Expanding the Use of Continuous Sedation Until Death and Physician-Assisted Suicide.

The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, "Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis" claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows proportionality protocols for which LiPuma's thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma's contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life.

Turkish Validity and Reliability Study of "Intensive Care Nurses" Attitude Scale Toward Brain Death and Organ Transplantation.

This study was carried out to analyze the validity and reliability of the Turkish adaptation of the "Intensive Care Nurses" Attitude Scale towards Brain Death and Organ Transplantation". The research was carried out as a methodological study and 256 nurses were included in the study. Language, content validity, explanatory and confirmatory factor analyzes were used to analyze data. Twenty-one point 5% of nurses stated that they had an organ donation card. It was determined that the Cronbach alpha coefficient of scale was .85, and item-total score correlations were between .143 and .700. It was established that the scale showed three-factor structure and the first factor was named as "Approving Organ Donation", the second factor as "Discomfort" and the third factor as "Improving The Quality of Life". The Turkish version of the scale was found to be an valid and reliable measurement tool.

The effectiveness of video training in improving intensive care nurses' knowledge about brain death identification.

BACKGROUND: Because patients diagnosed with brain death in intensive care units constitute a potential cadaveric donor group for organ transplantation, intensive care units are potential donor sources. Nurses who closely monitor the patient collaborate with medical personnel in the recognition and early diagnosis of brain death. Nurses also have an important role in supporting the patient's family. Therefore, it is very important for nurses to know the diagnostic criteria for brain death. AIM: The aim of this study was to compare the effectiveness of theoretical education and video-assisted education in equipping intensive care nurses to recognize brain death. STUDY DESIGN: A randomized, experimental study was conducted between February and May 2020 with a total of 50 intensive care nurses, split into 25 in the video-assisted training group and 25 in the theoretical training group. In study, intensive care nurses were given a theoretical training and video-assisted training on brain death criteria. One group was trained theoretically and the other group used a video showing criteria for brainstem reflexes (pupil assessment, spontaneous breathing, corneal reflex, retching and coughing assessments) and deep tendon reflexes in a simulated patient, supported by animation. The data were collected before, immediately after and 3 months after the training using the Brain Death Criteria Knowledge Test, the Brain Death Case Test, and the Training Effectiveness Evaluation Form. The independent samples t-test, Mann-Whitney U test, Friedman test, Wilcoxon test, and Chi-square test were used for statistical analysis of data. RESULTS: It was found that the knowledge scores of both groups immediately after training and 3 months after training were higher than before the training (p < .001). However, the post-training knowledge scores of the video-assisted training group were significantly higher than those of the theoretical training group (p = .011). CONCLUSIONS: To enable intensive care nurses to identify brain death, video-assisted training with a simulated patient is recommended, as is repeating the training at regular intervals. RELEVANCE TO CLINICAL PRACTICE: The simulated patient video-assisted training method can be used for in-service training to provide intensive care nurses with the ability to identify brain death. The training may be repeated at regular intervals (e.g., every 3 months) to increase nurse recall.

Role of intensive care nurses on guiding patients' families/relatives to organ donation.

OBJECTIVE: The aim was to determine the role of intensive care nurses on guiding the families/relatives of brain-death patients to organ donation. METHODS: This research is a descriptive study. While the population of the study consisted of 1710 nurses working in the intensive care units of public, private and university hospitals in the city of Istanbul, the sample consisted of 353 intensive care nurses selected with stratified random sampling method from the probability sampling methods from this population. The data were collected by using "Data Collection Form". RESULTS: It was determined that 74.5% of the intensive care nurses carefully listened the family/relatives of the patient with possible brain death or suffering from brain death and supported them to express their emotion and thoughts clearly; when the family/relatives of the patients hospitalised in the intensive care unit wanted to get information about organ donation, 20.7% of the nurses made the preliminary explanation themselves and then guided the patient to an organ transplant coordinator for detailed information and 3.1% of the nurses generally gave this information themselves. CONCLUSIONS: It was determined that the knowledge of the intensive care nurses about brain death and organ donation was partially adequate and the function of guiding the families/relatives of brain-death patients to organ donation was mostly done by the physician.

Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study.

Background: Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. Methods: In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. Results: A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. Conclusions: This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Evaluation of Physician's Attitudes and Knowledge Regarding the Diagnosis of Brain Death in Deceased Organ Transplantation in Northern Cyprus.

