This review investigates factors underlying organ donation refusals by describing person-centred care’s tenets of respect, shared decision-making and socio-contextual understanding. Exploration reveals four key refusal influences – cultural/religious beliefs, misunderstandings, systemic distrust from past care, and psychological concerns. Statistics highlight disproportionate effects on specific minority communities, yet their lived refusals remain under-researched. Critically discussing proposed remedies through a sociohistorically nuanced view aims to illuminate donation declination complexities while offering trust-building, empathetic communication approaches within an ethics-guided, patient-focused care model supporting all involved in life-shaping talks.
Person-Centered Care/Family-Centered Care (LO1 and LO2):
Person-centred and family-centred paradigms constitute fundamental models affirming respect for each party’s needs, ideals and choices. PCC’s core recognizes custom care through consensus discussions and clinician-patient rapport addressing lived truths. FCC expands this individualized philosophy, enlisting family support within planning and treatment through candor-fortifying outcomes. Both grasp sociocultural realities impact health choices, focusing on reliability and compassion, designating cultural variety (de Groot et al., 2015) and uniting communities’ sense of empowerment throughout wellness experiences as cherished collaborators. Continuous engagement and understanding across differences cultivate trusted partnerships.
When faced with organ donation choices, individualized, family-focused care proves essential. Medical experts must engage with sensitivity, discerning priorities, qualms and sociocultural contexts impacting viewpoints. Employing PCC principles, clinicians foster caring discussions through close listening, clarifying misconceptions by explaining information accessibly and involving family per FCC. This nurtures trust, respecting how faith, culture or consent unease shape end-of-life stances (de Groot et al., 2015), only through honouring self-determination and consensus decisions beginning with empathy addressing refusal thoughtfully, guided by humanity across dissimilar identities and life’s mysteries. Continuous learning across diversity sustains holistic wellbeing.
Person-centred care alongside family-centred care principles proves vital when navigating sensitive organ donation talks. Not only should experts connect empathetically to appreciate individuals’ views, but the FCC acknowledges the family’s supportive role in choices. Offering insights involves emotive nuances; thus, FCC stresses respect among all relatives during consideration. Rather than autonomy alone, FCC ensures sensitivity to how donation viewpoints emerge from relationships and communities’ compelling acknowledgement (de Groot et al., 2015). Healthcare can foster trusted care by honouring complexity in end-of-life care guidance by communicating care, clarifying processes clearly and providing aid.
Person-centered and family-centered philosophies emphasize relationship-centered care, cultivating trust through inclusion, clarification and respect. This mitigates refusal influences by establishing care, literacy and autonomy support. Consent barriers progressively decrease by nurturing partnerships between all involved and addressing psychosocial factors meaningfully across communities, and shared stewardship of this issue strengthens.
While espousing these frameworks holds promise, more than simply paying lip service is required. Embedding philosophy institutionally demands rigorous, sustained collaboration. Ongoing training, partnership-centered policies, and investment in inclusive engagement cultivate sensitivity within challenging discussions. Administrative champions and practitioners attuned to sociocultural nuance empower shared understanding (de Groot et al., 2015). With applied principles of respect, empathy and support systematically and authentically woven through all healthcare interactions and programs surrounding donation, outcomes envision trusting environments honouring autonomous yet relational decision-making.
Introduction to the Topic:
Organ donation refusal undermines the transplantation supply despite medical progress and awareness efforts. Personal factors disproportionately curb consent, including faith traditions, values, and uncertainties. Deeper inquiry into this dilemma necessitates respectfully comprehending its varied sociocultural underpinnings to foster cooperative solutions, maximizing supply while affirming autonomy across diverse populations. Multidimensional challenges require nuanced, sustained understanding and coordination to optimize this lifesaving resource’s community-wide benefit.
Comprehending influences on refusal decisions necessitates a dignified exploration of intricate individual and collective perspectives on this sensitive issue. Navigating ethical, legal and sociocultural intricacies to cultivate connectedness demands promoting literacy, clarifying uncertainties and building trust through respectful exchange across differences. Cooperative efforts empowering autonomous yet interdependent choices hinge on sensitive engagement and empathy to remedy impediments faced in diverse communities. Targeted understanding fosters empowerment around lifesaving donations. (Abbasi et al., 2018)
A comprehensive strategy necessitates coordinating healthcare practitioners, lawmakers, patient champions and citizens through respectful inquiry. Evaluating existing programs and root-cause analyses pinpoint where sensitivities impede consent across demographics. Targeted yet principled reforms emerge from a nuanced understanding of this urgent supply-demand gap in diverse communities. Ongoing multisectoral collaboration promotes accessible, dignified options, empowering all to contribute according to their barriers and capacities (Abbasi et al., 2018). Interdependence across sectors nurtures justice, compassion, and futures where no one suffers due to the lack of these medical resources.
