© Borgis - Postępy Nauk Medycznych 10/2015, s. 696-703
*Grażyna Kobus1, Marta Buzun-Milewska2, Jacek Małyszko3, Hanna Bachórzewska-Gajewska1, Jolanta Małyszko4
Transplantacja narządów w opinii pracowników systemu ochrony zdrowia
Organ transplantation – the view of healthcare employees
1Faculty of Clinical Medicine, Medical University, Białystok
Head of Department: prof. Hanna Bachórzewska-Gajewska, MD, PhD
2University Clinical Hospital, Białystok
Hospital Director: Bogusław Poniatowski, MD, PhD
3Department of Nephrology with Dialysis Unit, Medical University, Białystok
Head of Department: prof. Beata Naumnik, MD, PhD
42nd Nephrology Department, Medical University, Białystok
Head of Department: prof. Jolanta Małyszko, MD, PhD
Wstęp. Medycyna transplantacyjna wciąż wyłania szereg problemów natury obyczajowej i etycznej, które dotyczą również pracowników systemu ochrony zdrowia.
Cel pracy. Poznanie postaw i opinii na temat dawstwa narządów i transplantacji wśród pracowników systemu ochrony zdrowia.
Materiał i metody. Badania przeprowadzono z udziałem 262 losowo wybranych pracowników systemu ochrony zdrowia (lekarze, pielęgniarki, położne). Narzędziem badawczym, wykorzystanym do przeprowadzenia badań, był kwestionariusz ankiety.
Wyniki. Pobieranie narządów od dawców żywych akceptowało 100% położnych i pielęgniarek oraz 99% lekarzy; od dawców zmarłych akceptowało 96,16% lekarzy i ok. 95% pielęgniarek i położnych. Na pobranie narządów po śmierci osoby bliskiej nie zgodziłoby się 6,73% lekarzy i 1,86% pielęgniarek. Ok. 90% ankietowanych niezależnie od wykonywanego zawodu zgodziłoby się, aby po ich śmierci pobrano narządy celem przeszczepienia. Przeciwnych było 6,73% lekarzy, 2,8% pielęgniarek i 1,96% położnych.
Wnioski: Pracownicy systemu ochrony zdrowia akceptują pobieranie i przeszczepianie narządów od dawców żywych i zmarłych, jednak akceptacja ta maleje, jeśli dotyka to nas bezpośrednio i w obliczu śmierci bliskiej osoby lub za życia stajemy przed tym bardzo trudnym wyborem.
Introduction. Transplantation medicine is still the source of many moral and ethical issues, which also affect healthcare employees.
Aim. The aim of the work was to learn the attitudes and opinions of healthcare employees concerning donation of organs and transplantation.
Material and methods. The study involved 262 randomly selected healthcare employees (doctors, nurses, and midwives). The research tool used in the study was an original survey questionnaire.
Results. Organ removal from live donors was accepted by 100% of midwives and nurses, and by 99% of doctors, while from deceased donors by 96.16% of doctors and approx. 95% of nurses and midwives. To the removal of organs after the death of a close relative would not give their consent 6.73% of doctors and 1.86% of nurses. About 90% of the participants would agree to have their own organs removed for transplantation after their death, regardless of the profession. Only 6.73% of doctors, 2.8% of nurses and 1.96% of midwives were of the opposite opinion.
Conclusions. Health care employees accept the removal and transplantation of organs from living and cadaveric donors, but the acceptance is lower if the situation affects them directly, when they face this extremely difficult decision in their own lives or in the situation of death of a close relative.
In recent years, the knowledge and awareness of organ donation and transplantation has grown in the society, which has contributed to an increase in the number of transplantations both from living and deceased donors. However, the number of transplantations still does not satisfy the needs of those who are on the waiting lists (1, 2). Although the declared approval for transplantation is quite high, as a community we are still not well prepared to become organ donors after death. The declared positive attitude does not translate into actual acceptance of organ removal (3, 4). Acquiring organs from dead or living persons does not only depend on the attitude of the community but also on the effort of many medical circles, institutions and organizations. It greatly depends on the doctors themselves – on their professionalism, determination, but also sensitivity and psychological skills necessary in a conversation with the family of a potential donor (5). Personal conviction among doctors and nurses and the local environment also play a great role in the process of obtaining organs for transplantation (6). The situation of making the decision about the removal of organs for transplantation after the death of a close relative is not only difficult for the family but also for the medical personnel. One thing that prevents them from establishing contact with the family of the dead one is the fear concerning the person’s dignity, the wish to spare the family traumatic experiences and care about their emotional well-being (7). And although Polish law (8, 9) obliges healthcare centers to make the preliminary qualification of the potential donor and carry out clinical studies, not all hospitals diagnose the death of the brain and appoint a committee to discontinue the treatment and in – the case of lack of contraindications – carry out the removal of organs. One reason for the failure to identify potential donors may be the inability to talk with the dead person’s family about the potential removal, or fear connected with such a conversation, but the local attitude to transplantation, especially in small towns, is also a significant factor. This is no problem in hospitals where many identifications and removals are done, but it is otherwise in small hospitals, where the brain death diagnosis, donor identification and organ removal are very rarely carried out. The medical personnel of those hospitals do not always have knowledge concerning the identification of the potential donor, or experience in difficult conversations with the families. The innovative part of our research is that we decided to study the attitude of midwives, who accompany humans at birth and do not encounter in their work the brain death or the procedure of organ removal and transplantation.
