Structure, process and outcomes of organ and tissue donation for transplantation

Freire, Izaura Luzia Silvério; Vasconcelos, Quinídia Lúcia Duarte de Almeida Quithé de; Torres, Gilson de Vasconcelos; Araújo, Ednaldo Cavalcante de; Costa, Isabelle Katherinne Fernandes; Melo, Gabriela de Sousa Martins

doi:10.1590/0034-7167.2015680511i

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RESEARCH • Rev. Bras. Enferm. 68 (5) • Sep-Oct 2015 • https://doi.org/10.1590/0034-7167.2015680511i copy

Structure, process and outcomes of organ and tissue donation for transplantation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the factors related to the structure, process and outcomes of organ and tissue donation for transplantation.

Method:

analytic, longitudinal and quantitative study, conducted in six hospitals in Natal/RN, between August 2010 and February 2011, with 65 potential donors (PD), by means of no participant observation structured script.

Results:

regarding the donation structure, there was deficiencies of physical resources (temperature control), materials (mobile radiology) human resources (nurse technicians) and lack of adequate records and care protocols. In the process of donation, the biggest problems were related to the evaluation stages, brain death diagnosis, maintenance and documentation, with greater proportion of care for the non-donor.

Conclusion:

the structure and process possibly determined the result of 72.3% no donation implementation of potential donors, indices compatible with the national data, but contradictory to those of Spain, which manages to transplant organs of 86.7% of its donors.

Key words:
Nursing; Tissue and Organ Procurement; Brain Death

Structure of hospital units		Donor		Non-donor		Total		χ²
Structure of hospital units		n	%	n	%	n	%	p value
Physical resources
	Gas supply and vacuum	18	27.7	47	72.3	65	100.0	-
	Apparatus determine the cause of BD	18	27.7	47	72.3	65	100.0	-
	Blood bank	18	27.7	47	72.3	65	100.0	-
	Laboratory	18	27.7	47	72.3	65	100.0	-
	Illumination system	18	27.7	47	72.3	65	100.0	-
	Apparatus for diagnosis of BD	18	27.7	46	70.8	64	98.5	0.723
	View of the patient	13	20.0	38	58.5	52	78.5	0.449
	Electrical outlets	12	18.5	29	44.6	41	63.1	0.711
	Physical space	12	18.5	27	41.5	39	60.0	0.497
	Temperature control	4	6.2	9	3.8	13	20.0	0.743^* * Note: Fisher's exact test
Material resources
	Vacuum and connections	18	27.7	47	72.3	65	100.0	-
	Emergency carts	18	27.7	47	72.3	65	100.0	-
	Oxygen and connections	18	27.7	47	72.3	65	100.0	-
	Mechanical ventilator	18	27.7	47	72.3	65	100.0	_-
	Reducing valves	18	27.7	47	72.3	65	100.0	-
	Multiparameter monitor	18	27.7	46	70.8	64	98.5	0.723
	Linens	13	20.0	41	63.1	54	83.1	0.142
	Infusion pumps	14	21.5	35	53.8	49	75.4	0.528
	Electrocardiograph	13	20.0	32	49.2	45	69.2	0.746
	Manual resuscitator	14	21.5	31	47.7	45	69.2	0.271
	Hospital bed	13	20.0	31	47.7	44	67.7	0.629
	Glucometer	13	20.0	31	47.7	44	67.7	0.629
	Mobile radiology	12	18.5	32	49.2	44	67.7	0.913
Human Resources
	Social worker	18	27.7	47	72.3	65	100.0	-
	Nurse/physician OPO	18	27.7	47	72.3	65	100.0	-
	Nursing coordinator	18	27.7	47	72.3	65	100.0	-
	Physician on duty	18	27.7	47	72.3	65	100.0	-
	Neurologist / Neurosurgeon	18	27.7	47	72.3	65	100.0	-
	Neurosonologist/Electroencephalographist	18	27.7	47	72.3	65	100.0	-
	Physiotherapist	15	23.1	37	56.9	52	80.0	0.485
	Nutritionist	13	20.0	36	55.4	49	75.4	0.472
	Clinical Nurse	12	18.5	32	49.2	44	67.7	0.568
	Routine physician	12	18.5	32	49.2	44	67.7	0.568
	Technical manager	12	18.5	31	47.7	43	66.2	0.957
	Nurse technician	12	18.5	28	43.1	30	46.2	0.409
Organizational structure
	Continuing Education	18	27.7	44	67.7	62	95.4	0.371
	Documentation and registration	13	20.0	33	50.8	46	70.8	0.873
	Rules/Routines/Protocols	4	6.2	5	12.3	9	13.8	0.205^* * Note: Fisher's exact test

Evaluation of the potential donor	Donor		Non-donor		Total		χ²
Evaluation of the potential donor	n	%	n	%	n	%	p value
Blood typing	18	27.7	40	61.5	58	89.2	0.083
Electrolytes	13	20	39	60	52	80.0	0.332
Renal function	14	21.5	38	58.5	52	80.0	0.782
Complete hemogram	13	20	39	60	52	80.0	0.332
Lung function	13	20	33	50.8	46	70.8	0.873
Pancreatic function	4	6.2	20	30.8	24	36.9	0.107^* * Note: Fisher's exact test
Serology	18	27.7	2	3.1	20	30.8	<0.0017^* * Note: Fisher's exact test
Heart function	5	7.7	11	16.9	16	24.6	0.714
Liver function	3	4.6	8	12.3	11	16.9	0.6437^* * Note: Fisher's exact test
Microbiological cultures	1	1.5	0	0	1	1.5	0.2777^* * Note: Fisher's exact test

Potential donor maintenance	Donor		Non-donor		Total		χ²
Potential donor maintenance	n	%	n	%	n	%	p value
Hematologic function	18	27.7	37	56.9	55	84.6	0.033
Cardiovascular function	17	26.2	34	52.3	51	78.5	0.047^* * Nota: Teste Exato de Fisher
Respiratory function	15	23.1	34	52.3	49	75.4	0.281^* * Nota: Teste Exato de Fisher
Endocrine and metabolic function	16	24.6	31	47.7	47	72.3	0.057^* * Nota: Teste Exato de Fisher
Liver function	11	16.9	35	53.8	46	70.8	0.223
General care	15	23.1	30	46.2	45	69.2	0.108^* * Nota: Teste Exato de Fisher
Renal function	15	23.1	23	35.4	38	58.5	0.011^* * Nota: Teste Exato de Fisher
Care with corneas	15	23.1	22	33.8	37	56.9	0.007^* * Nota: Teste Exato de Fisher
Balance of electrolytes	10	15.4	26	24.6	36	55.4	0.986
Infection Control	12	18.5	23	35.4	35	53.8	0.199
Body temperature	16	24.6	15	23.1	31	47.7	<0.001^* * Nota: Teste Exato de Fisher

Brain death diagnosis	Donor		Non-donor		Total		Fisher's exact test
	n	%	n	%	n	%	p value
Identifies cause of coma	18	27.7	47	72.3	65	100.0	-
Performs the additional examination	18	27.7	33	50.7	51	78.4	0.006
Performs neurological assessments	18	27.7	31	47.7	49	75.4	0.002
Hypothermia exclusion	15	23.1	31	47.7	46	70.8	0.141

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[1] CORRESPONDING AUTHOR: Gilson de Vasconcelos Torres. E-mail: gilsonvtorres@hotmail.com