Refusal influences arise from diverse psychosocial contexts warranting sensitive discussion. Cultural traditions, misapprehensions regarding procedures or consent anxieties arising from fears of impaired care or ambiguity surrounding death may discourage some. Others must know transplantation’s saving potential or how bodily integrity persists after demise. Addressing supply shortfalls demands comprehending these nuanced factors respectfully through engaged discernment of varied experiences to cultivate mutual literacy and empower autonomous decision-making. Targeted understanding dismantles misinformation while affirming plural perspectives. (Abbasi et al., 2018)
Sensitively engaging the diverse public to clarify misconceptions and build donation literacy proves pivotal. Education through trusted interlocutors nurtures informed understandings of donation’s lifesaving potential while respecting plural viewpoints. Empathetic outreach cultivates caring communities where none endure needless suffering or loss due to solvable scarcity. Cooperative stewardship emerges from fostering knowledgeable autonomy through equipping varied members with navigational tools, mitigating fears and cultivating resilient health for generations to come (Abbasi et al., 2018). Interdependence thus flourishes where once isolation reigned.
Faith and cultural traditions profoundly impact donation perspectives, and nuanced understanding is key. Some see taboos or spiritual uncertainties where literacy builds empowerment. Religious views on corporeal integrity also warrant respect. Compassionate discourse across differences cultivates awareness of diverse life experiences while dismantling misconceptions to establish trust for considerate planning amid communal realities. Intersectional literacy uplifts everyone in navigating this complex issue with dignity.
Sociocultural barriers necessitate nuanced navigation. Marginalized groups weary of structural inequities prove rightly discerning partners. Historical exploitations cultivate warranted scepticism toward medical institutions. Remedying such impacts demands cross-sectional collaboration. Compassionate outreach nurtures health equity through participatory literacy campaigns empowering autonomous consent among diverse publics. Relationships premised on justice and interdependence optimistically reimagine this issue’s possibilities.
While autonomy warrants respect, donation’s life-giving leverage proves weighty. Practitioners carefully tread relations with grieving kin to highlight donation’s potential against complex socioethical concerns. Lawmakers confront nuanced policymaking with regulatory frameworks upholding civil liberties alongside public health. Stakeholders navigate tensions through sensitivity, seeking connection across differences with care, understanding and compassion. Shared stewardship of this issue embraces pluralism and humanizes all involved through dignity.
This issue’s humanitarian scale merits circumspection from diverse viewpoints. While self-determination proves sacrosanct, equitable care accessibility remains a foremost collective concern. Further, legal nuances across regions shape donation discussions requiring cross-cultural literacy. A comprehensive strategy engaging medical professionals, lawmakers and communities demonstrates sensitivity to individual rights alongside shared responsibilities within resource constraints. Through open yet prudent discourse, multifaceted challenges unfold pragmatically with justice and compassion for all. (Abbasi et al., 2018)
While sovereignty over their remains is morally just, refusal’s wider impacts warrant prudent discussion. With transplantation demand outpacing supply’s constraints, those awaiting donors endure elongated clinical uncertainty, potentially worsening prognoses, and even mortality. Society, too, bears consequences as overburdened facilities see elevated costs and non-transplant wait times lengthening as listing tallies climb (Abbasi et al., 2018). A model serving community wellbeing yet respecting diversity mandates examining solvable drivers of this stress and crafting equitable, compassionate policy reform, minimizing avoidable crises through understanding diverse perspectives and literacy around this issue’s interconnections.
This issue intersects with equity, as some groups disproportionately experience additional challenges. Underserved communities facing socioeconomic barriers restricting specialized care accessibility confront intensified issues amid donation shortfalls. The consciousness of such connections should thoughtfully guide comprehensive attempts to illuminate donation’s pros across varied populations. Just participation in wellbeing choices through nuanced cultural awareness alone may dismantle systemic obstacles, ensuring this lifesaving resource allocation predicated on medical necessity – advancing justice’s multifaceted domains through collaborative understanding between all involved with an informed, empathetic spirit.
