ORIGINAL RESEARCH

The role of nurses in the intra-hospitalar organ and tissue donation commission

Fernando Dalmaso Tolfo^I; Silviamar Camponogara^II; Maria José López Montesinos^III; Carmem Lucia Colomé Beck^IV; Suzinara Beatriz Soares de Lima^V; Gisele Loise Dias^VI

^I Nurse. Master's Degree. Doctorate Student, Federal University of Rio Grande. Rio Grande do Sul, Brazil. E-mail: fernandotolfo@gmail.com
^II Nurse. PhD. Associate Professor, Federal University of Santa Maria. Rio Grande do Sul, Brazil. E-mail: silviaufsm@yahoo.com.br
^III Nurse. PhD. Full Professor, Facultad de Enfermería de la Universidad de Murcia, Spain. E-mail: mjlopez@um.es
^IV Nurse. PhD. Full Professor. Federal University of Santa Maria. Rio Grande do Sul, Brazil. E-mail: carmembeck@gmail.com
^V Nurse PhD. Adjunct Professor, Federal University of Santa Maria. Rio Grande do Sul, Brazil. E-mail: suzibslima@yahoo.com.br
^VI Nurse. Master's Degree. Doctorate Student, Federal University of Santa Maria. Rio Grande do Sul, Brazil. E-mail: gidias18@gmail.com

DOI: https://doi.org/10.12957/reuerj.2018.27385

ABSTRACT

Objective: to learn about the role of the nurse on the in-hospital commission on donation of organs and tissues for transplantation. Method: in this qualitative study conducted in five hospitals in a metropolitan region of south Brazil, data were collected by semi structured interviews of 12 nurses, and treated using thematic content analysis. Results: three thematic categories emerged: the role of the nurse in active detection, the nurse and administrative procedures of the organ and tissue donation commission, and the nurse and the potential organ donor's family. The nurse is regarded as linking between the commission team and others involved in the organ donation and harvesting process. Conclusion: the nurse is present at all stages of the process, and also plays an important role in active detection, and in management and careful observation of nursing care for potential donors.

Descriptors: Nursing; nurse's role; transplants;tissue and organ procurement.

Brazil has been developing a transplant program in consolidation process. Statistical data show that the effective donor rate, obtained in the first quarter of 2016 in Brazil, had a reduction of 7.1% when compared to 2015, and was still 18.1% below the forecast.¹

The Brazilian legislation related to the donation and collection of organs and transplants is old and has been altered throughout its history, aiming at adapting and improving it. Nowadays, the law in force formalizes and establishes the Intra-Hospital Committees for the Donation of Organs and Tissues for Transplant (IHCDOTT).²

The IHCDOTTs are composed of multiprofessional teams that play an important role in obtaining organs, since they are allocated within the hospital units, performing the active search for potential donors, education and social awareness about organ donation. These committees are formed by a multiprofessional team composed of the institutions staff, it should be highlighted that only the doctor and the nurse can have the role of coordinator² Regardless of the role of coordinator of IHCDOTTs, the role of nurses in these committees has been recognized and related to the success of the transplant.³ This is due to the fact that the nurse is recognized as a professional who, through their technical knowledge and developed interpersonal ability, allows the increase and fluidity of the process of collection and donation of organs, which has repercussions on the quantity.⁴

On the other hand, it is necessary to consider that although this is an area of action of the nurse, little has been discussed on this topic. Studies point out that, although nurses are the professionals who are closest to the patients and act as members of IHCDOTT, there are gaps in the formal education regarding the organ donation that need to be fulfilled.^5-7

Given this context, it is necessary to approach both the training process and the scope of the scientific production on the role of the nurse in this process, broadening the theoretical bases to support a safer and more effective action. From this perspective, the following research question was developed: What is the role of the nurse who works in the IHCDOTT? Thus, the present study aimed to know the role of nurses in this committee.

