Nurses’ knowledge about and attitudes toward organ donation in state and private hospitals in Johannesburg, South Africa

Abstract

Background. Nurses are intricately involved in organ donation; however, the referral of donors appears to be declining in Johannesburg, South Africa (SA). This may be due to barriers in the referral process. Objectives. The objectives of this study were to explore nurses' knowledge of the organ donation process and to explore personal beliefs and attitudes around organ donation. Methods. A quantitative, self-administered questionnaire was completed by nurses in Johannesburg, SA. Results. A total of 273 nurses participated, of whom most were female and <50 years old. The majority of participants (64.2%) reported positive attitudes, and 63.2% stated that their personal beliefs about organ donation did not influence the advice they gave to patients. However, only 36.8% felt confident referring potential donors and 35.8% felt that referral was within their scope of practice. Most participants (84.5%) felt that it was the doctor's responsibility to refer donors, but 80.3% noted that they would refer donors themselves if there was a mandatory referral protocol. Only 61% of nurses were aware that there was access to a transplant procurement coordinator through their hospitals; however, there was uncertainty regarding the role of the coordinator. Conclusion. There is an urgent need to clarify the role of nurses in the process of organ donor referral in SA. Although nurses felt positive about organ donation, they expressed uncertainties about referring potential donors. However, if a clear protocol for referral was introduced, the majority of nurses noted that they would willingly follow it. We advocate for the development and implementation of a nationally endorsed protocol for donor referral and for the training of nurses in organ donation in SA.S Afr J Crit Care 2017;33(2):52-57. DOI:10.7196/SAJCC.2017.v33i2.322 As is the case in the rest of the world, the supply of donor organs in South Africa (SA) falls far short of the need for organs. The need to increase solid organ donor rates has spurred a number of innovative transplant programmes such as splitting livers from deceased donors, living donor liver transplants from adult donors to paediatric recipients, [1] and HIVpositive donor to HIV-positive recipient kidney transplants.[2] Such initiatives have generally been driven by motivated academic transplant teams at the hospital level, while there has been little corresponding change in transplant legislation or protocol at the national level, even though protocols for organ donor referral have been incorporated into best practice guidelines internationally.[3] There have been significant advances in transplantation in SA with regard to surgical technique and immunosuppression therapy that have allowed this specialised field of medicine to evolve with outcomes that are internationally comparable in many centres; [4] however, this is not supported by a solid regulatory framework that involves good governance procedures, national guidelines and protocols for clinical practice. Previous research in SA suggests that th...

Organ donation in South Africa – a call to action

“…In this issue of the SAJCC, Crymble et al [1] correctly point out that there is a desperate need for organ donors in South Africa (SA). Their article highlights the integral role of nurses in the organ donation process, [2] and elegantly shows that nurses would welcome a greater role, while at the same time noting that expanded education efforts are desperately needed.…”

“…[15] There is no mandated requirement for discussion of a potential donor with a transplant team in SA, nor is there any system in place to audit the standard of our end-of-life care discussions to ensure that all families are given the opportunity to support organ donation. Crymble et al [1] have illustrated a possible intervention to improve our organ donation system by empowering nurses, who deal intimately with the family during the dying process and beyond, with a role in the referral of patients for organ donation.…”

Early identification and referral of organ donors in five private hospitals: A survey to determine the knowledge and views of critical care professional nurses pre and post a PowerPoint training intervention

“…It was concluded by a small number of the participants in the present study, and has been underpinned by other studies, [6,11] that owing to the lack of a nationally endorsed protocol or policy on organ donor referral, CCPNs are reluctant to refer organ donors independently from the doctors, as they fear reprisal and the burden of caring for a mechanically ventilated donor. [16] The need for a national policy has been previously raised in SA, but at that time (2017) the SA Medical Association chairperson declared that doctors must first be educated prior to enforcing a policy.…”

“…SA studies recommend that protocols and policies regarding the organ donation process should be implemented to ensure a formal, unified referral process. [6,11] The success of organ donation depends on a robust identification and referral process, the key role of the intensivists, the importance of protocols and excellent communication between the CCPNs and the procurement team. [3][4][5] CCPNs experience uncertainty, insecurity and a lack of clarity regarding their roles in organ donation; therefore a nationally endorsed protocol could solve this problem.…”

“…[3][4][5] CCPNs experience uncertainty, insecurity and a lack of clarity regarding their roles in organ donation; therefore a nationally endorsed protocol could solve this problem. [11][12][13] International studies have reported barriers or challenges to donor identification and the donation process, [14][15][16] which include unfamiliarity with BSD diagnosis and the donor process, and inadequate training in stressful experiences such as discussing BSD and organ donation with donor families. [15] A Polish study concluded that poor physician communication and skills and fears about the procurement process may have affected involvement in organ procurement practice, with formal BSD diagnoses not being made by 41% of physicians owing to a lack of experience.…”