Donor programme after circulatory death in Slovenia: Analysis of the views of professional community and future perspectives
DOI:
https://doi.org/10.6016/ZdravVestn.2974Keywords:
donation after circulatory death, donor programme, the views of professional community in Slovenia, professional dilemmas, ethical dilemmasAbstract
Background: Beside predominant organ procurement following brain death according to neurological criteria (DBD), a growing number of countries are implementing donation after circulatory death (DCD). Although there is uniform agreement on DCD donor candidacy (ventilator-dependent individuals with non-recoverable or irreversible neurological injury not meeting brain death criteria), there are variations in legal and medical aspects of DCD practice. DCD practice has not been established in Slovenia yet. Clear professional guidelines and consensus are needed before the introduction of DCD protocol in deceased-donor programme. No studies or systematic open debates on the position of Slovenian professionals regarding the introduction of DCD practice in Slovenia have been conducted yet. The objective of the qualitative research was to fill this gap and to set grounds for next steps in the development of donor medicine in Slovenia.
Method: On the initiative of Slovenija-transplant (national competent authority), a qualitative research was designed and carried out from January to April 2013. A careful selection of participants was made based on their integration and professional experiences in Slovenian transplant medicine or nephrology. An invitation for cooperation was sent to 22 healthcare specialists around Slovenia. 12 semi-structured in-depth interviews on different arising themes in transplant medicine were conducted; one of the themes was understanding and introduction of DCD.
Results: The results have shown participants’ general support to the introduction of controlled DCD protocols in Slovenia, but they also shared several professional, ethical, and societal concerns on the subject. They opposed rapid or short-term introduction of DCD in Slovenia. They observed that the current Slovenian deceased donation programme, based on DBD, does not offer appropriate organizational scheme and facilities needed for DCD programme. They believed that Slovenia lacks well educated and motivated professionals for performing DCD programme. The opinions of participants were very coherent: except one, they did not oppose long-term endeavours for the establishment of DCD programme in the national donor programme, but they saw the lack of consensus among the medical and lay community and lack of clear professional protocols as an obstacle to the introduction of DCD programme. They suggested intensive educational and awareness raising activities as well as development of elaborated, clear, and consensual DCD medical and legal protocols.
Conclusion: A short-term goal of Slovenija-Transplant is to introduce a controlled DCD protocol in the national deceased donation programme, whose strategic orientations are presented. The authors elaborate on the results of the qualitative research that set an important grounds for organizational and educational steps that Slovenija-Transplant has already taken in the past six years. The aim of the article is not only to present the research results and steps already taken, but also to open further in-depth discussions among Slovenian professional community on DCD.
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