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Nurses' 'lack of trust in diagnosis' presents barrier to organ donation

A survey of Swedish intensive care unit nurses has uncovered attitudes which present barriers to organ donation.

A questionnaire was sent to half of ICU nurses in the country, with 69% of them responding.

Less than half of nurses trusted clinical diagnoses of brain death without a confirmatory cerebral angiography, while 25% of respondents indicated that mechanical ventilation was withdrawn without the issue of organ donation being raised.

Meanwhile, 39% had experienced occasions where the issue of organ donation had never been raised with relatives.

Readers' comments (7)

  • George Kuchanny

    I must say at the outset that this article has a very personal interest for me. I have personally witnessed someone being declared brain stem dead who was not. In fact she was recovering from a potassium chloride overdose induced by iv and supplemented by an off label quantity of oral potassium. Serum levels were unfortunately ignored by an incompetent ITU junior doctor who took the level being expelled in micturation as an indicator for further supplementation, hence the bolus oral doses administered despite the already dangerous serum levels.

    Here is the nasty bit. The patient was declared brain stem dead despite being alive just to cover errors in care made by doctors.

    I have no doubt whatsover that the concerns these Swedish nurses have about trusting puported brain stem death tests are well founded. Very well founded.

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  • george your very brave to speak out i also know of an incident prior to my husband dying,
    why are doctors allowed to get away with this incompetance theres a huge cover up hardly any wonder there is no trust
    some of these people think they are above the law and if patients or relatives complain or question they are branded trouble makers
    i truly hope that doctor was reported that how ever it is wrapped up is murder and premeditated to cover up, if he did that as a junior doctor and got away with it lord knows what he is capable of
    "Do No Harm" isnt that the oath ?

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  • In 2000 as a student nurse on ITU placement I was helping nurse an 65yr old lady who had suffer a ?haemorragic stroke. a few days later she deteriorated and suffered brain herniation and she was declared brain dead the following day. As she was a donor card carrier she was prepared for organ retrieval and I was given opportunity to watch the procedure. I think it was more curiosity that made me agree but that experience forever changed the way I feel about organ retrieval because as I found out the "dead" don't need an anaesthetic so are simply cut open without any form of anaesthesia which greatly concerned me, especially as I could have sworn I saw the BP rise when procedure began and I thought what if the body could still feel pain but was unable to respond even slightly imagine how terrible it must be? At first I tried to convince myself I was being oversensitive but while researching articles for my critical care assignment I came across an article written a few years earlier by a consultant anaesthetist who admitted he could not be certain beyond doubt that the donor could not feel pain during procedure which in the case of my experience lasted approx 8 hours from making first incision to removing last organ. While I believe organ donation is a wonderful gift I would not agree to it unless I could be absolutely convinced that my loved one would feel no pain.

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  • as an organ donor myself this article does concern me,

    i have little knowledge in the medical field and have put my faith into believing the higher consultants know best,
    if i could be of help to anyone 'when i am passed' then i think it is something for a very good cause,

    however i had not thought about the fact that nobody can be sure these patients can't feel pain,
    the idea that the patient may not be dead - well i' had hoped that the people who are responsible are so educated and knowledgeable in their position that they know and i trust their judgement...
    now this article has got me a bit nervous

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  • George Kuchanny

    Hello Michelle,
    In my opinion you are quite right to feel a bit nervous. Primum Non Nocere - 'first do no harm' is a universal medical maxim. Or is it? The entire truth here is that there a several conflicting notions going on in the minds of those who identify 'dead' donors. To trust someone to identify you as dead when being truly completely dead makes your organs useless for transplant is not widely talked about nor widely considered. This is my final comment on this article as I find it all rather distressing just as anon student 2000 has done.

    I sincerely hope organs harvested from your own stem cells and grown inn vitro will be the gold standard for future replacement interventions. What we have now is just too ill defined for my liking.

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  • I find much of the content of this forum alarming on many levels. If any professional disagrees with the findings on brain stem criteria then they are morally bound to intervene. Posting after someone expires does not help anyone unless you can substantiate this with written documentation.
    Having considerable neuro-icu experience i have witnessed the sensitivity and respect shown to both family and patient on many occasions. All it took was one article of someone waking from a coma after 5 yrs and everyone became a neurologist overnight. The terri schiavo case in the U.S being the best example.
    There are criteria to be met before someone can be declared brain dead. I urge the staff in this forum to familiarize yourself with this procedure and what signs may be misconstrued as purely reflexive.
    There are literally thousands of desperately ill people whose only last ditch chance may be the donation of an organ. Alarmist comments may set this program back a considerable way if members of the public thought the process to procure these organs under extremely tragic circumstances was somehow ad hoc. If there are anomalies document and report this.

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  • it is alarming also that many people are without relatives who would be able to make a decision on their behalf.

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