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THE POSSIBILITY OF DONATION OF ORGANS AND TISSUES
Jocinete F. Nascimento1
Abstract: Organ and tissue donation is a very important subject in our society in general. I intend to
discuss what organ donation is. The importance of organ and tissue donation. About the importance
of awareness. Organ or tissue donation is an act by which the living individual decides to help in the
treatment of other people. Donation may be from organs (kidney, liver, heart, pancreas and lung)
or tissue (cornea, skin, bones, heart valves, cartilage, bone marrow and umbilical cord blood). The
donation of organs such as the kidney, part of the liver and bone marrow can be done in life. For the
donation of organs of deceased persons, only after the conrmation of the diagnosis of brain death can
the procedure be performed. The most common is that it happens to people who suer some kind of
accident that causes head trauma, or who are victims of a stroke (stroke) and evolved to brain death.
To understand the transplantation of the organs it is necessary to emphasize that the right to separate
parts of the living or dead body integrate the personality, according to the understanding of Maria
Helena Diniz (2006, p.249). Most of the time, organ transplantation may be the only life expectancy or
the opportunity for a fresh start to about 40,000 patients waiting in the queue for Brazil. The gesture
of family members who lose a loved one and decide to donate is an act of life, altruism and generosity,
as a single donor can benet at least ten people and make the dierence between life and death.
Brazil has the largest public transplant system in the world, responsible for nancing about 95% of
transplants. It is the second country in absolute number of transplants, behind only the United States.
Keywords: Health, Organ Donation, Tissues
1 Bachelor of Nursing from the University Center of Maranhão - Ceuma in 2019. Graduated in
Audit in Nursing, Urgency and Emergency, Nephrology, and Capture, Donation and Transplantation
of Bodies and Tissues, Oncology and Hematology, and Public Health. Acting as an educational advisor
and higher education teacher at the Nursing Course Guidance Aerea, at Estácio de Sá University in
Santa Catarina.
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INTRODUCTION
Organ donation is provided for by the Federal Constitution, has a specic law to regulate the
subject (Law 9.434/97) and is dealt with by the Code of Medical Ethics, published by Resolution No.
1.246/88 of the Federal Council of Medicine.
Most of the time, organ transplantation can be the only hope for someone or the opportunity
for a fresh start for the approximately 40 thousand patients waiting on the waiting list. We have a huge
set of resources involved and rules so that all requirements are met.
From the rules related to medical procedures to who can receive the organs, many factors
must be respected.
Organ donation still generates great curiosity about the process to be pursued, what it means
and how its stages work. The basic denition of organ transplantation is the removal and exchange
of a non-functional organ or one that has a problem for another, and covers a long and extensive path
performed by trained professionals.
Currently, Brazil has one of the largest public transplant systems in the world, but it faces
some diculties, such as: bureaucracy and lack of infrastructure, the rst being a major problem to
be faced, on the part of the donor and those who will receive the organ, while the second, should be
something provided by the government, but that does not happen due to negligence in front of society.
It is justied by the fact that Brazil is increasing its rate of organ donations and transplants, but
the ideal rate is far from being reached, because in relation to the number of inhabitants in the country,
the percentage is very low, and some negative points are pointed out, which inuence this, such as:
poor distribution of teams that perform transplants throughout Brazil, Precarious infrastructure,
unprepared professionals and bureaucracy that slows down the process.
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DEVELOPMENT
Methodology
As for the methodology, this was done in the form of an online survey focusing on literature
relevant to the subject and informative sites, whether institutional or governmental, also on medical
and scientic research sites.
This work is a descriptive literature review that includes articles from electronic journals and
literary works, published over the last few years. To select the articles studied, we analyzed several
scientic articles and literary works pertinent to the theme. The criterion for choosing was the approach
to the subthemes into which this study is divided: organ transplantation, health education, organ
donation and harvesting. To capture the results, we conducted a survey and a comparison between
the opinions of the selected articles, from dierent authors, so that the documentary analysis of the
subject allows us to outline a generalist picture with a wealth of information about each subtheme.
