Intensive Care Nurses’ Attitudes Toward Organ and Tissue Donation after Circulatory Death: Qualitative Study

Abstract

Background: Organ and tissue Donation after Circulatory Death (DCD) is increasingly practiced in most health systems. The attitudes of the health-care workforce who participate in DCD remain understudied. This research study reports the attitudes of ICU nurses toward the process of organ and tissue procurement from DCD donors. Design and Methods: Drawing upon the principles of interpretative phenomenology, this qualitative study involved eight ICU nurses with direct experience of DCD donor care. Interviews were conducted between 2016 and 2023. Data interpretation used the Meaningful, Interpretative, Relational, Authentic, Contextualized, Linked, Emic (MIRACLE) framework, providing deeper insight into nurses’ experiences and enabling thick description. Results: The data were systematically collected and analyzed through a repeated cyclical process involving open and axial coding. The analysis of the collected data revealed four themes: (1) Nurses’ Attitudes toward Transplantation, (2) Procedure for Organ and Tissue Procurement from DCD Donors, (3) Ethical Aspects of the DCD Process, and (4) Family and Lay Public Perspectives. Nurses viewed DCD positively but noted limited experience. Terminal extubation emerged as the most ethically and emotionally sensitive phase. Participants reported communication challenges with families, especially when patients’ wishes were unknown, and highlighted a gap in the public's awareness of the legal and procedural aspects of the DCD process. Conclusion: Culturally and spiritually sensitive communication, institutional support, and ethically grounded training are key to improving DCD implementation. Enhancing education for both nurses and the public is essential in view of the role that ICU nurses play in DCD processes.