Public aspects of medicine
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AbstractTransplantation and human organ donation are controversial issues that have generated much interest and discussion. The lack of clarification and the sensationalist news about organ trafficking contribute to raise questions and render the myths and prejudices permanent.The donation of organs and tissues is seen by society in general, as an act of solidarity and love from the family. However, it requires decision-making at a time of extreme pain and distress, caused by the impact of breaking news of death, the feeling of loss and the unexpected interruption of a life course(1).As the criteria of death are modified, the concept of brain death arises, along with the possibility of using donor organs and tissues. When there is not a good understanding of the organ donation process, the relatives of potential donors feel apprehensive, doubtful and undecided at the time of occurrence, because it is a subject about which there hasn’t been much clarification(1).Brazil has the largest public transplants program in the world, since the government finances 92% of procedures done in the country. However, when we consider the rate of post mortem transplant into the population, Brazil’s results are little expressive(2).Family refusal is a major obstacle to the realization of transplants, and is also identified as major cause for the shortage of organs and tissues for transplantation. Families who understand well the diagnosis of brain death are more favorable to organ donation, compared to families who believe that death only occurs after the heart stops. Therefore, the poor level of information, either by the quality of information concerning brain death, either by not having exceeded the barrier of stigmatized fear of organ trading, propagated by the media, drastically reduces the number of patients who are benefited from receiving an organ(3).Although all people are responsible for disseminating information, we must also educate health professionals, since they interfere directly in the likely donor’s family decision. Perhaps, they lack the study of Thanatology. These professionals deal directly with death but do not investigate death, mourning. The family situation at the time of mourning, hardened by the difficult decision of donating the organs of their beloved one, should form a strong synergistic relationship, as it comes into question the shock of death and the decision to save other people’s lives. It has also been disclosed that religion is considered one of the reasons to refuse the donation of organs and tissues for transplantation. It is, thus, necessary to give greater attention to people’s religious beliefs and values by the time of the loss of their relatives. The literature is rich in references demonstrating that the mass media, despite their high national and global spreading power, are not best suited to provide sufficient explanation on such contentious issues as it is, among others, the organ donation. Instead, the means, the symbology and the repertoire often used by mass media cause more confusion than clarification(4).A study in Spain found that a lot of information spread in the media could be an alternative to the clarification of doubts, however, it sometimes reproduce misinformation, superficial and prejudice-based ideas, being unable to modify negative behavior related to organ donation.A research conducted with people attending health centers in Spain showed that only 7% of the respondents received information about transplantation from primary care professionals. Although the negative information has been quite absorbed, the study indicates that, even in small proportion, the positive information has generated a new way of interpreting organ donation(6)We here emphasize the importance of discussing the issue “organ donation” with friends and family, because people, being well educated, are capable of promoting discussions, which that can be understood as promotion of donation.The profile of the opponent to organ donation is: man or woman over the age of 45 years, with low schooling, who does not know the concept of brain death and has a partner also against organ donation, is not conducive to blood donation and fears the manipulation of the body after death. The main reasons for not accepting the donation is the lack of knowledge of how to become a donor and the fear of misdiagnosis of death(7).Facing this reality, health professionals should act as educators, to modify public opinion regarding the misconceptions. However, unfavorable beliefs can be modified only if educators are well prepared for that, so that the population is prompted to participate in debates on organ transplants and legislation.Modifying the existing reality means developing programs planned and evaluated in an ongoing educational process, supported by theoretical background and scientifically recognized models, for all segments of the community, along with incorporating the knowledge of thanatology in the formation of health professionals, with better appreciation of religious principles, to avoid making an aggressive approach to the families of potential donors. The preparation of families should be taken into consideration, to prevent the false idea that death is being expected in order to save others’ lives, because every family wants their patient to have the opportunity to live. Therefore, the government is to be exhorted to realize that the lack of support to the practice of organ donation is a real problem, and to include educational activities regarding transplants in priority governmental programs and in public policies of health care.Since organ donation in Brazil depends exclusively on the family permission, campaigns that seek to increase the understanding of the concept of brain death among the population, and, most of all, to encourage people to express their desire to be a donor and to discuss their decision with family are important strategies to tackle this problem.With a performance based on ethics and responsibility, the relationships and public policies contribute to the interests of society and organizations being achieved and established through dialogue. On the issue of transplantation, this contribution stands out because, through information and the establishment of relations with the public segments, the activity aims to reduce the suffering of many people awaiting in queues, as well as to alleviate the suffering of donor’s relatives and friends.It is also extremely valuable to include contents related to the theme of transplants / organ donation in undergraduate courses in the health area, so that professionals can act accordingly to the needs of their clientele, safely and efficiently, improving quality of life population.