Results and Discussions
The topic of human organ transplantation and organ donation are controversial and have
aroused interest and discussions in several areas. The lack of clarication, the sensationalist news
about organ tracking that generates various fears, the absence of permanent programs aimed at
raising awareness among the population, such as good publicity and marketing, and the encouragement
of organ harvesting, contribute to fueling doubts and ingraining myths and prejudices (NEUMANN,
1997). Perhaps, for these reasons, there is an insucient number of donors and a great loss of potential
donors, prolonging the suering of patients who depend on organ donation, condemning them to
remain on an endless waiting list (MORAES, GALLANI; MENEGHIN, 2006). The incentive must
start clearly, through the communication networks, proposed in the health centers in the face of the
presentation of the proposal by health professionals and in the private and public health networks.
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Tissue organ donation is seen by society, in general, as an act of solidarity and love from family
members as well as postmortem donors. However, it requires decision-making at a time of extreme
pain and anguish motivated by the impact of the news of death, by the feeling of loss and by the
unexpected interruption of a life trajectory (ALENCAR, 2006). Today, with the modication of the
criteria for death, the concept of brain death and the possibility of using donor organs and tissues
arise. When there is not a good understanding of the organ donation process, the relatives of potential
donors feel apprehensive, in doubt and undecided at the time of the occurrence, because it is a subject
about which they do not have much clarication (ALENCAR, 2006). This fact should be discussed
even in the case of the donor or possible donor. The objectives of the present study are to conduct a
literature review on factors associated with specic education for organ donation and to emphasize
how a higher level of knowledge on the subject positively inuences the statistics of organ donation
A potential donor is a patient who is admitted to a hospital, under medical care, for severe
brain collapse caused by an accident with head trauma, stroke, tumor and others, with subsequent
irreversible damage to the brain.
When there is the identication of a potential donor in an intensive care unit or emergency
room, there is a mandatory notication to the Notication, Procurement and Distribution of Organs
and Tissues (CNCDO) Center, decentralized in OPOs (Organ Procurement Organization). Thus, the
professionals of an intensive care unit have the ethical commitment to notify a potential donor to the
CNCDO of his or her state.
The OPO goes to the Hospital, evaluates the donor based on the clinical history, medical
history and laboratory tests, organ viability and serology, to rule out the possibility of infectious
diseases; and tests compatibility with likely receivers. The family is consulted about the donation.
Once the evaluation is nished, when the donor is viable, the OPO informs the Transplant
Center and passes on the information collected. The Transplant Center issues a list of registered
recipients, selected in its technical register, and compatible with the donor.
The Transplant Center informs the transplant teams about the existence of the donor and
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which recipient patient was selected from the single list in which everyone is enrolled by a team
responsible for the transplant procedure. The teams extract the organs in the hospital where the donor
is located, in the operating room, respecting all the techniques of asepsis and preservation of the
organs. Once the procedure is over, they go to the hospitals to proceed with the transplant; Liberation
of the Body: the body is delivered to the family with dignity recomposed.
Family refusal represents a major obstacle to transplantation, contributing to the insucient
number of donors to meet the growing demand for recipients on the waiting list, and is also pointed
out as one of the major factors responsible for the scarcity of organs and tissues for transplants
(JACOB et al, 1996). Families who understand the diagnosis of brain death well are more favorable
to organ donation compared to families who believe that death only occurs after cardiac arrest.
These usually manifest diculties in accepting the condition of death of the loved one (SMIRNOFF;
MERCER; ARNOLD, 2003). Dissemination and clarication are of fundamental importance so
that the population can create awareness about organ donation, and the media have an important
role in this process (MORAES; GALLANI; MENEGHIN, 2006). The mass media (television,
radio, newspapers, magazines) are the main vehicles of information about transplantation and organ
donation for the population. In addition, a portion of society is inuenced by individuals with whom
it relates and by campaigns that encourage the increase in organ donation (CONESA et al, 2004). The
literature is prodigal in references, demonstrating that the mass media, despite their great penetration
at the national and global levels, are not the most appropriate to promote sucient clarication on
controversial topics, such as organ donation. On the contrary, the form, symbology and repertoire
used by the mass media often cause more stir and confusion than clarication (MORAES; GALLANI;
MENEGHIN, 2006). A study carried out in Spain found that much information from the media,
which could be a way to clarify doubts, sometimes reproduces distorted, supercial and prejudiced
information, thus being unable to modify negative behaviors related to organ donation. It was observed
that the denial of consent to organ donation can be more easily modied through the implementation
of specic meetings, school campaigns and guidance by health professionals (CONESA et al, 2005).
