Navigating ethical challenges in donation after circulatory death: Nurses' perspectives.

Area of Science:

• Medical Ethics
• Nursing Practice
• Organ Donation

Background:

• Controlled Donation after Circulatory Death (cDCD) presents ethical challenges in organ donation.
• Existing research primarily addresses medical aspects, overlooking intensive care nurses' ethical reflections.
• A gap exists in understanding nurses' experiences with ethical dilemmas during cDCD.

Purpose of the Study:

• To explore ethical challenges faced by intensive care nurses during the cDCD process.
• Investigate ethical considerations in navigating life-sustaining treatment withdrawal and organ donation.
• Understand nurses' perspectives on ethical boundaries in cDCD.

Main Methods:

• Qualitative design with an inductive approach.
• Critical Incident Technique used for data collection.
• Interviews with five experienced intensive care nurses across two Swedish ICUs.

Main Results:

• Five themes identified: ethical boundaries, autonomy, emotional presence, uncertainty management, and interprofessional communication.
• Ethical challenges stemmed from unclear procedures, limited training, and fragmented communication.
• Structured guidelines and collegial support were found to enhance ethical coherence.

Conclusions:

• Controlled Donation after Circulatory Death (cDCD) necessitates balancing ethical, professional, and emotional aspects.
• Organisations must enhance ethical awareness, structured training, and interprofessional communication for sustainable practice.
• Integrating biomedical and caring ethics is crucial for patient autonomy, family support, and healthcare professional confidence.