1
Nurse, Sc.M., Facult y, Goiás Cat holic Universit y, Brazil, e- m ail: m .m adalena@ucg.br; 2 Nurse, Ret ired Professor, Minas Gerais Federal Universit y, Brazil, e-m ail: e-m arisa@enf.ufe-m g.br
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
THE MAI NTENANCE CARE OF POTENTI AL ORGAN DONORS: ETHNOGRAPHI C STUDY ON
THE EXPERI ENCE OF A NURSI NG TEAM
Mar ia Madalena Del Duqui Lem es1 Mar isa Ant onini Ribeir o Bast os2
Lem es MMDD, Bast os MAR. The m aint enance care of pot ent ial organ donors: et hnographic st udy on t he experience of a nur sing t eam . Rev Lat ino- am Enfer m agem 2007 set em br o- out ubr o; 15( 5) : 986- 91.
Th is et h n ogr aph ic st u dy aim ed t o u n der st an d a n u r sin g t eam ’s ex per ien ce on t h e m ain t en an ce of p ot en t ial or gan d on or s. Dat a w er e collect ed t h r ou gh et h n ogr ap h ic in t er v iew , par t icip at iv e obser v at ion an d docum ent al analy sis and analy zed in t hem at ic, cult ur al dom ain and t ax onom ical t er m s. The r esear ch enabled us t o ident ify t he m eaning of br ain deat h, r ev ealing t he int er r elat ion bet w een t he cat egor ies ( unit s, nur sing t eam and pat ient ) , which const it ut ed t his st udy m ain t hem e: “ it is not a person” . The t ransplant m eaning held by t he nur sing t eam is m ar k ed by disbelief due t o som e pr ev ious ex per iences in t he I nt ensiv e Ther apy Unit . Thus, beliefs and values of t his subcult ure int erfere or det erm ine a dist ancing from t he pat ient wit h a consequent loss in t he m aint enance of t he pot ent ial donor and qualit y of t he organs donat ed.
DESCRI PTORS: nur sing car e; or gan t r ansplant at ion; t issue and or gan pr ocur em ent
LOS CUI DADOS DE MANUTENCI ÓN DE LOS POTENCI ALES DONATI VOS DE ÓRGANOS:
ESTUDI O ETNOGRÁFI CO DE LA VI VENCI A DEL EQUI PO DE ENFERMERÍ A
Se t r at a de un est udio et nogr áfico que t uv o com o obj et iv o com pr ender la ex per iencia del equipo de en f er m er ía en la m an u t en ción d e los p ot en ciales d on ad or es d e ór g an os. Los d at os f u er an r ecolect ad os a t r av és de en cu est as et n ogr áficas, obser v ación par t icipan t e y an álisis docu m en t al y som et idos a an álisis del dom inio, t axonóm ico y t em át ico. En el proceso de inm ersión de los dat os recogidos fue ident ificado el significado d e la m u er t e en cef álica, q u e d esv eló la in t er r elación en t r e las cat eg or ías ( u n id ad es d e t er ap ia in t en siv a, equipo de enfer m er ía y pacient es) , const it uy éndose en el pr incipal t em a de ese est udio “ no es una per sona” . El significado del t r ansplant e at r ibuido por el equipo de enfer m er ía es m ar cado por la no cr eencia, m ot iv ada por ex per iencias ant er ior es v iv idas en las unidades de t er apia int ensiv a. Así, las cr eencias y v alor es de esa subcult ur a int er fier en o det er m inan un dist anciam ient o del pacient e y un consecuent e pr ej uicio en la at ención adecuada par a la m anut ención del donant e y calidad de los ór ganos donados.