LITERATURE REVIEW

The role of the nurse in the process of organs and tissues donation for transplantation is to work with the various components of this process. A Brazilian study of 2016 showed that factors such as fear, stress, religion and knowledge are the reasons that make it more difficult for nurses when faced with the organ donation process. And the same study considered that nurses, due to their professional characteristics, such as proximity and comfort given to the patient and family, communication skills, are an important part in a successful process of organs donation.⁸

Several studies around the world corroborate the above, when mentioning the relevance of the nurse member of the IHCDOTT as a necessary and participant professional in the donation process: in Poland,⁹ In Holland,¹⁰ in China,¹¹ In Turkey,¹² in Iran,¹³ in Australia,¹⁴ na Suécia,¹⁵ in the United States¹⁶ and in Brazil.^3,8,17 According to several authors, Brazil also recognizes the strong influence of nurses in the organ donation process and supports their work by citing it, along with the doctor, in the legislation in force, as the only professionals who can be coordinators of the Brazilian IHCDOTTs.^2,18,19 At the end of this section, it is perceived that, despite the importance of the theme and the fact that the nurse is an indispensable element in the organ donation process, little has been produced about their role in this committee.

METHODOLOGY

It is a qualitative research, with a descriptive character. This research was developed in five hospitals of a Metropolitan Region of the South of Brazil, that have IHCDOTTs registered in the Ministry of Health.

The participants were nurses who worked in the IHCDOTT. Therefore, the inclusion criteria were: to be a professional nurse and to have worked in the IHCDOTT for at least 6 months. Professionals who were on vacation or in a leave for any reason during the data collection were excluded. Twelve nurses were interviewed. Parity was sought in the number of participants among the scenarios surveyed, taking into account the number of nurses allocated in the IHCDOTT. In scenario 1: two participants; scenario 2: three participants; scenario 3: two participants. Scenario 4: one participant; and scenario 5: four participants. The collection period occurred in the months of May and June of 2014.

For the data collection, a form was used for the sociodemographic characterization, in addition to a semi-structured interview script with questions about the theme. The data collection began after the institutional authorization and formal contact with the participants, who were willing and agreed to proceed with the interview, after signing the Free and Informed Consent Term (FICT).

The interviews were audio recorded and transcribed in full. The participants were identified by sequential cardinal numbers, according to the interview (E1...). The treatment of the data was carried out based on the thematic content analysis.²⁰ The study was developed in accordance with the Resolution No. 466/2012 of the National Health Council. ²¹ Thus, an opinion was issued by the Research Ethics Committee with Human Subjects under the No. 578,553.

RESULTS

The participants in this study were aged between 24 and 53 years old. The majority of respondents (91%) were female. The IHCDOTT nurses, in their totality, have one or more specializations - in Intensivism (42%), Surgical Center (25%), and Emergency (25%). And among the participants, 17% are specialized in Organ Donation and Transplant. The results are organized in the following thematic categories: the role of the nurse in the active search; the nurse and the bureaucratic issues of the IHCDOTT; and the nurse and family of the potential organ donor. These categories are explained below.

The role of the nurse in the active search

In this category, the statements showed that the nurse is present and active in the IHCDOTT, according to the following reports.

It appears from the statements that the professionals recognize their role in the IHCDOTT. This fact may be related to the nursing professionals' work process, particularly related to the care management and overall view, according to the following statements:

The following reports show that the way nurses work - regarding their professional practice and their positioning before the team - is what favors the position of the link between the other members of the IHCDOTT.

Another role of the nurse professional is the active search for possible organ donors. In this case, when faced with situations in which patients can progress to the diagnosis of brain death, the IHCDOTT nurse works intensely, participating in all the stages of the process, according to the following statements:

The nurse and the bureaucratic issues of the IHCDOTT

This category deals with the bureaucratic aspects involved in the process of organ and tissue donation and collection. Thus, among the roles reported by the participants, there are the bureaucratic activities related to records, notifications, shifts and routines, data on protocols and processes of organs and tissue donation.

