Determining ICU Staff's Conceptions, Opinions, Views, Experiences and Reflection of Brain Death and Organ Donation (DISCOVER)

Brain death is the irreversible loss of brain function necessary to sustain life. Its diagnosis is based on the absence of brainstem reflexes, unresponsiveness to endo- or exogenous stimuli, apnea, and the exclusion of factors confounding the clinical presentation(4). While other organ functions may be preserved, the identification of brain death raises the question of whether viable organs can and should be transplanted to save the lives of critically ill patients in need of organ support.

With advancements in critical care techniques enabling the maintenance of organ function beyond brain death, as well as the intricate legal and regulatory frameworks surrounding organ donation, healthcare professionals in intensive care units are increasingly faced with complex clinical scenarios, considerations, and challenges related to the concept and diagnosis of brain death and ethical and legal aspects associated with organ donation. Studies investigating the individual conceptual understanding of brain death and organ donation of health care professionals on Intensive Care Units (ICUs) as well as their experiences and opinions related to these topics, are scarce(5-8).

The study aims to gather information regarding the individual perceptions, opinions, beliefs, and conceptual understanding of healthcare professionals working in the intensive care units at the University Hospital Basel and to determine associations of individual beliefs, personal, educational, and professional experiences with individual perceptions, opinions, and conceptual understanding regarding brain death and organ donation. 

To achieve the study objectives, we will employ a questionnaire-based survey administered to the consenting/participating nurses and physicians. The questionnaire will address various aspects related to personal background, religious affiliation, beliefs about life after death, the conceptual understanding of brain death and organ donation, as well as experiences and opinions related to these topics.

Participating in this study will create no additional risk or burden for patients and is therefore classified under category A according to HRO Art. 7.(1)

Hypothesis and primary objective

The primary objective of this study is to gather insights into the individual perceptions, opinions, beliefs, and conceptual understanding regarding brain death and organ donation of healthcare professionals working in the ICU at the University Hospital Basel in Switzerland. 

The following hypotheses will be tested: Individual perceptions, opinions, beliefs, and conceptual understanding regarding brain death and organ donation vary between the different professions and in dependence of specific aspects regarding personal, educational and professional experiences.

Primary and secondary endpoints

The primary endpoints of this study will be information on individual perceptions, opinions, beliefs, and conceptual understanding of healthcare professionals in the ICU regarding brain death and organ donation and the identification ofinterprofessional variations.

The secondary endpoints will be associations of specific demographics, beliefs, personal, educational, social and professional experiences with individual perceptions, opinions, and conceptual understanding regarding brain death and organ donation.

References

1.         Council TSF. Ordinance on Human Research with the Exception of Clinical Trials (HRO)2013.

2.         Council TSF. Ordinance on Clinical Trials in Human Research (HRA)2013.

3.         World Medical A. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013;310(20):2191-4.

4.         Wijdicks EF. The diagnosis of brain death. N Engl J Med. 2001;344(16):1215-21.

5.         Ferhatoglu SY, Ferhatoglu MF, Gurkan A. Approach of the Clinicians Practicing in Intensive Care Units to Brain Death Diagnosis and Training Expectations in Turkey: A Web-Based Survey. Transplant Proc. 2020;52(10):2916-22.

6.         Al-Mousawi M, Abdul-Razzak M, Samhan M. Attitude of ICU staff in Kuwait regarding organ donation and brain death. Transplant Proc. 2001;33(5):2634-5.

7.         Ong JS, James Foong W, Oo WL, Vallapil MK, Hossain MM, Hossain H, et al. Does knowledge and attitude of healthcare professionals working in critical care areas affect their willingness to offer the option of organ donation? results of a tertiary hospital survey. Med J Malaysia. 2022;77(3):347-56.

8.         Camut S, Baumann A, Dubois V, Ducrocq X, Audibert G. Non-therapeutic intensive care for organ donation: A healthcare professionals' opinion survey. Nurs Ethics. 2016;23(2):191-202.