The aim of the work was to learn the attitudes and opinions of health care employees concerning donation of organs and transplantation.
Material and methods
The study involved 262 healthcare employees (doctors, nurses, and midwives) randomly selected from hospitals in Białystok and Ełk. The research tool used in the study was a survey questionnaire. The questions in the questionnaire referred to organ transplantation.
The study was approved by the Bioethics Committee of the Medical University of Białystok. Each person participating in the study was informed of its purpose and of the anonymity of the survey.
Software such as Excel and Statistica 10.0 from Statsoft was used in the statistical analysis of the collected data. The following tests were used in statistical calculations: the Chi-square test, the Mann-Whitney test and the Kruskal-Wallis test. Results at the level of p < 0.05 were considered to be statistically significant. Differences in the participants’ beliefs concerning transplantation depending on the medical profession and religious practice were investigated in the work.
In the group of 262 participants, there were 40.85% of nurses, 39.68% of doctors and 19.47% of midwives. Women prevailed in the whole study group: 76.72%, compared to 23.28% of men. The mean age of participants was 38.4 ±10.9 years. More than a half (59.92%) of the participants were below 40 years of age, and 40.08% – over 40. The vast majority of the respondents (80%) lived in town. More than a half (62.98%) were married. People who had never married accounted for 27.86%, the divorced ones 6.87%, and widows and widowers 2.29%. The majority of the group composed practicing believers. Atheists accounted for 3.82%. The most common religion among the participants was Catholicism (76.72%); there were 18.70% Orthodox people and 0.76% Protestants.
Acceptance for the transplantation of organs removed from living and deceased donors
Treatment using organs removed from living donors was accepted by all midwives, by 99.0% of nurses and by 97.12% of doctors. The removal and transplantation of organs from deceased donors, was accepted by 96.16% of doctors, 95.33% of nurses and 94.11% of midwives. Doctors significantly more often objected to this method of treatment than nurses (1.92% vs 0.93%; p = 0.0275) (tab. 1).
Table 1. Approval for treatment with the use of organs removed from living and deceased donors.
|Approval for treatment with the use of organs removed||Doctor||Nurse||Midwife||Total|
|From living donors|
|Hard to say||1.92||0.93||0.0||1.14|
|From dead donors |
|Hard to say||0.96||3.74||5.88||3.05|
*p = 0.0275 (doctor vs nurse)
Consent to having organs removed from deceased relatives
A significant difference was found between the doctors and the nurses (p = 0.0052). The percentage of people who would allow the removal of organs from deceased close relatives was 86.54% among doctors, 76.47% among midwives and 73.83% among nurses. The mean age of those people was 37.8 ± 11.1 years. About 24% of nurses and midwives, as well as 6.73% of doctors, did not know in what way to answer the question. The mean age of those who could not answer the question was 43.8 ± 9.6 years. 6.73% of doctors and 1.86% of nurses would not agree to the removal of organs after the death of a close relative (tab. 2). The mean age of the opposing ones was 48.8 ± 11.5 years. Nonbelievers more often expressed such a consent than believers did (40% vs 34.92%).
90% of doctors, nurses and midwives would agree to have their organs removed after their own death. The mean age of those people was 37.3 ± 10.7 years. 6.73% of doctors, 2.8% of nurses and 1.96% of midwives were against it. The mean age of these people was 46.0 years (tab. 2).
Regarding religious practices versus the answer to this question, 70% of nonbelievers and 59.92% of believers chose “definitely yes”; 10% of nonbelievers and 4% of believers were against it.
Table 2. Consent to the removal of organs from close relatives after their death and after the respondent’s own death.
|Consent to the removal of organs||Doctor||Nurse||Midwife||Total|
|After the death of a close relative |
|Hard to say||6.73||24.30||23.53||17.18|
| After their own death |
|Hard to say||3.85||7.48||7.84||6.10|
*p = 0.0052 (doctor vs nurse)
Participants’ talking to their family members concerning their decision to allow the removal of organs after their own death
Approx. 39% of nurses and approx. 30% of doctors had not talked to their family members about their decision to donate organs after death. The mean age of those who had informed their families about their will was 37.9 ± 11 years. The mean age of those who had not was 39.5 ± 10.8 years. Religious practice had no impact on talking to family members; every third believer and nonbeliever alike had never talked to their families about the will to have their organs removed after death.
Declaration of will
24.3% of nurses, 18.27% of doctors and 15.69% of midwives had the declarations of will. 5.88% of midwives and approx. 2% of doctors and nurses had declared their objection in the Central Objection Register. 7.63% of the participants had never thought about it.
Who should ultimately decide about the removal of organs from a dead person?
The percentage of people who thought that the law should ultimately decide about the removal of organs from a deceased person was 54.81% among doctors, and 35% among nurses and midwives. The idea that the family should decide it was supported by 33.33% of midwives, 28.04% of nurses, and 18.27% of doctors (tab. 3).
Table 3. Who should ultimately decide about the removal of organs from a deceased person.
|Who do you think should ultimately decide about the removal of organs from a deceased person?||Doctor||Nurse||Midwife||Total|
|Hard to say||26.92||35.51||31.38||31.3|
*p = 0.0408 (doctor vs nurse)
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