Professional considerations regarding organ and tissue transplantation

Abstract

The aim of this literature review was to provide theoretical considerations on organ and tissue donation, an effective therapeutic alternative in the treatment of various diseases and in the control of terminal insufficiency of some organs and failure of certain tissues, with the potential to improve the quality of life and living outlook for transplant patients. The main obstacles to carrying out the procedure are the refusal of potential donors’ families, lack of knowledge about the donation-transplant process and scarcity of continuing education policies for health professionals working in the area, and the consequences of lack of knowledge. To change public opinion, this professional must act as an educator, encouraging the population participate in debates on organ transplants and legislation. The number of people on the waiting list is high compared to the total number of donations, despite the positive attitude of the general population towards organ donation.

Keywords
Tissue and organ procurement; Population; Transplantation

Resumo

Esta revisão bibliográfica objetivou tecer considerações teóricas sobre a doação de órgãos e tecidos, alternativa terapêutica eficaz no tratamento de diversas doenças e no controle de insuficiências terminais de alguns órgãos e falência de certos tecidos, com potencial de melhorar a qualidade e a perspectiva de vida de pacientes transplantados. Os principais empecilhos à efetivação do procedimento são a recusa da família de possíveis doadores, a falta de conhecimento do processo de doação-transplante e a escassez de políticas de educação continuada de profissionais da saúde que atuam na área, além dos desdobramentos decorrentes do não conhecimento. Para modificar a opinião pública, esse profissional deve atuar como educador, estimulando a população a participar de debates sobre transplantes de órgãos e legislação. É grande o número de pessoas na lista de espera em comparação ao total de doações, apesar da atitude positiva da população mundial sobre doação de órgãos.

Palavras-chave
Obtenção de tecidos e órgãos; População; Transplante

Resumen

Esta revisión bibliográfica trata la donación de órganos y de tejidos, una alternativa terapéutica eficaz en el tratamiento de diversas enfermedades y el control de las insuficiencias terminales de órganos y de ciertos tejidos, con el potencial de mejorar la calidad de vida y la perspectiva de los pacientes trasplantados. Los principales obstáculos para realizarla son el rechazo de la familia de los posibles donantes, el desconocimiento del proceso de donación-trasplante y la escasez de políticas de educación continua para los profesionales de la salud que trabajan en el campo, además de las consecuencias derivadas del desconocimiento. Para cambiar la opinión pública, el profesional debe actuar como educador al promover la participación de la población en debates sobre trasplantes de órganos y la legislación. La lista de espera es larga en comparación con el total de donaciones aunque es positiva la actitud de la población mundial sobre el tema.

Palabras clave
Obtención de tejidos y órganos; Población; Transplante

Organ and tissue transplantation is currently an effective therapeutic alternative for treating several diseases, improving patient quality and life prospects. However, the growing disproportion between the list of patients and the number of transplants is stark. Limiting factors range from organ procurement and distribution to the lack of continuing education policies for health professionals working in the donation-transplant process, in addition to consequences resulting from lack of knowledge about this process and family refusal ¹.

To change public opinion, health professionals must act as educators, working against misconceptions and unfavorable beliefs that discourage the population from participating in debates on organ transplants and legislation. Reality can only be transformed by a continuous educational process and development of programs aimed at all social segments of society, planned and evaluated with theoretical support and recognized scientific models.

Qualification of professionals who work in organ procurement and collection is essential, since this is a crucial work for Brazilian hospitals that offer this type of care. Nurse participation is fundamental and these professionals need permanent qualification as knowledge about organ donation indicators can speed up effective methods.

A broad and systematic observation at the technical and legal issues related to the organ and tissue donation rate is necessary to compare results in different cities, states or countries, and to identify successful practices. Research aimed at developing effective health policies reduces waste and increases the access to organ transplantation.

Factors such as access to information for family members of potential donors, continuing education of professionals, and articulation and correct execution of the interdependent stages of the process would enable efficient work and reduce the transplant queue. Bioethics presents a path that could facilitate conscious action based on foundations of human action, proposing that professionals transform their concepts and feelings when experiencing human loss and suffering at work.

This article raises theoretical considerations about organ and tissue donation, an effective therapeutic alternative in treating several diseases that can improve the quality of life and living outlook of transplant patients. Moreover, it seeks to stimulate discussion on the subject, contributing to argumentation and the sharing of ideas to help change the social reality of this issue ².

Organ donation process

Importance of the knowledge of participating professionals

When reflecting on their experience in the process of organ and tissue donation for transplants, professionals face many obstacles, some of which reflect the scarcity of human and material resources or the health team’s lack of knowledge due to no specialization in the subject. These factors interfere in identifying probable donors, diagnosing brain death, amicably communicating with family members, maintaining the viability of organs for transplantation, interviewing families, and releasing the donor’s body for burial ³.