DESCRI PTORES: at ención de enfer m er ía; t r asplant e de ór ganos; obt ención de t ej idos y or ganos
OS CUI DADOS DE MANUTENÇÃO DOS POTENCI AI S DOADORES DE ÓRGÃOS: ESTUDO
ETNOGRÁFI CO SOBRE A VI VÊNCI A DA EQUI PE DE ENFERMAGEM
Trat a- se de est udo et nográfico que t eve com o obj et ivo com preender a vivência da equipe de enferm agem na m anut enção de pot enciais doadores de órgãos. Os dados foram colet ados at ravés de ent revist as et nográficas, obser v ação par t icipant e e análise docum ent al e subm et idos à analise de dom ínio, t ax onôm ica e t em át ica. No pr ocesso de im er são nos dados colet ados, foi ident ificado o significado de m or t e encefálica, que desv elou a in t er - r elação en t r e as cat eg or ias, con st it u in d o- se n o t em a cu lt u r al d est e est u d o: “ n ão é u m a p essoa” . O sig n if icad o d e t r an sp lan t e at r ib u íd o p ela eq u ip e d e en f er m ag em é m ar cad o p ela d escr en ça em r azão d e experiências ant eriores vivenciadas na unidade de t erapia int ensiva. Assim , as crenças e valores dessa subcult ura int er fer em ou det er m inam dist anciam ent o do pacient e e conseqüent e pr ej uízo na assist ência adequada par a a m anut enção do doador e qualidade dos ór gãos doados.
I NTRODUCTI ON
T
h e car e deliv er ed t o pat ien t s w it h ch r on ic r e n a l f a i l u r e m a k e s t h e m d e p e n d e n t o nh em od ialy sis m ach in es. Th is d ep en d en cy con t in u es
u n t i l t h e y a r e s u b m i t t e d t o a s u c c e s s f u l r e n a l
t r a n s p l a n t . T h e r e a r e t w o f o r m s o f d o n a t i o n
m o d a l i t y i n r en a l t r a n sp l a n t s: l i v e a n d ca d a v er i c
d o n a t i o n .
Fr om 1984 onw ar ds, in Goiânia, GO, Br azil,
renal t ransplant s were generally done by live donat ion
from a fam ily m em ber. I t is only at t he end of 1998
t hat cadav er ic donat ion t r ansplant s st ar t ed, alt hough
int ensive t her apy unit s w er e not pr epar ed t o pr ovide
adequ at e m ain t en an ce t o br ain - dead in div idu als as
pot ent ial donor s.
Th e p r o b l e m s t h a t e m e r g e d t h r o u g h t h i s
pr ocedu r e w er e n ot dif f er en t f r om ot h er t r an splan t
cent ers. The available lit erat ure only appoint s failures
in t h e or gan don at ion pr ocess of people w it h br ain
deat h. These failures are linked t o t he fam ilies’ refusal
an d t o t h e pr of ession als’ t ech n ical w or k con dit ion s,
especially r egar ding t o inadequat e m aint enance car e
for t he pot ent ial or gan donor( 1).
I n a st u d y d e v e l o p e d a t t h e I n st i t u t e o f
Neurological Sciences, Glasgow, USA, t he causes t hat
pr ev ent t he incr ease of pot ent ial or gan donor s w er e
d e s c r i b e d . Th e s e i n c l u d e d t h e l a c k o f m e d i c a l
a v a i l a b i l i t y, r e l u c t a n c e i n a s k i n g t h e f a m i l y f o r
donat ion, t est failur es in confir m ing encephalic deat h
an d in ad eq u at e com m u n icat ion w it h t h e t r an sp lan t
t eam( 2).
My ex per ience at t he I nt ensiv e Ther apy Unit
( I TU) show ed m e t hat pat ient s w it h br ain deat h ( BD)
r eceiv ed less car e, w h ile at t en t ion w as d ir ect ed t o
t hose w it h pot ent ial t o r ecov er. Thus, I pr oposed t o
dev elop a st udy about t he inv olv em ent of I TU nur sing
t ea m s i n t h e p r o cess o f m a i n t a i n i n g h o sp i t a l i zed
people w it h br ain deat h as pot en t ial or gan don or s,
si n ce t h e m a i n t en a n ce o f p o t en t i a l d o n o r s i s t h e
s e c o n d c a u s e o f t h e n o n - o c c u r r e n c e o f o r g a n
don at ion in Br azil.
My in t er est w as t o st u dy t h e m ean in gs t h e
n u r sin g t eam at t r ib u t es t o t h e b r ain - d ead p at ien t ,
u n d e r s t a n d i n g t h e s e p r o f e s s i o n a l s ’ d a i l y c a r e
ex p er i en ce i n t h e m ai n t en an ce o f p o t en t i al o r g an
don or s. Hen ce, t h is st u dy aim ed t o u n der st an d t h e
ex p er ien ce of t h e n u r sin g t eam in r elat ion t o t h e
m aint enance car e t o pot ent ial or gan donor s.
