Facilitating organ donation in critical care practice: a discussion paper

Organs for transplantation are increasingly sought after, and this has led to widespread, macro-level government involvement, including advertising, education and a 10-year plan to encourage donation. Despite these initiatives, the impact of organ shortage continues to have significant consequences in the community. These consequences are wide ranging. Firstly it impacts on the individual awaiting organ transplantation with all that is involved, physiologically, psychologically and emotionally. Secondly there is an impact on wider society through an increasing reliance upon an already stretched and cost contained health system. When facilitating the organ donation process healthcare practitioners, in the ward, intensive care unit and the perioperative environment, face many significant and important issues, which represent a complex undertaking. Caring for organ donors therefore requires appreciation of several important areas of practice including emotional labour and ethics, which are examined in this paper. Emotional labour encompasses the ideas originating from Hochschild's (1983) seminal work and ethics is considered from the viewpoint of being a fundamental underpinning of nursing and healthcare practice. This paper explores these concepts' application to healthcare practitioner's practice related to organ donation for patients defined as brain stem-dead and their families. Healthcare practitioners need to be aware of the potential impact of their actions on individual donors, family members and the subsequent recipients. This includes raising an awareness of healthcare practitioner's educational role so that organ donation can become increasingly more available. This paper argues that healthcare practitioners should manage organ transplant care for brain-stem dead patients using a holistic approach, equivalent to that provided for live patients. Perioperative practitioners may or may not be directly involved with the brainstem dead organ donor patient and their family, but having an awareness of the powerful emotions that such a situation can generate for both family and healthcare practitioner, could help shape practice actions.