 2012;Huang et al, 2019;Kentish-Barnes, Siminoff, et al, 2019;Kesselring et al, 2007;López et al, 2018;Ralph et al, 2014;Rodrigue et al, 2006;Rodrigue et al, 2008;Sarti et al, 2018; Yousefi et al, 2014 Unstable family mood deGroot et al, 2012;de Moraes et al, 2019; Kentish-Barnes, Cohen-Solal, et al, 2019;López et al, 2018;Mojtabaee et al, 2018;Podara et al, 2021;Sarti et al, 2018; Vincent & Logan, 2012 Values and religious beliefsRespectful to the patient's wishes (not to donate)deGroot et al, 2015;de Moraes et al, 2019; Kentish-Barnes, Cohen-Solal, et al, 2019; …”

Factors Involved in Nurses' Health-Seeking Behaviors

“…Although nurses have access to resources and facilities related to health control and maintenance at their work environment, they do not pay as much attention to their health as expected 15. It was also found that despite nurses' high awareness of proper health-seeking behaviors (HSBs), it did not lead to appropriate practices among them 7,16,17…”