T H E O R E T I C A L - M E T H O D O L O G I C A L
REFERENCE FRAMEW ORK
I ch ose et h n og r ap h ic r esear ch in or d er t o
u n d e r st a n d t h e sy m b o l i c u n i v e r se sh a r e d b y t h e
nursing t eam . Et hnography is an adequat e m et hod t o
describe a syst em of cult ural m eanings of a det erm inat e
group from t he worldview of a nat ive of t his cult ure( 3). Th e cu l t u r al scen ar i o i s co m p o sed b y t h e
represent at iveness of t wo hospit als t hat int egrat e t he
t ransplant donat ion process in Goiânia: one int ensive
t her apy unit and one em er gency unit .
D a t a w er e co l l ect ed t h r o u g h p a r t i ci p a t i v e
obser v at ion, et hnogr aphic int er v iew and docum ent al
an aly sis( 3 ).
The observat ions w ere recorded descript ively
in relat ion t o t he environm ent , t o t he work condit ions
o f t h e i n t e n si v e n u r si n g a n d e m e r g e n cy t e a m s,
behav ior s, infor m ant s’ act ions and act iv it ies, dialogs
w it h t he inform ant s, generat ing records of reflect ions
about t he m et hod and t heory used in t he st udy.
The et hnogr aphic int er v iew s w er e per for m ed
dur ing t he infor m ant s’ w or k shift at a m om ent t hey
d e t e r m i n e d , s o t h a t t h e r e w o u l d b e n e i t h e r
int er r upt ions in t he developm ent of t he car e deliver y
nor int erference during t he int erview, since t hese unit s
ar e m ar ked by unpr edict abilit y.
Th e i n t e r v i e w s w e r e r e c o r d e d a f t e r t h e
infor m ant s’ aut hor izat ion and t he r ecor ds w er e fully
t ranscribed. I n addit ion t o t he dat a collect ed t hrough
par t icipan t obser v at ion , t h e f ield diar y w as u sed t o
t ake not es during and aft er int erviews and for writ ing
dow n m y per sonal r eflect ions as a r esear cher.
Of f icial d ocu m en t s w er e an aly zed , su ch as
t he Brazilian legislat ion t hat regulat es organ donat ion,
besides ot her t echnical docum ent s, such as t he report
an d p lan n in g of t h e Cen t r al of Or g an Not if icat ion ,
Acquir em ent and Donat ion in Goiás, files of pat ient s
w it h cer ebr al deat h , n u r sin g r epor t s an d r epor t s of
t h e Ren al Tran splan t Coor din at ion an d of t h e I n t r
a-Hospit al Tran splan t Com m ission .
A t o t a l o f f o u r n u r s e s a n d 1 3 n u r s i n g
t echnicians and aids who work at t he int ensive t herapy
unit and reanim at ion unit part icipat ed in t he st udy, an
int ent ional sam ple whose size was det erm ined by t he
dat a sat ur at ion pr ocess.
The inform ant s’ inclusion crit eria were: t hose
who spont aneously offered t o part icipat e in t he st udy,
had worked at t he unit for m ore t han six m ont hs and
My st ay in t h e st u d y sit e cor r esp on d ed t o
1 0 0 h o u r s . T h e r e w e r e m o m e n t s o f u p t o t e n
consecut iv e hour s of obser v at ion in t he m aint enance
p r o c e s s o f t h e p o t e n t i a l o r g a n d o n o r, f r o m t h e
d i ag n o si s o f cer eb r al d eat h , t h e f i r st an d seco n d
clinical ex am s, t o t he appr oach of t he fam ily and t he
r equest t o t r ansfer t he pat ient t o t he int ensiv e t her apy
unit .
This st udy follow ed resolut ion 196/ 96 by t he
Nat ion al Healt h Cou n cil. Th e p r oj ect w as ap p r ov ed
by t h e Feder al Un iv er sit y of Min as Ger ais - UFMG’s
I nst it ut ional Review Board and t he part icipant s signed
t he fr ee and infor m ed consent t er m .
