Solid Organ Naklinde Etik ve Hemşirenin Rolü
Özet
Organ kısıtlılığı tüm dünyanın yaşandığı evrensel bir sorundur. Bu sorunun yaşanmasının en temel nedeni; dünya genelinde beklenen yaşam süresinin uzamasıyla her geçen gün organ gereksinimi olan insan sayısı artmasına rağmen yapılan organ bağışı sayısının bu talebi karşılamada yetersiz olmasıdır. Organ bağışlarının sınırlı olması nedeniyle organ nakli öncesi ve sonrası süreçlerde çeşitli etik sorunlar yaşanabilmektedir. Organ nakli sürecinin her aşamasında önemli rol ve sorumlulukları bulunan sağlık profesyonellerinden biri de hemşirelerdir. Hemşireler organ nakli hastaları, vericileri ve aileleriyle en fazla zaman geçiren sağlık profesyonelleridir. Bu nedenle nakil süreçlerinde yaşanan etik sorunlara diğer sağlık profesyonellerine göre daha fazla tanıklık edebilmektedir. Bu bölümde organ nakli sürecinde yaşanan tüm süreçler; özerklik, gönüllük, yarar sağlama, zarar vermeme, adalet, dürüstlük, gizlilik ve ahlaki sıkıntı olan hemşirelik etik kodları çerçevesinde kapsamlı bir şekilde tartışılarak açıklanmıştır.
Organ limitation is a global problem experienced all over the world. The main reason why this problem occurs is; although the number of people in need of organs increases day by day as life expectancy increases worldwide, the number of organ donations is insufficient to meet this demand. Due to limited organ donations, various ethical problems may occur during the pre- and post-organ transplantation processes. Nurses are one of the health professionals who have important roles and responsibilities at every stage of the organ transplantation process. Nurses are the healthcare professionals who spend the most time with organ transplant patients, donors, and their families. For this reason, he is more able to witness the ethical problems experienced in transplantation processes than other health professionals. In this section, all the processes experienced during the organ transplantation process; It has been comprehensively discussed and explained within the framework of nursing ethical codes, which are autonomy, voluntariness, benefit, non-maleficence, justice, honesty, confidentiality and moral distress.
Referanslar
American Nurses Association (ANA), International Transplant Nurses Society (ITNS). Transplant nursing: scope and standards of practice. (2nd ed). Silver Spring, 2016. MD: https://www.nursingworld.org/~4ad074/globalassets/catalog/book-toc/transplant-nursing-scope--standards-of-practice-2e_toc.pdf
Burkhardt MA, Nathaniel AK. Çağdaş hemşirelikte etik (Ş. Ecevit Alpar, N. Bahçecik Ü. Karabacak, Çev.). 2013. İstanbul. İstanbul Medikal Sağlık ve Yayıncılık.
Beauchamp T, Childress J. Principles of Biomedical Ethics: Marking Its Fortieth Anniversary. The American Journal of Bioethics. (AJOB). 2019; 19(11): 9–12. https://doi.org/10.1080/15265161.2019.166540
Henderson ML, Gross JA. Living Organ Donation and Informed Consent in the United States: Strategies to Improve the Process. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics. 2017; 45(1): 66–76. https://doi.org/10.1177/1073110517703101
International Council of Nurses. 2021. The ICN Code Of Ethıcs For Nurses. Retrieved from: https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf
American Nurses Association (ANA). 2015. Code of ethics for nurses. Retrieved from : https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
AFSÜ (Afyonkarahisar Sağlık Bilimleri Üniversitesi) Sağlık Uygulama ve Araştırma Merkezi. 2022. Organ nakli ve Organ Bağışı. Erişim Adresi: https://hastane.afsu.edu.tr/organ-nakli-ve-organ-bagisi/
O'Keeffe LM, Ramond A, Oliver-Williams, C, et al. Mid- and Long-Term Health Risks in Living Kidney Donors: A systematic review and meta-analysis. annals of ınternal medicine. 2018; 168(4): 276–284. https://doi.org/10.7326/M17-1235
Maple H, Chilcot J, Weinman, J, et al. Psychosocial wellbeing after living kidney donation - a longitudinal, prospective study. Transplant International : Official Journal of The European Society for Organ Transplantation. 2017; 30(10): 987–1001. https://doi.org/10.1111/tri.12974
Ralph AF, Butow P, Craig JC, et al. Living kidney donor and recipient perspectives on their relationship: longitudinal semi-structured interviews. BMJ Open. 2019; 9(4): e026629. https://doi.org/10.1136/bmjopen-2018
