Frågan om organdonation: Anhörigas och internsivvårdsläkares erfarenheter och attityder

Syftet med den studie som presenteras har var att studera hur anhoriga och lakare forstod situationen nar organdonation aktualiserats vid ett dodsfall, samt vilka faktorer som var avgorande for beslut om donation i dessa fall. Lakare till 24 avlidna patienter samt 20 anhoriga till dessa patienter intervjuades. Intervjuerna analyserades med kvalitativ metodik. Elva av patienterna hade sjalva bestamt hur de ville ha det; i 14 fall fick anhoriga avgora fragan. Halften av dessa anhoriga sa ja till donation och halften nej. For familjen var dock donationsfragan sekundar; de var helt upptagna av dodsfallet och forsokte initialt undvika fragan genom att behandla ett nej som ett ”icke-beslut”. De behovde stod for att olustreaktioner skulle avklinga, for att orka tanka rationellt och fatta ett valgrundat beslut. Forutsattningen for att ta upp fragan var anda god: anhoriga hade forberetts val for det stundande dodsfallet genom fortlopande information fran lakarna, de kande fortroende for varden, accepterade att donationsfragan togs upp och forstod inneborden av hjarnrelaterade dodskriterier. Ungefar halften av lakarna upplevde dock konflikter nar det gallde att ta upp fragan och tala med de narstaende. Tre olika forhallningssatt identifierades: pro-donation, neutralt och ambivalent. Endast lakare med pro-donationsinriktning fick ja till donation av de narstaende. The aim of this study was to explore how relatives and physicians in cases where organ donation had been requested understood this situation and what factors were salient for the decision on donation. Physicians of 24 deceased patients and 20 relatives were interviewed. The material was analysed using qualitative methods. Eleven patients had declared their wishes on donation prior to death; in 14 cases the relatives had to decide. Half of these relatives accepted donation and half refused. The donation request was of secondary importance to the families; they were totally occupied by the death and initially tried to avoid the request by regarding “no” as a non-response. They needed support to relieve their immediate reactions of uneasiness, start rational thought processes and reach well-grounded answers. The basis for requesting donation was good; relatives had, with regard to circumstances, been well prepared for the death by continuous information from the physicians and had confidence in staff, accepted that the question was raised, and understood the death criteria. However, about half the physicians experienced conflicts regarding prerequisites of procuring organs and dealing with relatives. Three different approaches were displayed: pro-donation, neutral and ambivalent. Only physicians with a pro-donation approach received acceptance for donation. Key words: organ donation, transplantation, attitudes, intensive care physicians, relatives, organ donor.