Equitable efforts necessitate nuanced outreach comprehending sociocultural nuance. Engaging faith leaders and healthcare practitioners trusted among communities compassionately addresses concerns hampering consent through personalized discussions, elevating informed empowerment over apprehension. Materials embrace multiple tongues and respect diversity while cultivating an understanding of donation’s life-giving potential. Intersectional stewardship prioritizes equitable participation and partnership with groups differently impacted (Abbasi et al., 2018). Only through meaningful collaboration across experiences may we foster collective literacy and care for one another amid this issue’s complexities.
Sensitively navigating this issue warrants discourse prioritizing compassion. Practitioners can foster informed consent amid diversity by cultivating interactions, empowering preference discussions and cross-cultural competency throughout the healthcare continuum. Respecting self-determination and mediating confusion through targeted literacy builds trust, permitting exploration of donations’ life-giving potential. Intersectional alliance dignifying varied experiences uplifts all amid this shared challenge.
Honouring personhood necessitates nuanced care amid this complex issue. Providers cultivate autonomy through empathetic engagement, elucidating realities while respecting plural views. Compassionately partnering with individuals and kin to explore concerns permits discerning customized plans all find agreeable. Intersectional allyship dignifies diverse lived experiences, building understanding and trust across differences. Only by addressing each stakeholder with profound regard may we approach donation’s lifesaving potential through cooperative rather than divisive means, prioritizing wellbeing for all with fairness and care. (Abbasi et al., 2018)
Person-centeredness proves imperative to navigate this humanitarian issue sensitively. Honouring one’s intrinsic worth necessitates empathy, inviting collaboration on discerning wellness with concern for diverse insights. Healthcare stewards cultivate comprehending relationships through discernment of each party’s perspective, promoting autonomy amid complexity. Shared literacy dismantling apprehension becomes the cornerstone for maximizing consent opportunistically and minimizing preventable impacts through partnership across experiences. Individualized care dignifies humanity’s plurality and hence bears fruit by benefiting communities through compassionate alliance.
This issue invites comprehensive elucidation. My research explores donation refusal’s intricacies to serve community health through informed solutions. Academic works shed light on sociocultural determinants like faith, mistrust and unfamiliarity with transplantation impacting consent. By synthesizing such context, strategies may be refined to nurture understanding across diverse populaces, build rapport between citizens and medical stewards, and lift awareness of organ giving’s lifesaving blessing (Abbasi et al., 2018). Intersecting experiences enlighten paths respecting self-governance yet gently cultivating participation where medically viable. Joint literacy thus empowers communities through cooperation, empathy and care.
A nuanced exploration of innovative, compassionate practices holds promise. This analysis assesses personalized discussion, culture-mindful outreach, and public collaboration between care providers and receivers. Findings offer timely guidance on strengthening donor education and policy reform to lift consent and quality of life amid this issue. Comprehensively addressing refusal’s intricacies and equitable access through proven solutions, we work to foster understanding and resilience with wisdom and goodwill for all impacted by organ scarcity.
Method (Search Strategy) LO3:
This analysis methodology involved judiciously sourcing applicable literature. An exhaustive keyword compilation contained: “organ donation refusal”, “refusal rationales”, “patient-centered care”, and “strategic execution”. Boolean operators refined electronic database searches within PubMed, CINAHL Plus, PsycINFO and complementary archives. Reference mining revealed relevant sources receiving critical assessment dependent on contextuality and discourse contributions (Bramer et al., 2018). This rigorous, systematic search protocol properly addresses its complexities when contextualizing existing knowledge and formulating new strategies. Maintaining search precision guided fruitful retrieval to enlighten potential solutions supporting all impacted by this sensitive issue.
Databases such as PubMed, CINAHL, and PsycINFO were selected for their extensive coverage of healthcare literature. These databases were queried using the identified keywords and Boolean terms to retrieve relevant articles. In addition to academic databases, grey literature sources, including reports from healthcare organizations and government publications, were consulted to supplement academic findings. (Bramer et al., 2018)
Inclusion criteria were established to ensure the selection of pertinent literature. Articles were required to focus on the reasons behind organ donation refusals, propose implementation strategies for improving PCC in healthcare settings, and be published within the last ten years to ensure currency (Bramer et al., 2018). Exclusion criteria included studies not written in English or those needing full-text availability.