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We emphasize here the importance of discussing the subject of ‘organ donation’ with friends and
family, because people, when well instructed on the subject, are able to promote discussions, which
can be considered as donation promotion. Education is also an important variable, and people with a
higher level of education seem to have a better acceptance of organ donation (CONESA et al, 2005).
The individual opposed to organ donation appears in studies as being: a man or woman over 45 years
of age, with a low educational level, who does not understand or does not know the concept of brain
death, who has a partner against organ donation, who is not in favor of blood donation and is afraid
of manipulation of the body (cadaver) after death. The main reasons for not being a donor were the
lack of knowledge of how to be a donor and the fear of misdiagnosis of death (MARTINEZ; MARTI;
LOPEZ, 1995).
A study developed by Moraes and Massarollo (1995) pointed out that the main reasons for
refusing organ donation are religious belief, which is considered to be one of the reasons for refusing
to donate organs and tissues for transplantation.
Belief in God fuels the family’s hope that a miracle can happen. The belief that God can
resurrect or bless the patient with a miracle is so great that the family member, even when he is aware
of brain death, prefers to believe that the patient will get better.
The family’s lack of understanding about brain death makes it dicult to assimilate that a
person can be dead when they are on advanced life support. In this circumstance, the consent to organ
donation is interpreted by the family as being the same as murdering, decreeing or authorizing the
death of the relative. The family member has diculty accepting the manipulation of the relative’s
body for the purpose of removing organs for transplantation, and non-acceptance is a reason to deny
the donation, because he believes that the body is the sacred temple of God and, therefore, untouchable.
The family member who favors donation disregards his intention to donate for fear of repression by
another family member. The lack of conrmation of the diagnosis of brain death and the mismatch
of the information transmitted to the family by the hospital team generate doubts about the patient’s
condition and are reasons for her to refuse to donate the organs. There is a belief that the death of
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the relative can be anticipated or induced with the aim of organ donation. The request for organ
donation by the medical team, when made before the diagnosis is conrmed, is a reason for revolt
and indignation for family members. The family, when they feel charged by the team to authorize
the donation of organs, becomes suspicious and refuses the donation, even though they regret not
respecting the deceased’s desire to be a donor. The deceased’s wish, manifested in life, not to be an
organ donor, is respected, and the family member considers that the important thing is to comply with
the loved one’s wishes, even if for some people the patient’s will, after death, is not important or that
the act of refusing the donation seems a selsh attitude. It was revealed that the family member is
afraid of the loss by denying the donation of organs.
When we talk about education as a way to encourage organ donation, we should not stop only
at the population. The education of health professionals, specic to organ donation, is a decisive factor
both for the technical renement of the transplant and for the improvement of the organ harvesting
rate. Saúde em Debate • Rio de Janeiro, v. 36, n. 95, p. 633-639, out./dez. 2012 637 MORAIS, T.R.;
MORAIS, M.R. • Organ donation: it is necessary to educate in order to make insucient progress
among Brazilian health professionals on the subject of organ transplantation, which may justify the low
level of organ harvesting in our environment (AMARAL et al, 2002). A survey carried out with people
who attended health centers in Spain pointed out that only 7% of people received information about
transplantation from primary health care professionals; the rest from other vehicles. It was observed
that when the patient received negative information about transplants from a health professional,
this type of information had the worst impact on the acceptance of the donation. On the other hand,
when these same professionals provided positive information about transplants, there was a clear
increase in positive reactions, which were more important than those from other sources (89% and
65%, respectively) (TRAIBER; LOPES, 2006). It is estimated that only 15 to 20% of potential organ
donors become eective donors. There is the idea that the scarcity in the number of donations is the
result of the lack of donors or the high rate of refusal of donations by family members, but these data
reveal that there is not an absolute lack of donors, but of donations. In other words, although there is
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still the belief that the reason for non-donation is the lack of potential donors, it is described in studies
that, before the refusal by family members, one of the biggest obstacles to organ donation falls on
health professionals (SILVA, 2004). The family’s denial of consent could be circumvented more easily
if the professionals involved in the recruitment process competently claried the family’s doubts.
