INTRODUCTION:

Organ shortage is an ethical, social, moral, and political problem causing unjustifiable damage to society. Organ donation is the process of retrieving or procuring an organ from a live or deceased person and transplanted into the recipient who requires that organ.¹ Organ transplantation is one of the great headway in modern medical science and the most preferred treatment modality for end-stage organ disease and organ failures. Unfortunately, the need for organ donors is conspicuous than the number of people who donate.²

Since the first skin transplant was performed in 1869 followed by many failed attempts over the years, but since the middle of the 20th century, surgeons performing successful organ transplants³ A severe shortage of deceased organ donation is one of the most challenging issues in Indian deceased organ donation development.

Type of Organ donors:

India’s first organ transplantation was a kidney transplant conducted in the 1970s⁴ India is working towards reaching the required organ donation rate according to requirements but the progress is still very slow and a lot more needs to be done.

From deceased body organs and tissues that can be transplanted include the liver, intestine, kidneys, pancreas, heart, bone marrow, lung and cornea, middle ear, part of the skin, bone, heart valves, and connective tissue but, a living person can also donate some organs like Blood, Kidney, stem cells, and platelets, etc.⁵

Living donor:

Living organ donors” are the persons who can donate certain organs while they are still living. The majority of living donors are either family, close relatives, or friends who are willingly ready to donate an organ(s) to the person who is required for a transplant. They must have to fulfill the formalities including required permission workup and investigations to find suitability and compatibility with the receiver before being accepted as suitable donors. Organs such as "part of the liver" and "kidney" can be donated by a healthy individual only.⁶

Cadaveric donor:

Most donated organs and tissues are from people who have died. Cadaveric organs are the organs which are retrieved from brain dead declared deceased individual and transplanted into the body of a living recipient who requires it.¹ The barriers to cadaveric donations were lack of adequate information about the process, unease about body manipulation, and concerns about religious implications. It is reported by Turkey Organ and Tissue Information System study that cadavers organ donors are more than two-third (81.1%) and were less than one fifth (18.9%) are living donors in European countries; whereas almost 95% of the organ donors are cadavers in China⁷

The immense need for organs:

Although over the last century, organ donation and transplantation have overcome major technical, legal challenges to survive still due to the lack of awareness, knowledge, and myths about organ donation, people hesitate to take up this noble cause of giving a new life for the sake of others benefits. There is an enormous incongruity in the accessibility and availability of organs and tissue for transplantation in different regions across the world.^8,9

Indian perspective:

The deficiency of organ acquisition from a cadaveric donor is globally a matter of concern, especially against developing countries. Surprisingly, nationally, with a population of over 1.2 billion people, the statistics stand at only 0.08 persons as organ donors per million populations in India. This is an incredibly small and insignificant number compared to the statistics around the world.⁵

Organ donation has been one of the prodigious milestones in modern science that have been a new gleam of hope. The Transplantation of Human Organs Act (THOA) 1994 and the subsequent amendments in 2011 and rules in 2014 from the legislative foundation for brain death and organ donation. The act discusses the regulation of the removal of human organs and its storage and also includes the regulation of human organ transplantation for therapeutic purposes and the prevention of unlawful commercial activities of human organs. The main quest was to bridge the gap between the organs available and the organs needed.^10,11

Excluding the other reasons, the number of brain deaths because of trauma and accidents is nearly 1.5 lakh annually in India.¹² India is following an opt-in consenting system where consent for organ donation is required as compared to the opt-out consent system. The most scene practice of refusal for organ donation by the family or next of kin after brain death diagnosis is often the biggest hindrance in pushing this program further.¹³ The rate of deceased organ donation in India is around 0.34 per million^1,12 which is dreadful low if compared to the organ donation rate to few of better-performing countries such as Croatia’s 36.5, Spain’s 35.3, and America’s 26 per million, respectively where the Option out system.^12,13

The main aim of this article is to understand the need for organ donation and find the importance of the role of nurses in creating awareness about organ donation to inspire the patients and their caregivers to pledge organs, more information about organ donation can be spread.

Roadblocks to Organ donation:

Low interest in organ donation among the public in another showing the bitter unjustifiable truth is that society is denying another human’s chance to live. In contrast, the possible way out to fill the organ deficiency is more likely depends on the change in the current social behavior and acceptance towards organ donation. The role of increasing awareness about organ donation and acceptance could be achieved if the strategies would be adopted to modify social attitudes towards organ donation.

In India, the concept of life beyond demise is similarly connected with the theory of ancient ethics, belief, and spirituality. No religion in the world stops for organ donation but the people do. Standard guidelines to define brain death and law and criteria for organ donation are not similar worldwide, that contribute to a loss of potential donors. Another example of lack of knowledge and myth among people can understand by the fact that even this is difficult to discuss regarding organ donation especially in the case of a brain-dead donor.¹⁴

· Globally, the prevalence of knowledge about the organ donation need, legislations of transplantation was found to range from 60% to 85%, on using different knowledge variables.¹⁵

· Less awareness, myths, and religious beliefs and lack of faith in the healthcare system impact on the decision making regarding deceased organ donation. These factors have been believed to generate fear and mistrust in the minds of family members that leads to the refusal for giving organ donation consent¹

· Conflicts of interest among the health team and administration seem to be one of the most difficult barriers to cross.¹⁶

· Another key reason for low organ pledging and donation rate is no (lack of) knowledge about the process of registering one's wish to donate among people and misbelieves related to the organ donation.