The nurse and the family of the potential organ donor

In this category, the participants in this study report how the approach of the family occurs in the process of organs and tissue donation and collection. Thus, the nurse during this process allows the contact with the relatives, because, once the diagnosis of brain death is confirmed, the team needs to report this fact to the family. In this case, the importance of sensitivity to conduct all the contact with the family members is emphasized, which favors the approach and the creation of the bond with them, aiming at the dialogue about the donation of the patient's organs in brain death.

The sensitivity reported by the participants often requires that the IHCDOTT nurses hould be cautious and patient regarding the family members. In order to do so, one must empathize with the family and not pressure it, even though it is recognized that time is precious for the perfusion and preservation of the quality of the organs for the transplant.

Thus, the results show the importance of the nurse as a member of the IHCDOTT. The nurse plays a prominent role in this committee, especially in relation to the coordination and organization of the process, from the diagnosis of brain death to the organ donation, which includes having the necessary sensitivity to approach the family in this delicate moment.

DISCUSSION

The statements report that the nurse is considered a link between the IHCDOTT team. This is related to their academic and professional trajectory, in which they find means, subsidies and competence, which make them a manager and/or administrator. Thus, in the leadership role, they play an important role in the process of organ donation and transplant in organizations.

Thus, the IHCDOTT nurse has been gaining space, conquering the care teams, and, thus, consolidating bonds, from which confidence and security feelings between health professionals and nurses emerge. However, when considering the degree of complexity involved in the donation and collection processes, the multiprofessional team should be able to meet the needs of the potential donor, with up-to-date knowledge.^22,23

The nurse, by demonstrating mastery and skill in the development of their work, ends up assuming a leading position in the process, becoming a facilitator in the process of donating organs and transplants.^3,9-17 When considering the complexity that permeates the whole process of donation and organ transplants, the nurse not only understands but also sensitizes the people involved. The sensitivity shown in the statements expresses the essence of care, which goes beyond the patient itself. Thus, this professional cares and relates to all those involved in the donation process²⁴, especially with the family. ^10,12 It is understood that the nurse understands and respects the autonomy of families and, therefore, tends to make this experience positive, both for the multidisciplinary team and for the family members. ^25,8

It means that attitudes go beyond the technique, they are based on a constant relationship of exchange with the other, which permeates the touch, communication, physical care and respect, constituting a humanized relationship anchored in ethical and legal precepts.^26,27 In this perspective, this professional stands out in the IHCDOTT, and is projected in the multidisciplinary team, for gathering skills and competences in the development of the most varied activities related to the process of organ donation and transplant.²⁸ The active search is recognized as the main action of the IHCDOTT, because in the development of this action, it is possible to assess, diagnose, identify, and still perform care during the period of perfusion and preservation of the quality of the organs for transplantation.^3,29

CONCLUSION

From this study, it is evident that nurses have a fundamental role in the organs and tissue donation process for transplantation and their involvement considers all the processes, from the identification, maintenance, donation, collection and organ transplantation. The nurse is known for their knowledge, interpersonal skills and sensitivity in relation to all those involved, as a facilitator of the organ donation process, being an important element for the increase of organ donation rates in Brazil.

Their performance is present in all the stages of the process, even before the identification of the possible donor. Thus, their role in the IHCDOTT is focused on the active search, management and attentive observation of the potential donor, as well as the professional attitude and sensitivity that are characteristic and that allow nurses to perform their role.

As a member of the IHCDOTT, the role of nurses also extends to bureaucratic issues, notifications, construction of shifts and routines, standard operating procedures, protocol data records, training actions, and continuing education of health professionals. The nurse was mentioned as an indispensable professional among the care team, the family, and the teams of the transplant center, being the link through which these components interrelate. This study presented limitations regarding the reduced contingent of interviewees and also because it investigated this matter in a single region of the country. However, the article reflects a local reality, contributing to the development of new studies aimed at the improvement of nurses in the IHCDOTT.

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