I at t em pt ed t o ext ract values and beliefs t hat
cou ld g u id e t h e act ion s of t h e n u r sin g t eam s f r om
bot h t he I TU and reanim at ion unit s, in relat ion t o t he
m ain t en an ce of t h e p ot en t ial or g an d on or, t h r ou g h
cu lt u r al d om ain , t ax on om y an d t h em at ic an aly sis.
Dom ain analysis is consider ed t o be t he or ganizat ion
o f t h e t e r m s c h a r a c t e r i s t i c o f t h e i n f o r m a n t s ’
lan g u ag e, t h at is, com m on an d ow n t er m s of t h e
nur sing t eam t hat t ak es car e of t he pot ent ial or gan
d o n o r. Ta x o n o m y an al y si s i s ch ar act er i zed b y t h e
or ganizat ion of t he int er nal st r uct ur e of t he cult ur al
d om ain . Th em at ic an aly sis g iv es a h olist ic v iew of
t he cult ure under st udy( 3).
DESCRI BI NG THE NURSI NG TEAM CULTURE
The cont act w it h pat ient s and t he lack of k now ledge
in dealing w it h cer ebr al deat h
The frequency of t he cont act wit h brain- dead
pat ient s can be explained by causalit y, since t hey can
b e ad m it t ed at an y t im e. Th e m aj or it y of t h em is
r ef er r ed d u r i n g t h e n i g h t sh i f t , a t w eek en d s a n d
holiday s. Som e infor m ant s r epor t hav ing t ak en car e
of m any cases of cerebral deat h, around t en or even m ore…
How ev er, t h e in f or m an t s ex p r essed lack of
k now ledge about how t o t ak e car e, say ing: t h ey did
not know where t o st art from , had not received any t raining, t hus report ing lack of knowledge. We t ake care because it is what we t hink m ust be done, but we never receive any orient at ion, no, we
nev er did. Not ev en psy chological pr epar at ion, nobody ev er
prepared us.
Ed u cat i o n w i t h t h e p ar t i ci p at i o n o f h eal t h
pr ofession als an d societ y is on e of t h e det er m in an t
f a c t o r s i n t h e s u c c e s s o r f a i l u r e o f t r a n s p l a n t
p r o g r a m s. W h e n r e p o r t i n g o n t h e i m p o r t a n ce o f
cont inuous educat ion pr ogr am s, t he nur sing t eam is
m en t ion ed as a f u n d am en t al elem en t in t h e en t ir e
cont ex t of t he pr ocedur e( 2,4- 5) , since lear ning im plies a c h a n g e i n t h e p e r s o n ’ s b e h a v i o r d u e t o t h e
incorporat ion of new habit s, at t it udes, knowledge and
abilit ies.
Learning from t he doct or and t he supervisor was a
w ay of acquir ing k now ledge in or der t o deliv er car e
t o t he pot ent ial organ donor: …it was a rout ine we picked up according t o t he physicians. They arrive and advise: do t his,
do t hat.
Tr ain in gs, cou r ses, t ex t s an d lect u r es w er e
r e p o r t e d a s st r a t e g i e s t o a cq u i r e k n o w l e d g e o n
cerebral deat h. The inform ant s report having received
t raining from t he t ransplant cent ral. I t w as a one- w eek, 40- hour course. I t was a very good course t hat ranged from legislat ion t o
t he bureaucrat ic part of hospit alizat ion aut horizat ions. Likewise,
t hey report having learned by t hem selves, over t im e, in daily
realit y, observing m edical prescript ions and observing colleagues.
Nur sing car e t o pat ient s w it h cer ebr al deat h
Taking care of pot ent ial organ donors requires
t he m aint enance of art ificial vent ilat ion because t here
is an alt er at ion in gas ex ch an ge du e t o pu lm on ar y
neur ogenic edem a, pulm onar y t r aum a, infect ion and
collapses. Aspiring t racheal secret ion w hen necessary
i s a m e a su r e t h a t a i m s t o p e r m i t m o r e e f f i ci e n t
ar t ificial r espirat ion and, consequent ly, bet t er t issue
ox y gen at ion( 6 - 7 ).
