Conflitos éticos de enfermeiros no processo de doação de órgãos e tecidos para transplante

Abstract

This research aimed to know the perception of nurses on ethical conflicts in the process of donating organs and tissue for transplantation, as decisions are made and what is taken into account in decision-making in the face of ethical conflicts. We conducted an exploratory, descriptive and qualitative approach, using the content analysis proposed by Bardin. Eleven interviews were conducted with nurses who provided assistance to potential donors in professional practice for at least one year, allocated in the following units: adult and pediatric ICU, First Aid, surgical center, inpatient units and the Commission Intra Hospital Organ Donation and Tissues for Transplantation. After analyzing five categories: 1. Difficulty accepting brain death, 2. Non-acceptance of the multidisciplinary team to disconnect the ventilator patient's brain-dead organ donor is not 3. Difficulties of the multidisciplinary team during the process of organ donation 4. Situations that may affect the process of organ donation and 5. Decision making in the face of ethical conflicts in the process of organ donation. The results showed that nurses identify ethical conflicts in the process of organ donation, generated by several factors: the difficulty in accepting brain death as death of the individual, the resistance to accept the suspension of therapeutic support in brain death, the lack of knowledge and commitment during the donation process, neglect and inadequate care of the potential organ donor, the difficulty with the allocation of human and material resources including the release of ICU beds for the potential donor, religious beliefs and failures communication. Moreover, to make decisions in the ethical conflicts, they take into account the principle of beneficence, the legal duty, and especially the dialogue with colleagues. Thus, it became evident that the process of organ donation is permeated by ethical conflicts, demonstrating a need for reflection and discussion on the topic, including generating situations and decision making in the face of ethical conflicts.

Gaps and Impediments to Organ Donation in Brazil: A Literature Review

“…When the diagnosis of BD is made, family members are promptly notified, and the CIHDOTT tells the State Transplant Center (Central Estadual de Transplantes-CET), even if there is unfeasibility of organs or family refusal to donate. 20,22 However, the BD declaration process still needs to overcome obstacles related to failures to complete the diagnosis. To investigate inefficiencies at this stage of the donation process, a survey in the United States studied the possible factors associated with Potential Donors by BD that were never declared during four years, and these represented 15% of all PD by BD.…”

Lacunas e Fatores Impeditivos da Doação de Órgãos no Brasil: Revisão de Literatura

“…Vale citar que a CIHDOTT deve atuar em conjunto com as equipes médicas do hospital, principalmente UTI e Urgência e Emergência. 22 Ademais, é importante destacar o encaminhamento do potencial doador pelo departamento de emergência do hospital, já que nesse setor existe maior taxa de sucesso de doadores, além de uma tendência de doação de mais de um único indivíduo, em comparação com encaminhamentos oriundos da UTI.…”

“…Quando feito o diagnóstico de ME, os familiares são prontamente avisados e a CIHDOTT notifica a Central Estadual de Transplantes (CET), mesmo que exista inviabilidade de órgãos ou recusa familiar à doação. 20,22 No entanto, o processo de declaração de ME ainda passa por obstáculos relacionados a falhas em completar o diagnóstico. Em virtude de investigar ineficiências nessa etapa do processo de doação, uma pesquisa dos Estados Unidos estudou os possíveis fatores relacionados aos PD por ME que nunca foram declarados durante quatro anos, sendo que estes representaram 15% de todos os PD por ME.…”