· Another hurdle during cadaveric donation reported by studies is improper information to caregivers, concerns about body handling, and agitation about the lengthy legal and documentation process of organ donation.^16,18

Role of a nurse as a leader:

Proficiency among healthcare professionals about organ donation is paramount for enhancing the awareness and encouragement of peoples for organ donation. Adequately educated nurses are equipped with defined knowledge about organ donation and transplantation process and commitment towards pledging for organ donation can act as a significant player to enhance the deceased donation program.¹⁸

Nurses are a professional body of knowledge and understand every aspect as well as the cultural, ethical, and legislative considerations regarding organ donation.¹⁹ A well-informed nurse should be capable of changing the behavior among caregivers and respond positively and unreservedly for the utilization of organs after death.¹³

Few important reasons to understand why nurses can act as an ambassador to increase organ donation and can spread awareness.

1. The area of nursing practices is filled with empathy, compassion, and esteem for the majesty, value, and unique attributes of every person.

2. The nurse’s core concern and commitment are always towards their client/ patients.

3. The nurse advocates for their patients when they can’t speak for themselves.

4. The nurses can help families, caregivers to provide the information with all the facts, legal procedures regarding the organ donation and pledging process.

5. Nurses can educate people with more clarity about common myths regarding organ donation due to cultural and social reasons involved.

6. During their routine work with patient’s care nurses offer an opportunity to patient’s kin to see their patient every day and provide a chance to get involved in patient care

7. The patients and their families found nurses more accessible as compared to senior physicians and other team members.

8. Nurses are closely involved in end of life care and can greatly affect requests for organ donation. Also, they can recognize early signs and symptoms of brain death and can initiate the consenting and counseling about organ donation.

9. Nurses can talk to the patients' relatives more comfortably and thoroughly explain policy and procedure which may end up as a affects factor on family members commitment to organ donation.

10. Working in patients' care round the clock, nurses are in a better place to explain the process of organ donation and can support families psychologically.

Studies suggested that the donor families accepted transplant coordinators and found it easier to discuss and express their thoughts compared to doctors. Countries such as Spain, Australia, and the United Kingdom are a step ahead and have introduced nurses as transplant coordinators.^19-21

In the study accredit as “beliefs and attitudes of healthcare professionals about brain death and organ donation”, reported that as the communication power of nurses with organ donors or beneficiary, impact on their frame of mind towards organ donation and can be deciding factor for donation.^20,21

Capacity building program for Nurses:

Studies reported that nurses who are having sufficient information and knowledge can play a substantial role in maximizing the limited organ supply for patients with multi-organ failure.^1,4

Masoumian Hoseini. S. T. et al. concluded in their study that the majority of nurses had good knowledge regarding their title role in the organ donation process. ¹⁷Studies suggested that regular educational updates can increase nurses’ knowledge about organ donation and the transplantation process. Educational programs and activities should be implemented to update knowledge and develop a better understanding among nurses towards organ donation.¹⁰

What needs to be done?

Worldwide, around 47% of the population asked to donate their organs have given agreement even though in the survey result, almost 75 to 90% of the people are in favor of the donation. Awareness about organ donation helps to ease people to understand their rights to receive and donate organs and tissue during their entire life.

· Collaborative approaches are necessary to increase awareness about organ donation and try to change the attitude of the people from society towards the organ donation campaign.

· Factors responsible for ‘No organ donation’ should be kept in mind during the planning of awareness campaigns; it will be more explanatory with the use of electronic devices and paper media.

· The ‘holy’ dimension of the word ‘donation’ may be overstretched during these campaigns. Public awareness activities should be coordinated about their cultural and religious belief.

· Political and social leaders and other popular public personalities should give extensive public awareness to the organ donations.

· The donors and their families should get the privilege, respect, honor, and appropriate assistance if need to access health care facilities.

· Prospective donors and their family needs positive assurance that after donation their bodies will be handle with high regard and dignity.

· To ensure the courteous treatment to the cadaver from students, the invaluableness of donated bodies, and the feelings of the donors behind body donation pressurized on students’ minds.

· Guidance and support to understand the process of body/organ donation should be easily available for persons showing their willingness to donate.

· Appropriate counseling to the next of kin/legal guardian of the donors essential to honor the will of the donor done.

· If we continue to push the boundaries for trauma and intensive care improvement and standardization across the country, we will indirectly by creating a bigger pool of potential donors in our hospitals.²³

Thus, educational interventions to improve understanding of brain death and organ donation are extremely important as Kim et al suggested that it is necessary to implement essential educational training for nurses to enhance their knowledge and skills and to promote organ donation.²²

CONCLUSION:

For the review, published studies across e-sources from Pub Med, Research Gate, and Google Scholar, and other databases addressing the key role of the nurse in organ donation were identified. The list of people waiting for organ transplantation is escalating by every passing day. The paucity of organs can be rectified by upraising awareness and educating young people as a willingness to donate organs is associated with younger age since they comprise the majority of the population. Nurses should be trained to play a specialized role in organ donation and transplantation. Efforts should be intensified to give comprehensive and appropriate continuing programs to nurses about organ donation.

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Received on 17.10.2020 Modified on 08.11.2020

Asian J. Nursing Education and Research. 2021; 11(3):321-325.

DOI: 10.52711/2349-2996.2021.00077