I n t h e i n f o r m a n t s’ d i sco u r se , t h e se ca r e
dem ands for br ain- dead pat ient s w er e also ident ified
because t hey report t he need t o t ake care of t he airways,
w at ch in g t h e r en al fu n ct ion , con t r ollin g liqu id r eplacem en t ,
observing volum e and diuresis. This care is perform ed t o
cont rol t he endocrine dysfunct ion, which is due t o t he
r u p t u r e o f t h e h y p o t h a l a m u s - h i p o f i s a r y a x i s ,
ch ar act er ized by t h e pr esen ce of diabet es in sipidu s
which, when not t reat ed, leads t o a large liquid loss,
pr ov ok ing differ ent elect r oly t e disor der s( 6- 7).
War m in g t h e pat ien t , obser v in g t h e t em per at u r e,
put t ing on a blanket is essent ial car e because, in case of
cer eb r al d eat h , t h e h y p ot h alam ic t h er m or eg u lat or y
cen t er is lost , w h ich t r igger s h y pot h er m ia t h at can
gener at e depr ession of t he m y ocar dium , ar r hy t hm ia,
d ecr ease in ox y g en t r an sp or t , in cr eased af f in it y of
hem oglobin by oxygen, renal dysfunct ion, pancreat it is
and coagulopat hies. War m ing t he v enous fluids is a
ca r e t h a t r e sp o n d s t o t h e n e e d t o co n t r o l b o d y
Check ing and w r it ing dow n blood pr essur e, obser v ing
p er f u sion , v it al sig n s m u st b e p er f or m ed d u e t o t h e
ca r d i o v a scu l a r d y sf u n ct i o n , w h i ch i s m a n i f e st e d
t h r o u g h s e v e r e h y p e r t e n s i o n , f o l l o w e d b y
p r og r essiv e h y p ot en sion an d , con seq u en t ly, t issu e
h y p o p e r f u s i o n . I t o r i g i n a t e s f r o m t h e s y s t e m i c
v a s o d i l a t a t i o n r e s u l t i n g f r o m t h e l o s s o f m o t o r
a c t i v i t y. Th e m y o c a r d i a l f u n c t i o n i s a l t e r e d b y
e l e ct r o l y t e d i so r d e r s, r e n a l l o sse s a n d h o r m o n a l
d i so r d er s. I n ad d i t i o n , o n e m u st p ay at t en t i o n t o
t h e c a u s e o f h y p o t e n s i o n , w h i c h c a n b e
m u lt if act or ial( 6 - 7 ).
Taking care of t he corneas t hrough hum idificat ion was
also report ed as essent ial, since it is current ly one of
t h e m ost t r an splan t ed t issu es. Th e cor n ea m u st be
kept hum idified and prot ect ed wit h oint m ent t o prevent
k er at it es( 6- 7).
The care ident ified in t he inform ant s’ report s
w as also r elat ed t o keeping r igor ous cont r ol of asepsis in
order t o prevent infect ious processes. Such care is described
in t he lit er at ur e as t he pr ev ent ion of pr essur e ulcer s
and t he need for body hygiene t o dim inish t he risk of
infect ion( 6- 7).
Ot h e r c a r e p r o c e d u r e s r e p o r t e d b y t h e
infor m ant s ar e also m ent ioned in lit er at ur e, such as
v er ify ing and w r it ing dow n glucose lev els. Hy per gly cem ia,
due t o insulin secret ion failure, alt ers glycogen st orage
a n d r e q u i r e s t h e r e p l a c e m e n t o f i n s u l i n . Ot h e r
procedures in t he m aint enance of t he pot ent ial donor
m u st be per f or m ed, su ch as obser v in g an d w r it in g
down t he blood coagulat ion level, since it is relat ed t o
t h e d eg r ee of cer eb r al d ecom p osit ion . Th e u se of
i n f u s i o n p u m p s i s a l s o r e c o m m e n d e d w h e n
adm inist ering dopam ine, m edicat ion used w hen t here
is adequat e r esponse t o v olem ic r eplacem ent( 6- 7).