Introduction Increasing deceased organ transplantation rates is an important strategy to overcome the organ shortage. Prior to the pandemic in Northern Cyprus, there were more transplants from deceased donors than from living donors. However, after the pandemic, living donor organ transplants were almost equal to cadaveric organ transplants. The purpose of this study was to explore the knowledge, attitudes, and experiences of hospital-based clinicians involved in the diagnosis of brain death and donor care in order to raise the deceased organ transplantation rate. Methods The study population consisted of three departments: physicians' anesthesiology, neurology, and neurosurgeons, who signed off on the brain death report. The demographic information of the participants was recorded. A total of 31 questions in the questionnaire were about personal experiences, attitudes toward brain death, organ donation, and donor care, and the level of knowledge and expertise required for the identification and care of potential organ donors. The answers are "agree," "indecisive," and "disagree." Results A total of 29 physicians, seven (24.1%) neurologists, six (20.7%) neurosurgeons, and 16 (55.2%) anesthesiologists answered the questionnaire. Although all of the participants stated that brain death is a definite death, it was determined that they did not agree on how the process should proceed for non-donors after the diagnosis of brain death. Conclusion Physicians' attitudes towards deceased organ transplantation are positive. It is pointed out that society's insensitivity and indifference to the decrease in organ donation rates. Multidisciplinary work motivation may increase deceased organ transplant rates.

Dramatic neuromuscular paralysis following occult snakebites: An awareness for the primary care physician.

Neurotoxic snakebites are a common emergency in tropical countries and account for significant morbidity and mortality worldwide. Manifestations vary from mild ptosis and ophthalmoplegia to severe flaccid paralysis with ventilatory failure. At times, the neuromuscular paralysis may be severe enough for patients to be misdiagnosed as a locked-in syndrome or brain dead. Occult snakebites, wherein patients are unaware of the bite and fang marks are absent, have been reported in kraits, an endemic neurotoxic snake belonging to the Elapidae family. We report a series of three cases in which young males presented with dramatic neuromuscular paralysis and were likely suffering from elapid snake bites. Each of these patients presented an intriguing clinical challenge and had different in-hospital outcomes. Primary care physicians in the emergency department are usually the first respondents to such patients. Owing to a lack of snake bite history and unavailability of specific diagnostic tests, severe envenomation presents a challenge for physicians, unless they are aware of it and a high level of suspicion is maintained.

Nurses' Challenges in Caring for an Organ Donor Brain Dead Patient and their solution strategies: A Systematic Review.

BACKGROUND: Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges. MATERIALS AND METHODS: In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000-2018 on the keywords "brain dead OR brain death" and "nurses OR nursing." After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation. RESULTS: According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care. CONCLUSIONS: Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be thefirst step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.

Effectiveness of Interventional Strategies in Modulating Knowledge and Attitude of Health Care Professionals for Promoting Organ Donation: A Study in Tertiary Care Public Hospital of North India.

OBJECTIVE: To evaluate the impact of interventional "educational module" on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance. STUDY DESIGN: Interventional and prospective. METHODS: We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention. RESULTS: A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the "concept of organ donation," while nurses were more familiar with "procedures and protocols." Both had low knowledge about "clinical criteria for brain death" and "legal issues" preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause. CONCLUSION: Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

Analysis of the reasons for nurses' confusion in relation to the concept of brain death from clinical and legal points of view.

BACKGROUND: Nurses in intensive care units (ICU) play a key role in taking care of brain dead patients and they are often in contact with such patients given the high rate of brain deaths. Consequently, they are in a challenging and stressful condition, which may be aggravated due to the need for increased organ donation, and this may also affect the quality of care provided for these patients. OBJECTIVE: This review analyzes the different studies on the concept of brain death from both medical and legal points of view. The aim of this study was to identify the challenges the nurses face with the perception of the concept of brain death and its effects on the care provided for the patients suffering from brain death, as well as organ donation. METHODS: This Narrative review study summarizes the information obtained from relevant literature through a targeted search of library texts and electronic resources including Science Direct, PubMed, Google Scholar, Scientific Information Database (SID), IranMedex, and Magiran databases during 2000-2017 in English and Persian, on the subject of interest by keywords such as brain death, organ donation, care, legal, regulations and nursing. Finally, a total of 44 relevant articles were reviewed. RESULTS: Nurses play an important role in taking care of brain dead patients; therefore, recognizing challenges can be the first step in taking accurate care of these patients and subsequently maintaining the organs' health for transplants. Although there are clinical and legal uncertainties regarding the concept of brain death, nurses have an important effect on taking care of brain dead patients as well as the rate of organ donation. CONCLUSION: Nurses in intensive care units should have a clear understanding of the concept of brain death in order to be able to take care of brain dead patients by avoiding psychological effects. In this regard, it is recommended that a comprehensive educational program be designed on the dimensions of brain death. Therefore, the nurses' awareness of brain death and their ability to clarify this concept to the patients' relatives would have a great effect on the decrease in the challenges and the stress imposed on the nurses. Also, there would be an increase in the quality of the care given to brain dead patients and even the rate of organ donation.