The search process involved reviewing article titles, abstracts, and keywords to determine relevance. Full-text articles meeting the inclusion criteria were obtained and thoroughly examined for their contribution to the literature review. Reference lists of selected articles were also screened to identify additional relevant studies, ensuring a comprehensive search strategy.
This systematic search strategy aimed to retrieve high-quality literature relevant to the research question while minimizing bias. By employing a combination of academic and grey literature sources and adhering to predefined inclusion criteria, this approach facilitated the identification of diverse perspectives and insights into organ donation refusal and person-centred care implementation strategies. (Bramer et al., 2018)
Findings ( LO2/LO3/LO4):
This section synthesizes findings from 5-10 original studies on organ donation refusals, critically evaluated using CASP. Implications for how their insights could support person-centred approaches to ethical issues in healthcare and end-of-life decision-making are explored.
The qualitative research examines potential donors’ personal beliefs and perspectives on organ donation through interviews and narratives, revealing the emotional and psychological dynamics involved in their end-of-life care decisions (Cooper, 2012). Concurrently, quantitative studies utilize statistical analysis to uncover any demographic traits correlated with refusal rates. Mixed methods integrate qualitative and quantitative interviews to develop a holistic view of the complex interplay between individual experiences and societal factors shaping organ donation stances.
By analyzing results from various research designs, common reasons for refusal, like fear of medical interventions, distrust in healthcare organizations, religious and cultural views, and anxiety over bodily integrity, can be recognized. With this evidence, clinicians can create nuanced educational programs, and policymakers can enact systemic reforms addressing such challenges. Together, these efforts can support patient-centred end-of-life conversations and informed consent surrounding organ donation within diverse populations. (Cooper, 2012)
The literature reveals several key findings regarding the reasons behind organ donation refusals:
Lack of Knowledge and Awareness:
The research uncovered that organ refusal commonly originates from cultural/faith-based views, anxiety over medical intervention, or distrust in healthcare. Other individuals expressed worries over impacts on personal health or potential organ commodification after death. Correcting misinformation through targeted education initiatives and community involvement is paramount to boosting consent alongside raising awareness of the urgent need to help those awaiting transplants. (Ghorbani et al., 2011)
Educational programs to increase rates must directly address common misconceptions through factual details on donation procedures and outcomes for recipients. Facilitating sensitive discussions within communities empowers individuals with accurate information to make informed registration choices. Respecting diverse cultural and religious views while raising awareness in a supportive manner can help ensure prospective donors feel respected in their end-of-life decisions regarding this selfless act.
Cultural and Religious Beliefs:
Dispelling misperceptions requires acknowledging how cultural and faith-based conceptions of death and the afterlife shape perceptions of organ donation. Some traditions prioritize bodily integrity during burial or see donation as unnaturally intervening with demise. Conversely, other beliefs elevate donation as charity or continuing aid to others even after demise. Comprehending diverse viewpoints allows for crafting sensitive educational initiatives addressing each community’s concerns, whether related to impacts on funeral rites or portraying the altruism within donation. Nuanced understanding promotes informed choice and saving lives through consent.
Faith-based perspectives require thoughtful consideration. Religious doctrine shapes views on the body’s sanctity and morality of donation. Some faiths promote donation’s compassion; others base reservations or prohibitions on theological stances. By initiating respectful interfaith discussions and providing religion-specific donation details, medical experts can connect communities facing need with opportunities to give life (Ghorbani et al., 2011). Respect across differences remains key, with providers helping address each group’s concerns to enable fully voluntary, informed consent from all. Through understanding diverse end-of-life philosophies and mutual learning, transplant waiting lists may shorten as shared humanity overshadows division.
Trust in the Healthcare System:
Relationships between healthcare providers and communities significantly impact donation views. Individual experiences and assumptions regarding medical workers’ aims shape trust. Individuals may refuse donation over worries that their organs will not receive fair allocation or concerns over process transparency. Dialogue addressing these anxieties through discussing candidate selection and distribution policies remains pivotal. Details on oversight and consent procedures reassure prospective donors (Ghorbani et al., 2011). Demonstrating equitable access to transplants for all in need, regardless of background, builds confidence and encourages participation in this lifesaving act. With openness and understanding, distrust diminishes as people feel respected in end-of-life care choices.