The nursing t eam ’s react ions t o pat ient s wit h cerebral
d eat h
Th e t eam ’s r eact ion s w h en facin g a pat ien t
w it h cer ebr al deat h ar e descr ibed as: get t ing inhum an,
having difficult ies t o t ake care and t aking care wit h love. Thus, w hen t he pat ient is br ain- dead, ( s) he is t he m ost for got t en. Som e ignore, j ust t hink ( s) he is in cerebral deat h…
Th e h ea l t h p r o f essi o n a l g et s f r a g m en t ed ,
isolat ed, denies and loses cont act wit h a form of act ion
t hat , alt hough uncom fort able, is part of his( er) hist ory
a n d e s s e n c e , w h e n d e a l i n g w i t h a p p r e h e n s i v e
sit uat ions, which can explain t he inform ant s’ difficult y
in deliv er ing car e t o pot ent ial or gan donor s( 8).
H e n c e , w h e n t h e y r e a l i z e t h e i r h u m a n
condit ion, t he professionals experience m om ent s t hat
a f f e c t t h e m , t h a t e l i c i t f e e l i n g s l i k e i n s e c u r i t y,
incapacit y, em bar r assm ent , im pot ence, suffer ing and
p ai n( 9 - 1 0 ). Th ese r eact i o n s w er e ex p r essed b y t h e inform ant s: t aking care of som eone wit h cerebral deat h becam e painful. [ …] So it is like crazy. When it is a child, t hen, oh dear, do
not put m e t o t ake care because I am not able t o. I t hink t hat I am
not really, really prepared t o deal wit h t his…
Th e h ealt h p r of ession als d o n ot ap p r eh en d
t he deat h and life as belonging t o t he sam e sphere of
nat ure and cult ure, alt hough t heir scient ific background
t r eat s t he life and deat h phenom ena as ev ent s fr om
t he biological spher e( 9).
Despit e t h e w h ole ex per ien ce an d t h e pain
felt when t aking care of a pat ient wit h cerebral deat h,
t hose nursing professionals who neglect t he approach
of t heir feelings wit h regard t o life, t he deat h process
an d d eat h in it self d o n ot d ev elop t h e cap acit y t o
analyze and face t heir own personal needs. Not being
able t o deal wit h t heir em ot ions and int ernal conflict s
can lead t o t h em n ot deliv er in g qu alit y car e t o t h e
pot ent ial or gan donor( 11).
A s t u d y t h a t a n a l y z e d n u r s e s ’ a t t i t u d e s
r egar din g t h e m ain t en an ce of t h e or gan don or in a
p ed iat r ic in t en siv e t h er ap y u n it d em on st r at ed t h at
32% of t hem t ake care wit hout any concern regarding
t he pot ent ial donor; 25% believe in t he benefit s t hese
pat ient s can provide t o ot her people; and 25% report
t h at t ak in g car e of an or g an d on or is an “ em p t y ”
ex per ien ce( 1 2 ).
The present st udy dem onst rat es t hat t he t eam
also cares wit h hope, because t hepat ient is brain- dead but
has a good organ, it is necessary t o t ake good care t o m ake us feel
like, sat isfied, t hat a good kidney of his will cure m any lives,
yeah, save m any lives…
Th e m ea n i n g o f cer eb r a l d ea t h a t t r i b u t ed b y t h e
nur sing t eam
The scient ific knowledge of t he pat ient ’s deat h
sit u at ion an d of t h e p h y siop at h ological aspect( 1 3 ) is im port ant for t he nurse. However, t his is not sufficient
t o int roduce t he t ransplant cult ure in a t eam wit h m any
per son al h ist or ies.
Fr om t h e in f or m an t s’ r epor t s, t h e m ean in g
of cer ebral deat h em er ged as or gan donor. The idea
t hat t he pat ient wit h cerebral deat h is received at t he
u n i t t o d o n a t e o r g a n s i n d i ca t e s t h a t p a r t o f t h i s
ion-t r ansplanion-t pr ocess, incor por aion-t ed inion-t o ion-t he ion-t eam since
1998, when t his procedure was init iat ed in t he services
of Goiânia. According t o t he inform ant s, here it happens
a lot t hat a pat ient wit h cerebral deat h arrives, t o rem ove t he
organs. He is very im port ant , t here are so m any organs t hat go t o
som eone else. We have t o im agine t hat we are helping anot her
person, anot her life...