Potenciais doadores de órgãos em morte encefálica: caracterização e identificação de diagnósticos de enfermagem / Potential brain-dead organ donors: characterization and identification of nursing diagnoses / Donantes potenciales de órganos en muerte cerebral: caracterización e identificación de los diagnósticos de enfermería

RESUMO Objetivo: Identificar os diagnósticos de enfermagem de potenciais doadores de órgãos em morte encefálica segundo a Taxonomia NANDA-I. Método: Estudo observacional, transversal realizado em hospital público no interior do Ceará, Brasil. Coleta de dados nos meses de outubro e novembro de 2021, em 23 prontuários de potenciais doadores de órgãos. Dados foram analisados por estatística descritiva. Resultados: Identificaram-se 22 diferentes diagnósticos, em cinco dos 13 domínios da taxonomia da NANDA-I. Prevaleceram: risco de glicemia instável; risco de função hepática prejudicada; troca de gases prejudicada; mobilidade no leito prejudicada; padrão respiratório ineficaz; risco de infecção; risco de lesão por pressão; risco de aspiração; risco de débito cardíaco diminuído; risco de quedas, eliminação urinária prejudicada; risco de desequilíbrio eletrolítico e risco de pressão arterial instável. Conclusão: A identificação dos diagnósticos poderá favorecer o aprimoramento da prática e a aplicação do processo de enfermagem diante da assistência aos potenciais doadores de órgãos.

ABSTRACT Objective: To identify the nursing diagnoses of potential organ donors in brain death according to the NANDA-I Taxonomy. Method: Observational, cross-sectional study conducted in a public hospital in the interior of Ceará, Brazil. Data collection was realized in October and November 2021 in 23 medical records of potential organ donors. Descriptive statistics analyzed data. Results: Twenty-two diagnoses were identified in five of the 13 domains of the NANDA-I taxonomy. The following were prevalent: risk of unstable blood glucose; risk of impaired liver function; impaired gas exchange; impaired bed mobility; ineffective breathing pattern; risk of infection; risk of pressure injury; risk of aspiration; risk of decreased cardiac output; risk of falls, impaired urinary elimination; risk of electrolyte imbalance and risk of unstable blood pressure. Conclusion: The identification of diagnoses may favor the improvement of practice and the application of the nursing process in the care of potential organ donors.

RESUMEN Objetivo: Identificar los diagnósticos de enfermería de los posibles donantes de órganos en muerte encefálica según la Taxonomía NANDA-I. Método: Estudio observacional, transversal, realizado en un hospital público del interior de Ceará, Brasil. Recogida de datos en octubre y noviembre de 2021, en 23 historias clínicas de posibles donantes de órganos. Los datos se analizaron mediante estadísticas descriptivas. Resultados: Se identificaron 22 diagnósticos diferentes, en cinco de los 13 dominios de la taxonomía NANDA-I. Predominaron los siguientes: riesgo de glucemia inestable; riesgo de deterioro de la función hepática; deterioro del intercambio gaseoso; deterioro de la movilidad en la cama; patrón respiratorio ineficaz; riesgo de infección; riesgo de lesión por presión; riesgo de aspiración; riesgo de disminución del gasto cardíaco; riesgo de caídas, deterioro de la eliminación urinaria; riesgo de desequilibrio electrolítico y riesgo de tensión arterial inestable. Conclusión: La identificación de diagnósticos puede favorecer la mejora de la práctica y la aplicación del proceso de enfermería en el cuidado de los donantes potenciales de órganos.