Unfortunately, many professionals are not prepared to answer questions about donation. Another
factor to be considered is the incorrect classication of organs and tissues that, for this reason, are
rejected, reducing the number of transplants (ESPÍNDOLA et al, 2007). Health professionals play an
important role in disseminating information about organ donation, as they have access to a large part
of the population and have a greater impact than other means of communication on attitudes towards
the subject. Clarication campaigns should take place within the institutions themselves, with the
participation of doctors, nurses, nursing technicians and all other professionals who work in the
hospital. The same should happen in health centers, clinics and smaller hospitals. These campaigns
should provide clear and specic information about the basic concepts of brain death, organ donation,
donation cost, appearance of the body after organ removal, ethical aspects, experiences of the donor’s
and recipient’s families, among other guidelines, because these people, as they are opinion makers,
inuence patients and their families (TRAIBER; LOPES, 2006).
Research carried out with families of organ donors shows that an important factor for this
decision was the previous discussion about donation among family members. A study carried out in
the city of Pelotas (RS), which evaluated a sample of 3159 adults, through a questionnaire, showed
that 80.1% of the participants would be in favor of organ donation from a family member, if he had
previously expressed the desire to be a donor. On the other hand, only a third of those investigated would
authorize the donation if there was no prior discussion with the family (BARCELLOS; AHMAD;
COSTA, 2005). A Canadian study that investigated family members of patients who progressed to
brain death in nine hospitals found some dierences between donor and non-donor families. Family
members of young male patients with death associated with trauma were more likely to consent
to donation. The fact that the family had discussed donation with the patient or believed that the
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patient would like to be a donor, even without having had an explicit discussion on the subject, was
strongly associated with consent for organ donation in this study (SMIRNOFF; MERCER; ARNOLD,
2003). It is inferred that campaigns that inuence people in such a way to discuss organ donation and
transplants with their families are fundamental.
CONCLUSION
The nurse, together with the nursing team, are responsible for welcoming the patients’
families, in addition to oering support and adequate information for the family to collaborate with
the donation and transplantation process, showing how fundamental this process is.
Since nursing is active in the donation-transplant process, it must be able to meet the basic
needs of a transplant, considering the degree of complexity it involves, and must be very well trained,
qualied and updated, following technological and scientic evolution.
A study conducted in the United Kingdom shows that nurses commonly have concerns about
their lack of knowledge and experience, feeling insecure in the process of organ donation.
The contribution of nurses to the success of transplantation is undeniable. In Brazil, few
higher education institutions oer training courses in the area of organ transplantation. It is important
that nurses involved in transplants continuously check their professional practice, seeking increasing
training. The training strategies adopted have proven to be failures to remedy the existing shortcomings
in the market, from the beginning of the process, which goes from the diagnosis of brain death to
the family approach, to the performance of the transplant that involves the care of the recipient in the
hospital. This scenario is understandable since, in Brazil, there are few higher education institutions
with a specic discipline of donation and transplantation in their curriculum.
Nurses working in this area of organ and tissue transplantation need a greater load of scientic
knowledge about it. Whose clinical competencies need to be greater than just the undergraduate
degree in nursing. The donor, the transplant recipient, the potential donor or the living donor must be
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evaluated. There should be counseling from the living donor related to self-care, healthy living and
preparation for complications.
Having an important role in successful transplantation and being a crucial member of the team
providing quality care to patients and families, using technological, logistical and human resources,
for the development of coordination, assistance, education and research activities in organ and tissue
donation and transplants. Therefore, nurses need to have comprehensive and practical knowledge
about work ethics and have resources available to assess the possible donor and recipient, risks and
social issues related to transplants.
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