Attitudes to organ donation among Swedish ICU nurses

Aims and objectives. To present data on Swedish ICU nurses' attitudes to brain death and organ donation and to test a questionnaire designed to explore these issues in terms of validity and reliability. Background. Previous studies have identified various barriers to organ donation. The single most important factor was the attitude of ICU staff. Design. A 34-item instrument was developed to explore attitudes and experiences of organ donation. Method. The questionnaire was sent to 50% of ICU nurses in Sweden (n = 1013) and the response rate was 69% (n = 702). The expected scale dimensionality was examined both by explorative principal component analysis and confirmatory multi-trait analysis. Scale reliability was further estimated using Cronbach's alpha. Chi-squared test was used to compare proportions between ICU specialities and Pearson correlations were calculated to investigate relationships between each of the factors verified and the single items. Results. The main findings were that less than half of the ICU nurses trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. Twenty-five percent of the respondents indicated that mechanical ventilation was withdrawn to reduce the possible suffering of a person assumed to be clinically dead, without the issue of organ donation being raised. A total of 39% had experienced occasions when the question about organ donation was never raised with the relatives. Four factors were verified and labelled: personal attitudes to organ donation as a situation; Organisational attitudes to organ donation as a phenomenon; Environmental resources; and Personal wish to donate, which accounted for 70% of the variance. Conclusions. Swedish ICU nurses reported several barriers to organ donation. An action plan including education in brain death diagnostics, interpersonal relationships and interaction with relatives as well as regular follow-up regarding donation issues in various ICU settings would be useful. Relevance to clinical practice. All nurses working in ICUs are obliged to participate in organ donation and are therefore included in these results.