Brain death: health team's experience with parents of children and adolescents / Muerte encefálica: experiencia del equipo de salud con los padres de niños y adolescentes / Morte encefálica: vivência da equipe de saúde junto aos pais de crianças e adolescentes

ABSTRACT Objective to understand the health team's experience with parents of children and adolescents during the brain death protocol stages. Method a qualitative and exploratory research developed in two health institutions of high complexity and reference in the care of children and adolescents with polytrauma. Participants were health professionals from critical patient units. Data collection took place between October and December 2019 through semi-structured interviews. For content analysis, we used the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires as support. Results twenty-one professionals (physicians, nurses and nursing technicians) participated in the study. The general corpus consisted of 21 texts, separated into 123 segments, with the emergence of four classes. The study shows feelings of support and compassion at all brain death protocol stages. In the protocol opening stage, the team's emotions are focused on the actions of clarifying and revealing information in this process, in addition to pointing out the need for the team to detail the step by step of the exams to be performed. In the communication of death stage, the feeling of being, caring for and welcoming the family relates to other feelings experienced by them. Conclusion the study reveals that the health team experiences unique feelings during the brain death protocol in the reality of children and adolescents, revealing the team's concern with being with the family, paying attention and caring for the pain of loss.

RESUMEN Objetivo comprender la experiencia del equipo de salud con los padres de niños y adolescentes durante las etapas del protocolo de muerte encefálica. Método investigación con enfoque cualitativo y exploratorio desarrollada en dos instituciones de salud de alta complejidad y referencia en la atención de niños y adolescentes con politraumatismo. Los participantes fueron profesionales de la salud de unidades de pacientes críticos. La recolección de datos ocurrió entre octubre y diciembre de 2019 a través de entrevistas semiestructuradas. Para el análisis de contenido se utilizó como soporte el software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados participaron del estudio 21 profesionales (médicos, enfermeros y técnicos de enfermería). El corpus general estuvo compuesto por 21 textos, separados en 123 segmentos, surgiendo cuatro clases. El estudio muestra sentimientos de apoyo y compasión en todas las etapas del protocolo de muerte cerebral. En la etapa de apertura del protocolo, las emociones del equipo están enfocadas en las acciones de esclarecimiento y revelación de información en este proceso, además de señalar la necesidad de que el equipo detalle el paso a paso de los exámenes a realizar. En la etapa de comunicación de la muerte, el sentimiento de ser, cuidar y acoger a la familia se conecta con otros sentimientos vividos por ellos. Conclusión el estudio revela que el equipo de salud vive sentimientos únicos durante el protocolo de muerte encefálica en la realidad de los niños y adolescentes, revelando la preocupación del equipo por estar con la familia, prestar atención y cuidar el dolor de la pérdida.

RESUMO Objetivo: compreender a vivência da equipe de saúde junto aos pais de crianças e adolescentes durante as etapas do protocolo de morte encefálica. Método: pesquisa exploratória de abordagem qualitativa desenvolvida em duas instituições de saúde de alta complexidade e referência no atendimento a crianças e adolescentes com politrauma. Os participantes foram profissionais de saúde das unidades de pacientes críticos. A coleta de dados ocorreu entre os meses de outubro e dezembro de 2019 por meio de entrevistas semiestruturadas. Para análise de conteúdo, utilizou-se como apoio o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: participaram do estudo 21 profissionais (médicos, enfermeiros e técnicos de enfermagem). O corpus geral foi constituído por 21 textos, separados em 123 segmentos, emergindo quatro classes. O estudo mostra sentimentos de apoio e compaixão em todas as etapas do protocolo de morte encefálica. Na etapa da abertura do protocolo, as emoções da equipe estão voltadas às ações de clarificar e transparecer informações deste processo. Além de apontar a necessidade de a equipe detalhar o passo a passo dos exames a serem realizados. Na etapa da comunicação da morte, a sensação de estar, cuidar e acolher a família se conecta com outros sentimentos experimentados por eles. Conclusão: o estudo revela que a equipe de saúde vivencia sentimentos únicos durante o protocolo de morte encefálica na realidade de crianças e adolescentes. Revela também a preocupação de a equipe em estar com a família, atentar e cuidar ante a dor da perda.

ICU Nurses' Knowledge, Attitude, and Practice Towards their Role in the Organ Donation Process from Brain-Dead Patients and Factors Influencing it in Iran.

