Sowing “seeds of trust”: How trust in normothermic regional perfusion is built in a continuum of care

IF 8.9 2区 医学 Q1 SURGERY American Journal of Transplantation Pub Date : 2024-11-01 DOI:10.1016/j.ajt.2024.05.017
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Abstract

Normothermic regional perfusion (NRP) is a promising technology to improve organ transplantation outcomes by reversing ischemic injury caused by controlled donation after circulatory determination of death. However, it has not yet been implemented in Canada due to ethical questions. These issues must be resolved to preserve public trust in organ donation and transplantation. This qualitative, constructivist grounded theory study sought to understand how those most impacted by NRP perceived the ethical implications. We interviewed 29 participants across stakeholder groups of donor families, organ recipients, donation and transplantation system leaders, and care providers. The interview protocol included a short presentation about the purpose of NRP and procedures in abdomen versus chest and abdomen NRP, followed by questions probing potential violations of the dead donor rule and concerns regarding brain reperfusion. The results present a grounded theory placing NRP within a trust-building continuum of care for the donor, their family, and organ recipients. Stakeholders consistently described both forms of NRP as an ethical intervention, but their rationales were predicated on assumptions that neurologic criteria for death had been met following circulatory death determination. Empirical validation of these assumptions will help ground the implementation of NRP in a trust-preserving way.
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播下 "信任的种子":如何在持续护理中建立对常温区域灌注的信任。
常温区域灌注(NRP)是一项很有前途的技术,它可以逆转在循环系统确定死亡后控制捐献造成的缺血性损伤,从而改善器官移植的效果。然而,由于伦理问题,加拿大尚未实施该技术。这些问题必须得到解决,以维护公众对器官捐赠和移植的信任。这项定性、建构主义的基础理论研究试图了解受 NRP 影响最大的人是如何看待其伦理影响的。我们采访了捐赠者家属、器官接受者、捐赠和移植系统领导者以及护理提供者等利益相关群体的 29 名参与者。访谈方案包括简短介绍 NRP 的目的以及腹部 NRP 与胸腹部 NRP 的程序,然后提出问题,探究可能违反死亡捐献者规则的行为以及对脑部再灌注的担忧。研究结果提出了一种基础理论,将 NRP 置于为捐献者、其家属和器官受者提供的建立信任的连续护理中。利益相关者一致认为两种形式的 NRP 都是合乎伦理的干预措施,但他们的理论依据都是假设在确定循环系统死亡后,神经系统的死亡标准已经达到。对这些假设进行经验验证将有助于以维护信任的方式实施 NRP。
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来源期刊
CiteScore
18.70
自引率
4.50%
发文量
346
审稿时长
26 days
期刊介绍: The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.
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