I t was evidenced in ot her inform ant s’ report s
t hat t he concept s and values of cer ebr al deat h differ
from t he current donat ion- t ransplant policy, since t hey
consider t hat t he brain- dead pat ient is dead, it is not a
pat ient and it is not a person. That one over t here, t he brain died,
so t hat one only has t he heart beat ing and wit hout t he ot her part
it will not work. For m e, t he pat ient wit h cerebral deat h is not a
pat ient , not a person, t here is no affect ion, t hat feeling really …
A q u alit at iv e st u d y d ev elop ed w it h n u r sin g
under graduat es, ent it led “ educat ing for deat h”, found
t h e i m p o r t an ce o f t h e t h em e “ d eat h ” f o r st u d en t
educat ion, opening a w ay t o m ov e bey ond t he ont ic
a sp e ct o f n u r si n g p r a ct i ce , t o t h e e x t e n t t h a t i t
cont em plat es t he ont ological dim ension of t he hum an
being we are delivering caring t o. Deat h is a concret e
possibilit y of t his hum an being’s ex ist ence( 8). The infor m ant s also consider cer ebr al deat h
as a pat ient in a sev er e condit ion, w hich cont r ibut es
t o a successful donat ion. Accor ding t o t he pot ent ial
organ donor m aint enance crit eria, ( s) he m ust be kept
in int ensive t herapy unit and be t reat ed as a pat ient
in a sev er e condit ion( 6).
Th e m e a n i n g t h e n u r si n g t e a m a t t r i b u t e d t o t h e
t r an splan t
Th e br oadest ph ilosoph ical im plicat ion s an d
t he m ost com plet e et hical im plicat ions of t he t ransplant
age w ere raised t hrough heart t ransplant s, w hich led
t o t h e dem y st if icat ion pr ocess t h at m edicin e w as a
science exem pt of values. That is, t he t ransplant at ion
o f o r g an s b ecam e a f u n d am en t al i ssu e i n h u m an
r elat ions( 14).
Alt hough t hey r epor t non- fav or able pr ev ious
ex p er ien ces w it h t r an sp lan t ed p eop le, som e of t h e
in f or m an t s believ e in t r an splan t as a ch an ce of lif e
f or t h ose t r an splan t ed, w h o m ay ach iev e a n or m al
life. Accor ding t o t he nur sing t eam , t he m eaning of
t ransplant is help, a really great help. Everybody should becom e
aware and donat e…I t is a cont inuit y, since t hose who need an
organ t o cont inue…t o im prove t heir life.
Th e “ Fi r s t M i n i M a r a t h o n o f Or g a n
Tr an splan t ed People in Br azil” h appen ed in 2 0 0 2 in
Sã o Pa u l o a n d w a s a su cce ss. Th e a i m s o f t h i s
m ar at h on w er e t o giv e back t o societ y t h e posit iv e
result s of t he “ yes” it said t o organ donat ion, t o provide
qualit y of life t o t ransplant ed people and t o favor t heir
insert ion in social life. I t is believed t hat a societ y is
b a s e d o n p o s i t i v e r e s u l t s a n d r a i s e s d o n a t i o n
a w a r e n e ss a m o n g i t s m e m b e r s( 1 5 ), a l l o w i n g t h e p o p u l a t i o n t o b e l i e v e i n t h e t r a n sp l a n t - d o n a t i o n
p r o cess.
How ev er, som e do not believ e in t ransplant s
and raise t he idea t hat it is st ill som et hing quest ionable
f r o m t h e p e r s p e c t i v e o f q u a l i t y o f l i f e a n d t h e
com plicat ion risks t hat can m ake t he pat ient die even
fast er, so:We know t hat it t akes a lot of t im e for a pat ient t o get
well and norm al. Lat ely, we have seen a lot of post - t ransplant in
t he I TU wit h sept icem ia. I don’t know why t here are t ransplant s,
t he pat ient s die…
CULTURAL THEME: I T I S NOT A PERSON
Th e su b cu l t u r e u n d e r st u d y e l a b o r a t e d a
sy m bolic u n iv er se in r elat ion t o t h e pot en t ial or gan
d o n o r. Th i s sy m b o l i c u n i v e r se g u i d e d b e h a v i o r s,
at t it udes and act ions. Thus, in t he analysis process of
t he nur sing t eam ’s exper ience in t he m aint enance of
pot ent ial organ donors, t he m eaning of cerebral deat h
for t h ese pr ofession als em er ged.
