Healthcare professionals' experiences in applying presumed consent legislation in organ donation in three European countries: a phenomenological study.

Neades, Barbara Louise (2007) Healthcare professionals' experiences in applying presumed consent legislation in organ donation in three European countries: a phenomenological study. PhD thesis, Edinburgh Napier University.

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    The crisis in the numbers of donated organs has featured strongly in the U. K.
    literature highlighting the growing gap between those waiting for a transplant
    currently 6,698 and the numbers of organs available for transplant in 2006
    numbering 2,195 (UKT, 2006). To address this the new Human Tissue (Scotland)
    Act 2006 and the Human Tissue Act 2004 (England and Wales) have sought to
    increase the numbers of organs available for donation, whilst upholding the
    principle of informed consent to the donation of one's organs contained within the
    previous legislation. Critics of this "opt in" system however, suggest the adoption
    of presumed consent legislation or "opt out" as is the case in much of Europe.
    Little research exists that explores impact on the health care professionals (HCPs),
    the bereaved relatives, the health care system and society overall of any change to
    presumed consent legislation. The aim of this study was to explore the views and
    experiences of the HCPs who utilise this legislation in their practice, identifying
    implications for these professionals, the bereaved relatives and the health care
    system of using presumed consent legislation.
    Adopting a phenomenological approach this study utilised the responses to an
    initial quantitative survey using a questionnaire and combined this with qualitative
    semi- structured interviews with HCPs who had experience of organ donation in
    three European countries, Portugal, Norway and Belgium thus capturing the
    "lived experiences" of the professionals who use this approach to organ donation.
    A phenomenological framework first identified by Heidegger (1962) and
    Gadamer (1976) was adopted to structure these interviews and analyse the data
    developed from these sources.
    Results and Discussion
    The initial survey of HCPs in the three countries yielded 31 responses (10.6%
    n=300) from Portugal, 47 (10.4% n=450) from Norway and 44 (35.7% n=123)
    from Belgium, providing data relating to their experiences in applying presumed
    consent legislation in organ donation, together with the benefits and challenges of
    their particular organ donation system. Subsequently, semi-structured interviews
    undertaken with 14 HCPs in Portugal, 13 HCPs in Norway and 15 HCPs in
    Belgium demonstrated different approaches to the application of this legislation in
    these three countries, as a result of varying infrastructures utilised to underpin
    organ donation. Additionally, there was a dissonance between the requirements of
    the legislation and the application of this by HCPs within the individual counties
    resulting from ethical, cultural and professional practice considerations identified
    by these professionals. Key amongst these considerations was the need to respect
    the wishes of the donor and involve the bereaved relatives in the organ donation
    decision-making process.
    Implications exist for HCPs, bereaved relatives, NHS and society of any change to
    presumed consent legislation from ethical, cultural and professional practice
    perspectives. These require to be explored in more detail and addressed, should
    this approach to organ donation be considered in the U. K.

    Item Type: Thesis (PhD)
    Additional Information: Appendices not included
    Uncontrolled Keywords: Organ donation; transplants; Human Tissue Act (2006); informed consent; impact; health care professionals; presumed consent; legislation; bereaved relatives;
    University Divisions/Research Centres: Faculty of Health, Life & Social Sciences > School of Nursing, Midwifery and Social Care
    Dewey Decimal Subjects: 100 Philosophy & psychology > 170 Ethics > 174 Occupational ethics
    Library of Congress Subjects: B Philosophy. Psychology. Religion > BJ Ethics
    Item ID: 4343
    Depositing User: Mrs Lyn Gibson
    Date Deposited: 15 Apr 2011 16:29
    Last Modified: 15 Apr 2011 16:29

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