BACKGROUND: Nowadays, ICU nurses play a significant role in the care of brain-dead patients and their families. Therefore, their knowledge, attitude and practice towards this issue are extremely important to the success of organ donation. OBJECTIVE: To assess ICU nurses' knowledge, attitude and practice towards their role in the organ donation process from brain-dead patients and factors influencing it in Iran. METHODS: In a cross-sectional analytical study, 90 ICU nurses working in Ghaem and Emam Reza Hospitals affiliated to Mashhad University of Medical Sciences were selected through a stratified random sampling. Data were collected from the participants by a questionnaire included demographic information, and factors influencing the nurses knowledge, attitude, and practice towards their roles in the organ donation process. RESULTS: 90 nurses participated in this study. 70% of the research subjects had spoken with their own families about organ donation; 20% had organ donation cards. The mean±SD score of nurses' knowledge was 49.13±9.6, attitude 21.49±14.32, and practice was 3.66±6.04. 80% of nurses had a mean knowledge about their roles in the organ donation process; 82% agreed with their roles in this process, and 97% showed weak practice in this regard. CONCLUSION: Nurses did not have adequate knowledge, attitude, and practice towards their role in organ donation process. It is suggested to include nursing courses on the organ donation process and organ transplantation as well as educational programs to acquaint nurses with their roles in the organ donation process.

Morte Encefálica: Conhecimento e Opinião dos Médicos da Unidade de Terapia Intensiva / Brain Death: Knowledge and Opinion of Physicians from an Intensive Care Unit

RESUMO Objetivos Verificar o conhecimento dos médicos de UTI sobre o diagnóstico de morte encefálica (ME) e averiguar a opinião dos médicos de UTI sobre doação de órgãos. Métodos Estudo quantitativo, exploratório, descritivo e transversal. Foram entrevistados 38 médicos que trabalham em UTI adulto em um hospital estadual da cidade do Rio de Janeiro. O instrumento de coleta de dados foi dividido em três partes: a primeira se referia a informações profissionais; a segunda era composta por nove questões fechadas, de múltipla escolha, que abordavam critérios técnicos para a realização do diagnóstico de morte encefálica; outras sete questionavam a opinião dos entrevistados sobre morte encefálica e doação de órgãos. Resultados A população do estudo possui média de idade de 38,45 anos (DP = 10,58). Em relação ao tempo de formação, observou-se a média de 11,87 anos (DP = 8,94). O quantitativo geral de acertos das questões conceituais foi de 8,07 (DP = 0,78). Dos 38 participantes, apenas 31,57% acertaram todas as questões. Observou-se que dois entrevistados (5,2%) não se consideravam seguros em realizar o exame clínico. Não foram encontradas diferenças significativas nos números de acertos em comparações referentes a idade e/ou sexo dos entrevistados. Conclusão Somente o grupo profissional de intensivistas teve participantes que acertaram todas as questões técnicas. No entanto, algumas questões básicas precisam ser mais bem discutidas. É importante a incorporação de disciplinas que abordem o tema nos cursos de graduação da área de saúde. Atitudes educativas sobre o tema podem ser mais bem difundidas nos cursos de graduação das diversas áreas de saúde, com a inclusão de disciplinas na grade curricular, bem como a abordagem do tema de forma extensiva nos cursos de especialização em terapia intensiva, de modo a permitir que se formem profissionais com maior grau de conhecimento sobre todo o contexto que envolve a ME e o processo doação-transplante, uma vez que esse processo não admite falhas em nenhuma das etapas.

ABSTRACT Objectives Verify the knowledge of ICU physicians about the diagnosis of brain death and the opinions of ICU physicians about organ donation. Methods Quantitative, exploratory, descriptive and cross-sectional study. Methods We interviewed 38 physicians at an adult ICU of a State hospital in the city of Rio de Janeiro. The data collection instrument was split into three parts: the first to gather professional information; the second was composed of nine closed-ended, multiple-choice questions, which addressed technical criteria for the diagnosis of brain death; a further seven questions asked for the interviewee's opinion on brain death and organ donation. Results The study population had a mean age of 38.45 years (DP = 10.58). In relation to training time, the average was 11.87 years (DP = 8.94). The overall quantity of correct answers to the conceptual questions was 8.07 (DP = 0.78). Of the 38 participants, only 12 (31.57%) correctly answered all the questions. Two interviewees (5.2%) did not feel confident about conducting the clinical examination. No significant differences were found between the number of correct anwers and the age and/or gender of the interviewee. Conclusion Only the professional group of intensivists had participants who answered all the technical questions correctly. However, some basic issues require deeper discussion. It is important to incorporate disciplines that approach this subject in undergraduate courses in the health area, which may help diffuse educational attitudes. Such themes should also be extensively addressed in specialization courses in intensive care in order to improve training about the whole context involving brain death and the donation-transplant process, since this process must be absolutely watertight at every step.

