Achievements and barriers in the organ donation process: a critical analysis of donation coordinators' discourse.

ABSTRACT

CONTEXT Donation coordinators play an important role in the success or failure of organ donation and transplant programs. Nevertheless, these professionals' perspectives and practices have hardly been explored, particularly in low- and middle-income countries. OBJECTIVE: To examine donation coordinators' discourse on the organ donation process and the barriers they perceive. DESIGN: A critical qualitative study was carried out in Guadalajara, Mexico. SETTING AND PARTICIPANTS: Twelve donation coordinators from public and private hospitals participated. DATA GATHERING AND ANALYSIS: Data were gathered by using semistructured interviews and critical discourse analysis. RESULTS: Participants indicated that partial results have been achieved in deceased organ donation. Concomitantly, multiple obstacles have adversely affected the process and outcomes: at the structural level, the fragmentation of the health system and the scarcity of financial and material resources; at the relational level, nonegalitarian relationships between coordinators and hospital personnel; at the ideational level, the transplant domain and its specialists overshadow the donation domain and its coordinators. Negative images are associated with donation coordinators. CONCLUSIONS: Organ donation faces structural, relational, and ideational barriers; hence, complex interventions should be undertaken. Donation coordinators also should be recognized by the health system.