Grot D, Wasiak K, Tyszkowski J, Regeneration difficulties in patients with FQAD can limit the use of iPSc-based cell therapy. Stem cell research & therapy. 2022; 13(1): 210. https://doi.org/10.1186/s13287-022-02886-0
Wirken L, van Middendorp H, Hooghof CW, et al. Combining transplant professional's psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study. BMJ Open.2022; 12(3): e045249. https://doi.org/10.1136/bmjopen-2020-045249
Türkiye Cumhuriyeti Başkanlığı Mevzuat Bilgi Sistemi. Hasta Hakları Yönetmeliği. Resmî Gazete Tarihi: 01.08.1998 Resmî Gazete Sayısı: 23420. Erişim adresi: https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=4847&MevzuatTur=7&MevzuatTertip=5
American Hospital Association (AHA). 1992. American Hospital Association Guide to the Health Care Field, Chicago: Author. Retrieved from: https://www.qcc.cuny.edu/socialsciences/ppecorino/medical_ethics_text/Chapter_6_Patient_Rights/Readings_The%20Patient_Bill_of_Rights.htm
Lentine KL, Lam NN, Axelrod D, et al. Perioperative complications after living kidney donation: a national study. American Journal of Transplantation: Official Journal of The American Society of Transplantation and The American Society of Transplant Surgeons. 2016; 16(6): 1848–1857. https://doi.org/10.1111/ajt.13687
Meyer KB, Bjørk IT, Wahl AK, et al. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews. BMJ Open,. 2017; 7(2): e014072. https://doi.org/10.1136/bmjopen-2016-014072
Barnieh L, Arnold JB, Boudville, N, et al. Living kidney donors' financial expenses and mental health. Transplantation, 2021; 105(6): 1356–1364. https://doi.org/10.1097/TP.0000000000003401
Kestenbaum BR, Seliger SL. Commentary on risks of living kidney donation: current state of knowledge on core outcomes ımportant to donors. Clinical Journal of the American Society of Nephrology, CJASN. 2019; 14(4): 609–610. https://doi.org/10.2215/CJN.01650219
Meyer KB, Hartmann A, Mjøen G, et al. Relationships between clinical, self-reported, and donation specific outcomes: A prospective follow-up study 10 years after kidney donation. Annals of Transplantation. 2017; 22: 148–155. https://doi.org/10.12659/aot.902330
Canadian Nurses Association .(CNA). 2017. Code of Ethics-For Registered Nurses. Retrieved from: https://www.nscn.ca/sites/default/files/documents/resources/code-of-ethics-for-registered-nurses.pdf
Global Observatory on Donation and Transplantation (GODT). 2022. Prelimanry report Newsletter Transplant International Figures on Donation and Transplantation. Retrieved from: https://www.transplant-observatory.org/wp-content/uploads/2023/04/NL_GODT-PRELIMINARY-REPORT-2022.pdf
Bayona Molano MDP, Barrera Gutierrez JC, Landinez G, et al. Updates on the model for end-stage liver disease score and ımpact on the liver transplant waiting list: A Narrative Review. Journal of Vascular and Interventional Radiology. JVIR. 2023; 34(3): 337–343. https://doi.org/10.1016/j.jvir.2022.12.029
Carrero JJ, Hecking M, Chesnaye NC, et al. (2018). Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nature Reviews. Nephrology. 2018; 14(3): 151–164. https://doi.org/10.1038/nrneph.2017.181
Inker LA, Levey AS, Tighiouart H, et al. Performance of glomerular filtration rate estimating equations in a community-based sample of Blacks and Whites: the multiethnic study of atherosclerosis. Nephrology, Dialysis, Transplantation : Official Publication of The European Dialysis and Transplant Association - European Renal Association. 2018; 33(3): 417–425. https://doi.org/10.1093/ndt/gfx042
Katz-Greenberg G, Shah S. Sex and Gender Differences in Kidney Transplantation. Semin Nephrol. 2022;42(2):219-229. doi:10.1016/j.semnephrol.2022.04.011
Vart P, Gansevoort RT, Joosten MM, Bültmann U, Reijneveld SA. Socioeconomic disparities in chronic kidney disease: a systematic review and meta-analysis. Am J Prev Med. 2015;48(5):580-592. doi:10.1016/j.amepre.2014.11.004
Salter ML, McAdams-Demarco MA, Law A, et al. Age and sex disparities in discussions about kidney transplantation in adults undergoing dialysis. J Am Geriatr Soc. 2014;62(5):843-849. doi:10.1111/jgs.12801
Wasylenko E. Jugglers, tightrope walkers, and ringmasters: priority setting, allocation, and reducing moral burden. Healthcare Management Forum. 2013; 26(2): 7- 81. doi: https://doi.org/10.1016/j.hcmf.2013.04.006.
Victorino JP, Wilson DM. Moral distress experienced by nurses in relation to organ donation and transplantation. International Journal of Nursing Student Scholarship. 2017; 21(4): 1-13.