Physicians' Belief about Organ Donation.

BACKGROUND: Several studies have suggested that knowledge, attitudes and determinants concerning organ donation are influenced by many factors including gender, educational level, occupation, sociodemographic status, income level, culture and religion. OBJECTIVE: To highlight the awareness of cardiopulmonary and brain death (CD and BD) among the physicians and their belief about the organ donation. METHODS: In a cross-sectional study, 15% of 1700 physicians working under the auspices of Ministry of Health in Makkah region, were selected randomly from two hospitals of Makkah city, i.e., Alnoor Specialist Hospital and King Abdalaziz Hospital. A self-administered questionnaire with dichotomous answers was distributed to them. RESULTS: Out of 185 respondents, 174 (94.1%) identified the right definition of BD and CD and 155 (83.3%) agreed organ donation. The difference among physicians to differentiate CD from BD was not significant (p=0.2). CONCLUSION: Physicians had enough knowledge to differentiate CD from BD; most of them are highly positive regarding the concept of organ donation.

Actitudes y conocimientos de intensivistas colombianos sobre donación y trasplantes: retos actuales para el país / Knowledge and attitudes of Colombian intensive care physicians towards organ donation and transplantation: current challenges for Colombia

Antecedentes. Las tasas de donación y trasplantes en Colombia han descendido. Actualmente, se implementa una norma que exige capacitación al personal médico de cuidado intensivo en gestión de la donación. Objetivo. Identificar actitudes y conocimientos frente a la donación en médicos intensivistas de Colombia. Materiales y métodos. Estudio transversal descriptivo realizado a través de un formulario enviado por correo electrónico a los miembros de la Asociación Colombiana de Medicina Crítica y Cuidado Intensivo. Resultados. 93.75% donaría sus órganos, 97.91%, los órganos de un familiar fallecido, 95.83% donaría en vida uno de sus órganos, 83.33% ha manifestado su intención de donar, 41.66% conoce campañas de promoción a la donación, 12.5% tiene carné de donante y 22.92% ha donado sangre en el último año. 66.66% cree que se debe fortalecer la comunicación sobre donación en la unidad de críticos, 60.42% no aborda la donación con familias de potenciales donantes. 54.17% no conoce la legislación sobre donación 43.75% tiene un concepto desfavorable sobre el modelo de trasplantes colombiano, y 18.75% califica como regular/mala la interacción laboral con los coordinadores de trasplantes. Conclusiones. Los participantes tienen buena actitud ante la donación; sin embargo, muchos desconocen el marco legal de esta en Colombia. Habitualmente no se incluye la donación dentro del ejercicio clínico en cuidado intensivo. La Resolución 2003 de 2014 podría impactar las tasas de donación, si, además de capacitar a los intensivistas, se les brinda la opción de integrarse con la medicina de donación y de ejercer labores propias de la coordinación de trasplantes, se promueve la formación de nuevos coordinadores de trasplante y se integra a las ciudades intermedias del país con la Red Nacional de Donación y Trasplante.

Background. Donation rate and the number of transplants performed in Colombia have decreased. Currently, a new health rule that requests training of health staff in intensive care units to encourage donation, is being implemented. Objective. This study aims to identify Colombian intensive care physicians' attitudes and knowledge about donation. Materials and methods. This is a cross-sectional, descriptive study performed through a structured questionnaire, sent by e-mail to members of the Colombian Association of Critical Care Medicine. Results. 93.75% of participants would donate organs after death, 97.9% would donate organs from a death family member, 95.83% would donate as living donor to a family member. 88.33% have communicated to their family their intention to donate, 41.66% acknowledge some donation promotional campaigns, 12.5% carry donor card. 22.92% have donated blood during the last year; 66.66% consider that it is important to improve communication of donation strategies between staff members of critical care units; 60.42% don't talk about donation with families of potential donors; 54.17% don't know Colombian legislation about donation and transplantation; 18.75% consider fair/poor its working relationship with transplant coordinators; and 43.75% have an unfavorable concept of Colombian transplantation model. Conclusions. Participants show a favorable attitude towards organ donation. However, there is no significant knowledge on Colombian legal issues of donation. Participants do not routinely talk about donation. Resolution 2003 of 2014 will positively influence on national rates of donation given that additionally to intensive care staff training, they have the opportunity to become part of the transplant process and to manage transplant coordination activities. Formation of new transplant coordinators, and integration of intermediate cities to the National Net of Transplant, will also help to increase donation rates.