I n acco r d an ce w i t h l i t er at u r e, t h e n at i v es
knew how t o describe adequat e care t o m aint ain
brain-dead pat ient s, t hat is, hy dr at e t he cor neas, hy dr at e
t h e p at ien t , ev alu at e b od y liq u id losses, w ar m t h e
b o d y, k e e p m e c h a n i c a l v e n t i l a t i o n a n d c a r d i a c
m onit or ing, use dr ugs t o k eep t he hear t cont r act ion
st r en gt h an d dr u gs t o pr eser v e ot h er or gan s. Th ey
also k n ow t h er e is a n eed t o p er f or m t w o clin ical
ex am s, appr opr iat ely r egist er ed, t o assess cer ebr al
d eat h .
N e v e r t h e l e s s , m a i n t e n a n c e h a s b e e n
r e s t r i c t e d t o t h e b e d b a t h , o n - t i m e m e d i c a t i o n
applicat ion, change bed sheet s and warm t he pat ient ,
and do not include t he car e needed for t he effect iv e
m aint enance of t he pot ent ial or gan donor.
Since t he beginning of t he t ransplant program
w i t h c a d a v e r i c d o n a t i o n , t h e n u r s i n g t e a m h a s
g r ad u ally acq u ir ed k n ow led g e f or car e d eliv er y t o
b r a i n - d e a d p a t i e n t s. Th e y h a v e l e a r n e d i n d a i l y
pr act ice, fr om a colleagu e or fr om som e ph y sician s
and only som e of t hem r epor t hav ing par t icipat ed in
I n t he beginning of t he im plem ent at ion of t he
t r a n sp l a n t p r o g r a m w i t h ca d a v e r i c d o n a t i o n , t h e n u r sin g t eam ’s lack of t r ain in g allow ed b elief s an d
v a l u e s t o t u r n i n t o r e a s o n s f o r t h e s e n u r s i n g p r of ession als n ot t o b ecom e or g an d on or s. I t also
sh ow ed t h eir lack of pr epar at ion in t h e f ace of t h e concept of cerebral deat h and t he t ransplant donat ion
policy in for ce.
I n t he pr ocess of im m er sion in t he collect ed
dat a, I ident ified t he m eaning of cerebral deat h, which revealed t he int errelat ion bet ween t he cat egories and
com posed t he cult ural t hem e of t his st udy: it is not a
p er son .
The nursing t eam ’s react ions t o cerebral deat h
were revealed t hrough t he feelings of pit y, it is painful,
it is difficult , it shocks, do not get involved when delivering
c a r e t o t h e p o t e n t i a l o r g a n d o n o r, l e a d i n g t o dim inished at t ent ion t o t he pat ient ’s m aint enance.
CONCLUSI ON
Th e u n d e r st a n d i n g o f v a l u e s, b e l i e f s a n d
k n o w l e d g e s h a r e d b y t h e n u r s i n g t e a m t h a t ex p er i en ces m ai n t en an ce car e f or p ot en t i al or g an
don or s r ev eals t h e con cept t h at is r ecu r r en t in t h e c u l t u r a l d o m a i n s , t h a t i s , i t i s r e p e a t e d i n t h e
infor m ant s’ ow n language.
The m eaning of t r ansplant at t r ibut ed by t he
nur sing t eam is m ar k ed by disbelief due t o pr ev ious ex per iences in t he int ensiv e t her apy unit . Thus, t he
b el i ef s a n d v a l u es o f t h i s su b cu l t u r e i n t er f er e o r
d e t e r m i n e a d e t a c h m e n t f r o m t h e p a t i e n t a n d , con sequ en t ly, h in der adequ at e car e deliv er y for t h e
m aint enance of t he donor and t he qualit y of donat ed organs, which m ight , perhaps, j ust ify t he m aint enance
of t he pot ent ial or gan donor as t he second cause of
non- occur r ence of or gan donat ion.
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