Rice EM, Rady MY, Hamric, A, et al. Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. Journal of Nursing Management. 2008; 16(3): 360-373. doi:10.1111/j.1365-2834.2007.00798.x.
Monforte-Royo C, Roque MV. The organ donation process: A humanist perspective based on the experience of nursing care. Nursing Philosophy. 2012; 13: 295-301. doi: 10.1111/j.1466-769X.2012.00544.x.
Austin W. Contemporary healthcare practice and the risk of moral distress. Reflections on Healthcare Leadership Ethics. 2016; 1: 1-3. doi: 10.1177/0840470416637835.
Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics. 2009; 20(4): 330-342. Retrieved from: https://goo.gl/gr1JPN.
US Food and Drug Administration. Xenotransplantation. 2021. Retrieved from: https://www.fda.gov/vaccines-blood-biologics/xenotransplantation.
U.S. Food and Drug Administration. (FDA). 2020. FDA xenotransplantation guidances. Retrieved from: https://www.fda.gov/vaccines-blood -biolo gics/biolo gics-guida nces/xenot ransp lanta tionguidances.
Referanslar
American Nurses Association (ANA), International Transplant Nurses Society (ITNS). Transplant nursing: scope and standards of practice. (2nd ed). Silver Spring, 2016. MD: https://www.nursingworld.org/~4ad074/globalassets/catalog/book-toc/transplant-nursing-scope--standards-of-practice-2e_toc.pdf
Burkhardt MA, Nathaniel AK. Çağdaş hemşirelikte etik (Ş. Ecevit Alpar, N. Bahçecik Ü. Karabacak, Çev.). 2013. İstanbul. İstanbul Medikal Sağlık ve Yayıncılık.
Beauchamp T, Childress J. Principles of Biomedical Ethics: Marking Its Fortieth Anniversary. The American Journal of Bioethics. (AJOB). 2019; 19(11): 9–12. https://doi.org/10.1080/15265161.2019.166540
Henderson ML, Gross JA. Living Organ Donation and Informed Consent in the United States: Strategies to Improve the Process. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics. 2017; 45(1): 66–76. https://doi.org/10.1177/1073110517703101
International Council of Nurses. 2021. The ICN Code Of Ethıcs For Nurses. Retrieved from: https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf
American Nurses Association (ANA). 2015. Code of ethics for nurses. Retrieved from : https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
AFSÜ (Afyonkarahisar Sağlık Bilimleri Üniversitesi) Sağlık Uygulama ve Araştırma Merkezi. 2022. Organ nakli ve Organ Bağışı. Erişim Adresi: https://hastane.afsu.edu.tr/organ-nakli-ve-organ-bagisi/
O'Keeffe LM, Ramond A, Oliver-Williams, C, et al. Mid- and Long-Term Health Risks in Living Kidney Donors: A systematic review and meta-analysis. annals of ınternal medicine. 2018; 168(4): 276–284. https://doi.org/10.7326/M17-1235
Maple H, Chilcot J, Weinman, J, et al. Psychosocial wellbeing after living kidney donation - a longitudinal, prospective study. Transplant International : Official Journal of The European Society for Organ Transplantation. 2017; 30(10): 987–1001. https://doi.org/10.1111/tri.12974
Ralph AF, Butow P, Craig JC, et al. Living kidney donor and recipient perspectives on their relationship: longitudinal semi-structured interviews. BMJ Open. 2019; 9(4): e026629. https://doi.org/10.1136/bmjopen-2018
Grot D, Wasiak K, Tyszkowski J, Regeneration difficulties in patients with FQAD can limit the use of iPSc-based cell therapy. Stem cell research & therapy. 2022; 13(1): 210. https://doi.org/10.1186/s13287-022-02886-0
Wirken L, van Middendorp H, Hooghof CW, et al. Combining transplant professional's psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study. BMJ Open.2022; 12(3): e045249. https://doi.org/10.1136/bmjopen-2020-045249
Türkiye Cumhuriyeti Başkanlığı Mevzuat Bilgi Sistemi. Hasta Hakları Yönetmeliği. Resmî Gazete Tarihi: 01.08.1998 Resmî Gazete Sayısı: 23420. Erişim adresi: https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=4847&MevzuatTur=7&MevzuatTertip=5
American Hospital Association (AHA). 1992. American Hospital Association Guide to the Health Care Field, Chicago: Author. Retrieved from: https://www.qcc.cuny.edu/socialsciences/ppecorino/medical_ethics_text/Chapter_6_Patient_Rights/Readings_The%20Patient_Bill_of_Rights.htm
Lentine KL, Lam NN, Axelrod D, et al. Perioperative complications after living kidney donation: a national study. American Journal of Transplantation: Official Journal of The American Society of Transplantation and The American Society of Transplant Surgeons. 2016; 16(6): 1848–1857. https://doi.org/10.1111/ajt.13687