Improving knowledge about organ donation indicators can streamline the process through effective and uniform methods for measuring efficiency in different regions. This would enable the comparison of results from different locations so that successful practices could be replicated globally. Moreover, research can assist in developing effective health policies reduces waste and increases population access to organ transplantation ⁴.

A broad and systematic look at the technical and legal issues of this process is necessary to increase donation rates of organs and tissue. A social approach from an ethical perspective, based on legal understanding and respect for the autonomy of potential donors and their families is recommended.

Actions are needed to ensure ethical and legal handling, as defined in Brazil’s transplant legislation, which must be strictly followed by the professionals involved, ensuring commitment to the quality and safety of the organ and tissue donation process. Hence, transplantation depends on the effectiveness of this process, since its interdependent stages need to be well articulated and executed ⁵.

Nurse participation in organ procurement and donation is crucial, as this professional is responsible for planning, executing, coordinating, supervising and evaluating the care provided to potential donors. Thus, nurses must be trained and qualified to perform the necessary procedures to capture all possible organs, increasing donations and reducing waiting lists for transplants ⁶. Improvement of care made possible by health team safety would also neutralize resistance due to distrust in the process, a factor that hinders donation ⁷.

Problems such as lack of knowledge about the organ and tissue donation process, queue waiting time and lack of notification, non-compliance with legislation and lack of humanized relations highlight the lack of knowledge from physicians, nurses and medical and nursing students. Consequently, promoting the continuous education of professionals involved, starting from undergraduate school, is necessary to make them aware of the importance of their work. This seeks to expedite the process and reduce the time of suffering for those waiting in the transplant queue in Brazil ⁸.

Donation is a process permeated by conflicts related to the end of life, body representation, the donor’s body and spirit, the meaning of person and uncertainties regarding the validity of the donation and transplantation process. In this scenario, bioethics unveils meanings for a conscious action based on values that are expressed in human action, proposing to professionals to transform their concepts and feelings when experiencing human loss and suffering at work ⁹.

Importance of donation campaigns

Despite the world population’s positive attitude towards organ donation, the number of people on the waiting list surpasses the total number of donations, and the training and preparation of professionals working in this field is lacking. An important strategy to reduce this issue are campaigns for explaining the concept of brain death and encouraging individuals to express to their families the desire to be organ and tissue donors ¹⁰.

According to the Standard Operating Procedure Manual, as noted by Andrade, Silva and Lima ¹¹, nurse professionals who work in organ procurement perform technical-care work. But the reality of health services reveals limitations in human, material, and financial resources that hinder proving the identified cases and maintaining potential donors, which reduces the number of effective donors. Thus, in-hospital transplant teams lack awareness regarding the systematic care of potential donors with brain death.

Consequently, professionals involved in this process perform more than simple care, making it necessary to define their responsibilities and establish the needs and logistics of the standard operating procedure, expanding the debate on organ donation. Considering the importance of this social issue, these operations may reduce the indecision of family members caused by lack of information when answering questions during the donation interview. This provides a new survival opportunity for those waiting for a transplant ¹¹.

The failure of physical components to keep the body fit for transplantation and non-notification to the State Transplant Center (CET) are the main causes of loss of possible organ and tissue donors. Thus, health teams need to develop strategies to face the identification, validation, assistance, diagnosis and maintenance stages of potential donors, and to identify the causes of non-notification ¹².

These data represent the reality to be worked with, allowing to identify ways to encourage nurse participation in the process of organ and tissue donation and transplantation, and thus improve the system. Such an approach, in addition to presenting the professional’s work with its difficulties, also presents paths like training and continuing professional education. With this information, as well as the expansion of debates on organ donation, governments can issue health policies that consider the needs of both patients and potential donors and their families.

Final considerations

Although transplantation is an extremely effective procedure in controlling terminal insufficiency of some organs and failure of certain tissues, the disproportion between potential donors and transplant patients remains large. Enforcing continuing education policies for health professionals who work in the donation-transplant process is therefore necessary given the consequences from lack of knowledge and family refusal.

Moreover, to change public opinion, health professionals must act as educators, working against misconceptions and unfavorable beliefs that discourage the population from participating in debates on organ transplants and legislation. This education process must be continuous and aimed at all segments of society to change the current reality.

The obstacles faced by transplant nurses result in human and material resources scarcity, as well as in a lack of knowledge on the subject by the health team. These factors directly impair the work and interfere with identifying probable donors.

Professionals involved in the organ and tissue donation process provide more than care; they define the responsibilities of the agents, establishing the necessary procedures. Given the size of this social problem, these operations can reduce the indecision of family members when answering questions during the donation interview, allowing a new opportunity for survival for those waiting for a transplant.

Referências

• ¹
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• ²
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• ¹¹
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• ¹²
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Publication Dates

• Publication in this collection
  23 Sept 2024
• Date of issue
  2024

History

• Received
  27 Aug 2023
• Reviewed
  30 Jan 2024
• Accepted
  06 Feb 2024