Regional ethics of surgeon resuscitation for organ transplantation after lethal injury

Peetz, Allan B.; Kuzemchak, Marie D.; Streams, Jill R.; Patel, Mayur B.; Guillamondegui, Oscar D.; Dennis, Bradley M.; Betzold, Richard; Gunter, Oliver L.; Karp, Seth J.; Beskow, Laura M.

doi:10.1016/j.surg.2020.11.037

Cited by 8 publications

(10 citation statements)

References 8 publications

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“…Interpersonal factors were also explored in relation to the moral distress among surgeons (3,(5)(6)(7)(8)(9)(25)(26)(27)(31)(32)(33)(34)(35)(36)(37)(38)(39). In some instances, these interpersonal factors arose in connection to the care provided, such as having unclear or inconsistent goals of care (7,25,34,37), discordance among and between teams or families (3,5,8,26,38), disruptions to the doctorpatient relationship (32), providing life prolonging intervention for terminally ill patients (3,(6)(7)(8)(9)25,33,34,37,39) and pressure from others to drive care (7,8,25,26,33,34,37). In studies assessing surgeons, interpersonal factors' impact on moral distress appear to differ based on surgeon roles.…”

Section: Interpersonalmentioning

confidence: 99%

“…Practice environment was found to influence moral distress among surgeons (2)(3)(4)(6)(7)(8)24,25,27,30,(32)(33)(34)(35)(36)38,39). While some studies focused on the type of setting (e.g., intensive care units, Veterans Affairs hospitals, private practice) (2,8,33) others focused on the influence of subspecialty (33), and differences based on patient population (e.g., pediatric vs. adult) (36,38).…”

Section: Environmentmentioning

confidence: 99%

“…They also report higher rates of moral distress among surgeons whose patient census contained more patients in a critical care setting compared to surgeons who did not. In other instances, studies focused on the impact of limited medical resources (6,32,36,39), including, but not limited to personal protective equipment especially during the COVID-19 pandemic (27). Other studies focused on the impacts of logistical and administration issues, including the difficulty surrounding redeployment (27,30,32,33), the impacts of a demanding patient workload (3,25,27,36), the lack of provider continuity (33,36) and perceived persistence of stressful situations (27).…”

Section: Environmentmentioning

confidence: 99%

“…Community level factors have also been found to influence moral distress among surgeons (6,8,25,34,38,39). For this analysis, "community" was used as an umbrella term to capture the values and identities among surgeons as a population and American society as a whole.…”

Section: Communitymentioning

confidence: 99%

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To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

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Background: There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist. Methods: We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies.A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis.Results: A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress. Conclusions:The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.

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Section: Interpersonalmentioning

confidence: 99%

Section: Environmentmentioning

confidence: 99%

Section: Environmentmentioning

confidence: 99%

Section: Communitymentioning

confidence: 99%

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To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

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“…Results from a recent survey suggest wide variability in practice patterns and extent of resource utilization. 12 Our primary aim with this study is to expand on this survey to better understand the resource constraints and ethical considerations influence resuscitation decisions.…”

Section: Introductionmentioning

confidence: 99%

Trauma Surgeons’ Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation

Peetz

Kuzemchak

Hammack

et al. 2021

The American Surgeon

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Background Trauma surgeons face a challenge when deciding whether to resuscitate lethally injured patients whose organ donor status is unknown. Data suggests practice pattern variability in this setting, but little is known about why. Materials and Methods We conducted semi-structured interviews with trauma surgeons practicing in Level 1 or 2 trauma centers in Tennessee. Interviews focused on ethical dilemmas and resource constraints. Analysis was performed using inductive thematic analysis. Results Response rate was 73% (11/15). Four key themes emerged. All described resuscitating patients to buy time to collect more definitive clinical information and to identify family. Some acknowledged this served the secondary purpose of organ preservation. 11/11 participants felt a primacy of obligation to the patient in front of them even after it became apparent, they could not personally benefit. For 9/11 (82%), the moral obligation to consider organ preservation was secondary/balancing; 2/11 (18%) felt it was irrelevant/immoral. Resource allocation was commonly considered. All participants expressed some limitation to resources they would allocate. All participants conveyed clear moral agency in determining resuscitation extent when the goal was to save the patient’s life, however this was less clear when resuscitating for organ preservation. Across themes, perceptions of a “standard practice” existed but the described practices were not consistent across interviewees. Discussion Widely ranging perceptions regarding ethical and resource considerations underlie practices resuscitating toward organ preservation. Common themes suggest a lack of consensus. Despite expressed beliefs, there is no identifiable standard of practice amongst trauma surgeons resuscitating in this setting.

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How does damage control strategy influence organ’s suitability for donation after major trauma? A multi-institutional study

Altomare,

Bekhor,

Sacchi

et al. 2024

Eur J Trauma Emerg Surg

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Regional ethics of surgeon resuscitation for organ transplantation after lethal injury

Cited by 8 publications

References 8 publications

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Trauma Surgeons’ Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation

How does damage control strategy influence organ’s suitability for donation after major trauma? A multi-institutional study

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