The Importance of Reconstituting the Bodies of Organ and Tissue Donors: a Look at Human Dignity

Corsi, Carlos Alexandre Curylofo; Assunção-Luiz, Alan Vinicius; Monteiro-Silva, Leonardo; Scarpelini, Katia Carmen Gabriel; Bento, Rodolfo Leandro; Ribeiro, Mayara Segundo; Garcia, Flávio Luis; Martins, Luís Gustavo Gazoni

doi:10.53855/bjt.v27i1.566_PORT

Brasil

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REVIEW ARTICLE • Braz. J. Transpl. 27 • 2024 • https://doi.org/10.53855/bjt.v27i1.566_ENG linkcopy

The Importance of Reconstituting the Bodies of Organ and Tissue Donors: a Look at Human Dignity

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction: Family refusal to authorize the donation of human organs and tissues has remained high over the years. Among the many reasons for not donating, we highlight the lack of information about the process and the family’s lack of knowledge about the donor’s wishes in life, as well as other issues, such as the appearance of the donor’s body after donation. In this sense, it is necessary to bring to light the aspects that permeate the concepts of death, human dignity, and care for the donor’s image, especially in the case of tissue donors, where the removal may be more noticeable.

Objectives: An integrative literature review (ILR) was carried out, seeking to highlight gaps and characterize the process of donating human organs and tissues, with a focus on the reconstruction of the donor’s body and human dignity. In addition, the aim was to describe the experience of a professional from a human tissue bank (BTH).

Methods: Using the PICO strategy, the study’s guiding question was drawn up following an IR carried out over the last 10 years, operationalized by controlled descriptors in the SciELO, LILACS, Google Scholar, and PubMed databases. In addition to the search, an experience report was described on the techniques used to reconstruct the donor’s body after the tissues used by a BTH located in the interior of the state of São Paulo were harvested.

Results: Nine specific studies were found on donation and the use of prostheses to reconstruct donated areas. The results show the reasons for family refusal, as well as the care taken by the technical teams in reconstructing donors’ bodies. The family’s concern about the donor’s aesthetic situation influences acceptance for donation, so it is necessary to invest in the safety and quality of the services provided by BTH to reduce family refusal for donation.

Conclusion: Clear communication and the safety of the processes involved in the procurement of human organs and tissues proved to be the best way to facilitate donation and could thus increase donations.

Descriptors Doadores de Tecidos; Obtenção de Tecidos e Órgãos; Coleta de Tecidos e Órgãos; Cadáver; Banco de Tecidos

Controlled descriptors
Portuguese		English
P	“Doadores de tecidos”	“Tissue Donors”,
I	“Obtenção de órgãos e tecidos”	“Tissue and Organ Procurement”
Co	“Reconstituição de Cadáver”, “Cadáver”, “Extração de tecidos humanos”, “Próteses ósseas”, “Dignidade humana”	“Corpse Reconstitution”, “Corpse”, “Body Reconstruction”, “Human tissue extraction”, “Bone prostheses”, “Human dignity”

Author/country	Title	Objective	Comments
Vialle et al.¹⁶/Brasil	A technique for the reconstruction of the limbs of osteomuscular tissue donors	Demonstrate the technique used to reconstruct limbs from musculoskeletal tissue donors.	The method of reconstructing donor limbs from musculoskeletal tissue developed by the Bone Bank of Paraná is a versatile, low-cost transplant option with good aesthetic results.
Pompeu et al.¹⁷/Brasil	Aspectos intervenientes na efetivação da doação do tecido ósseo durante o acolhimento e a entrevista familiar para doação de órgãos e tecidos	Understand the aspects involved in the completion of bone tissue donation during reception and the family interview carried out by professionals from the Organ Procurement Organization (Organização de Procura de Órgãos) from the perspective of the professional and the potential donor’s family member.	The need for educational actions by government bodies was highlighted to raise awareness among the population so that all information is understood in future donation campaigns and possible taboos concerning tissue capture processes and reconstruction of the donor body are avoided.
Pompeu et al.¹⁸/Brasil	Fatores envolvidos na negativa da doação de tecido ósseo em doadores de órgãos nos hospitais públicos e privados de Ribeirão Preto e região	Determine the prevalence of bone tissue donors and the main variables involved in denying this tissue in organ donors.	Some critical factors that influenced family members’ refusal of bone tissue donation were identified: a lack of knowledge about which bones could be removed, how these structures would be reconstituted, and how the donor’s body would appear after harvesting.
Vanholder et al.¹⁹/União Europeia	Organ donation and transplantation: a multi-stakeholder call to action	Review policy and clinical measures that should be considered to increase access to transplantation and improve post-transplant outcomes.	They indicate that one main reason for refusing donations concerns bone harvesting, which can alter the donor’s body.
Jawoniyi et al.¹⁰/Reino Unido	Organ donation and transplantation: awareness and roles of healthcare professionals – A systematic literature review	Investigate the role of health professionals in the organ donation and transplant process.	The health professional must be appropriately specialized to carry out an appropriate and humanized approach to the donors’ families, enabling the acceptance of conscious and educated donation.
Santos et al.⁹/Brasil	Trend analysis of organ and tissue donation for transplantation	Identify the trend in tissue and organ donation from brain-dead donors between 2001 and 2016 registered by an organ procurement organization in the city of São Paulo.	It is reported that factors related to donation refusal may be associated with the lack of information to family members about aspects of the surgery, body reassembly and use of such organs and tissues.
Srivastava & Mani²⁰/Índia	Deceased organ donation and transplantation in India: promises and challenges	Analyze ongoing efforts being implemented to encourage organ transplantation.	It was identified that there are still challenges, including the interaction of sociocultural factors, beliefs, and superstitions that result from a lack of communication and organizational support. These factors impact negative opinions and refusal to donate. The main factor is the lack of information about using the collected organs and tissues and the deformation of the donor’s body.
Schmidt et al.²¹/Alemanha	Fresh osteochondral allografts-procurement and tissue donation in Europe	Highlight Europe’s current human organ and tissue donation situation, focusing on bone processing and possible safety and quality concerns.	It was identified that among the main barriers to accepting the donation is the need for knowledge of the situation in which the donor’s body will be after the extraction of bone tissue, highlighting the scarcity of work with this approach and objectives.
Hage et al.²²/Brasil	Bone tissue donation: tendency and hurdles	Identify the percentage of bone tissue donation in situations of brain death and the trend in the donation rate of this tissue in an organ procurement organization in the city of São Paulo from 2001 to 2016	A significant increase in the rate of bone donation has been observed, but more is still insufficient to meet the demand. This rise is attributed to educational and awareness-raising initiatives about the collection process, donor body restructuring, and using collected tissues and organs. The positive impact of this surge in donation rates is not just in the numbers but in the lives being saved and improved, underscoring the urgency of addressing the organ and tissue shortage. This gives us hope for a future where such shortages are a thing of the past.

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[1] Source: Elaborated by the authors.