Elsevier

Social Science & Medicine

Volume 53, Issue 6, September 2001, Pages 693-706
Social Science & Medicine

The dilemma of “to-be or not-to-be”: needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition

https://doi.org/10.1016/S0277-9536(00)00378-6Get rights and content

Abstract

There has been little study of the Chinese cadaveric donor family's decisions to donate organs within the Chinese cultural framework. A convenience sample of 25 cadaveric donor family members (12 men, 13 women) who gave their consent to donation at National Taiwan University Hospital agreed to participate in this study and completed in-depth interviews. Data were analyzed by a three-steps within-method qualitative triangulation method. The factors influencing the donor family's decisions to donate organs, the needs of donor families, and their expectations of health care providers during the pre-donation transition — the critical period of time between signing a donation and consent to organ harvesting — were examined. The background context and a conceptual framework were further developed to discuss and depict this phenomenon. This project aims to broaden the horizon on organ donation and contribute to the understanding of some of the psychodynamic issues in the Chinese family in Taiwan.

Section snippets

Terms

  • 1.

    “The donor” in this study describes the deceased person who is the organ source. Often, that person may not have made a decision to donate organs.

  • 2.

    “The donor's family member” is the subject who agreed to participate in this study. He or she made the legal decision to donate organs and signed the consent form.

  • 3.

    “The donor's living will” refers to an advance declaration of willingness by the deceased to donate organs, even if this was not expressed in writing.

Data collection method

An in-depth, semi-structured interview (Schatzman & Strauss, 1973) was the primary data collection technique used. The semi-structured interview guide was developed by the investigator in consultation with seven well-known interdisciplinary experts: a grounded theorist and nursing theorist familiar with multiple qualitative methods, two organ transplant surgeons, three organ transplant coordinating nurses, and one faculty member familiar with “the great and little Chinese traditions” (Redfiled,

Results

The donors were between 19 and 45 years old; 14 were men and 18 were accident victims. Sixteen donors had a college education and 7 were laborers (Table 1). Donor family members ranged in age from 25 to 58. The type of kinship of the participants included the donor's father (N=12), mother (N=7), elder sister (N=2), wife (N=2), and husband (N=2). Nineteen subjects (donor's families) had an educational level higher than junior high school. Eleven subjects were laborers. The majority (N=18) of

Discussion

A rising branch of the medical profession like organ transplantation has brought with it new ethical considerations in the understanding of health, life, death, human rights, and gift giving. There will be a multifaceted, strong impact on donors, recipients, their families and OT professionals alike. The factors contributing to organ transplantation need to be taken into full consideration if this discipline is to evolve in ways that are thought to be beneficial for all concerned (Daar &

Implications

Since most Taiwanese share cultural roots with the Chinese, several suggestions can be made for OTTMs who take care of Chinese cadaveric organ donors’ families in different countries. First, western OTTMs should not turn their backs on Chinese donors’ families, but rather, they should learn the cultural, ethical, and religious background which often frame their client's decision-making for organ donation and their need for help. By doing so, both western and eastern health care providers would

Limitations

Several limitations were inherent in this study. First, the timing of interviews was not standardized since the time of interviews ranged from 2 to 24 h before the organ-harvesting surgery, depending on when the family consented and when the organ-harvesting surgery was performed. Second, five donors’ family members refused to participate in the project and reported that they were too distressed to think or talk at that time. They might have been more vulnerable than the family members who were

Future research

Future researchers may also explore further: (a) the possible benefits and complications of a donor's family support group and an IHCT from the donor's family's as well as the OTTM's perspectives in an ethical manner; (b) the strategies for early detection and helping the donors’ families, their parents in particular, who have demonstrated abnormal grieving behaviors and a negative impact of the decision of donation during the pre- and post-donation stages; (c) the appropriateness of inviting

Acknowledgements

The researchers’ thanks go to the men and women who were willing to share their difficult experience of organ donation during a critical stage of losing a beloved family member. Without their courage and wisdom in facing this crisis, and their support for human science, this academic undertaking would not have been possible. We also thank Dr. Beverly Henry and Prof. Su-Ming Hsu for their valuable suggestions. Financial support was graciously received from the National Science Council, Republic

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