Meyer KB, Bjørk IT, Wahl AK, et al. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews. BMJ Open,. 2017; 7(2): e014072. https://doi.org/10.1136/bmjopen-2016-014072
Barnieh L, Arnold JB, Boudville, N, et al. Living kidney donors' financial expenses and mental health. Transplantation, 2021; 105(6): 1356–1364. https://doi.org/10.1097/TP.0000000000003401
Kestenbaum BR, Seliger SL. Commentary on risks of living kidney donation: current state of knowledge on core outcomes ımportant to donors. Clinical Journal of the American Society of Nephrology, CJASN. 2019; 14(4): 609–610. https://doi.org/10.2215/CJN.01650219
Meyer KB, Hartmann A, Mjøen G, et al. Relationships between clinical, self-reported, and donation specific outcomes: A prospective follow-up study 10 years after kidney donation. Annals of Transplantation. 2017; 22: 148–155. https://doi.org/10.12659/aot.902330
Canadian Nurses Association .(CNA). 2017. Code of Ethics-For Registered Nurses. Retrieved from: https://www.nscn.ca/sites/default/files/documents/resources/code-of-ethics-for-registered-nurses.pdf
Global Observatory on Donation and Transplantation (GODT). 2022. Prelimanry report Newsletter Transplant International Figures on Donation and Transplantation. Retrieved from: https://www.transplant-observatory.org/wp-content/uploads/2023/04/NL_GODT-PRELIMINARY-REPORT-2022.pdf
Bayona Molano MDP, Barrera Gutierrez JC, Landinez G, et al. Updates on the model for end-stage liver disease score and ımpact on the liver transplant waiting list: A Narrative Review. Journal of Vascular and Interventional Radiology. JVIR. 2023; 34(3): 337–343. https://doi.org/10.1016/j.jvir.2022.12.029
Carrero JJ, Hecking M, Chesnaye NC, et al. (2018). Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nature Reviews. Nephrology. 2018; 14(3): 151–164. https://doi.org/10.1038/nrneph.2017.181
Inker LA, Levey AS, Tighiouart H, et al. Performance of glomerular filtration rate estimating equations in a community-based sample of Blacks and Whites: the multiethnic study of atherosclerosis. Nephrology, Dialysis, Transplantation : Official Publication of The European Dialysis and Transplant Association - European Renal Association. 2018; 33(3): 417–425. https://doi.org/10.1093/ndt/gfx042
Katz-Greenberg G, Shah S. Sex and Gender Differences in Kidney Transplantation. Semin Nephrol. 2022;42(2):219-229. doi:10.1016/j.semnephrol.2022.04.011
Vart P, Gansevoort RT, Joosten MM, Bültmann U, Reijneveld SA. Socioeconomic disparities in chronic kidney disease: a systematic review and meta-analysis. Am J Prev Med. 2015;48(5):580-592. doi:10.1016/j.amepre.2014.11.004
Salter ML, McAdams-Demarco MA, Law A, et al. Age and sex disparities in discussions about kidney transplantation in adults undergoing dialysis. J Am Geriatr Soc. 2014;62(5):843-849. doi:10.1111/jgs.12801
Wasylenko E. Jugglers, tightrope walkers, and ringmasters: priority setting, allocation, and reducing moral burden. Healthcare Management Forum. 2013; 26(2): 7- 81. doi: https://doi.org/10.1016/j.hcmf.2013.04.006.
Victorino JP, Wilson DM. Moral distress experienced by nurses in relation to organ donation and transplantation. International Journal of Nursing Student Scholarship. 2017; 21(4): 1-13.
Rice EM, Rady MY, Hamric, A, et al. Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. Journal of Nursing Management. 2008; 16(3): 360-373. doi:10.1111/j.1365-2834.2007.00798.x.
Monforte-Royo C, Roque MV. The organ donation process: A humanist perspective based on the experience of nursing care. Nursing Philosophy. 2012; 13: 295-301. doi: 10.1111/j.1466-769X.2012.00544.x.
Austin W. Contemporary healthcare practice and the risk of moral distress. Reflections on Healthcare Leadership Ethics. 2016; 1: 1-3. doi: 10.1177/0840470416637835.
Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics. 2009; 20(4): 330-342. Retrieved from: https://goo.gl/gr1JPN.
US Food and Drug Administration. Xenotransplantation. 2021. Retrieved from: https://www.fda.gov/vaccines-blood-biologics/xenotransplantation.
U.S. Food and Drug Administration. (FDA). 2020. FDA xenotransplantation guidances. Retrieved from: https://www.fda.gov/vaccines-blood -biolo gics/biolo gics-guida nces/xenot ransp lanta tionguidances.