Fairness profoundly shapes donation views, with allocation inequities understandably dissuading participation. Transparency regarding candidate prioritization protocols and access and initiatives rectifying systemic disparities prove paramount for cultivating trust that each patient may receive impartially lifesaving care. Addressing concerns around unequal distribution demands ongoing work to ensure donated organs are all according to need alone. With trust that the system functions with justice and empathy for diverse experiences, more individuals may feel reassured to register altruistically, convinced that their gift assists whoever requires it most (Ghorbani et al., 2011). Equality strengthens communities by donating through difficult times.
Emotional and Psychological Factors:
Emotional turbulence emerges as a natural yet impactful consideration for families facing end-of-life organ discussions. Research establishes that counselling support mitigates distress during traumatic times, fostering the clarity needed to respect loved ones’ preferences. Rather than intensifying fear and anxiety through a lack of empathy, medical experts aim to alleviate suffering through patient listening and addressing underlying worries. By acknowledging psychological complexity intertwined with physiological realities, compassionate care better equips grieving individuals to donate life by their priorities and principles (Ghorbani et al., 2011). With open acknowledgement of emotional pain as valid, mourners feel respected navigating donation’s intimacy amid sorrow.
The psychological weight upon all parties in organ donation necessitates respect and aid. Incorporating counselling acknowledges emotional complexity for donors coping with loss and recipients confronting new life with someone else’s gift. Tailored support networks empower families to navigate sorrow while saving others. Open dialogue allows for sharing concerns with receptive medical experts committed to overall wellbeing, not just physical health (Ghorbani et al., 2011). Only with compassionate acknowledgement of the human experience accompanying physiological procedures can thriving communities emerge where life’s fragility and value are universally understood.
Communication and Decision-Making Processes:
Recipient outcomes and donation rates improve through compassionate cooperation across stakeholders. Studies emphasize that specialists skilled in empathetic exchanges must facilitate explorations of options to honour donor intent. Adequate support networks allow for addressing concerns with care, respect, and timely facts. Empowered decision-making can occur only with culturally aware guidance and open dialogue accommodating diverse perspectives.
Establishing trust involves acknowledging the humanity of each process member, from grieving families to waiting patients. Together, through understanding and teamwork, transplantation can inspire as a reminder of our shared hopes. (Irving et al., 2011)
Socioeconomic Factors:
Socioeconomic realities are undeniably tied to donation views. Research links restricted access to data-constrained finances and healthcare system distrust among disadvantaged demographics with additional obstacles. Addressing root inequities demands acknowledging social determinants of health (Irving et al., 2011). Tailored initiatives strive to expand awareness by encountering underserved groups empowered to choose via timely facts within welcomed community settings. Only through sensitive outreach mitigating barriers can donation achieve its potential, serving all equally regardless of means. Together, by understanding challenges, stakeholders progress this call for life.
Organizational and System-Level Factors:
After reviewing the research on factors influencing organ donation rates, it is evident that system-level improvements are urgently needed. Standardizing hospital policies and workflows while investing in robust staff education can maximize donations amid grieving conversations. Families deserve clarity and compassion above all else during such vulnerability. Infrastructure must evolve with communities, from translation capabilities to technological coordination enhancing matching potential (Irving et al., 2011). Only with synchronized medical, legal and social supports prioritizing dignity can this gift of life spread equitably for all awaiting hope. Continuous reform honours each donor’s legacy.
By comprehending donation’s intricate interplay between medical, social and psychological realities, focused efforts emerge. Initiatives educating communities and sensitizing staff cultivate understanding across differences. Dialogue skills promoting inclusion lift every voice as systemic changes address real disparities limiting lifesaving options. With humility and care, stakeholders from various backgrounds cooperatively refine practices to honour each gift’s significance. By respecting humanity in all its diversity, possibility awakens communities navigating loss but finding hope through shared lives. (Irving et al., 2011)
Discussion (LO2/LO4):
Findings shed light on influencing donation through a person-centred lens. Analyzing tied medical, emotional and socioeconomic implications aligns with established works, uncovering avenues for respecting diverse perspectives when navigating life-altering decisions. Continued exploration of enhancing community trust and support networks promotes understanding during grieving moments (Pourhosein et al., 2022). Adapting education and systems to honour wishes with empathy strengthens stakeholder bonds amid shared hopes. Together, through compassionate discourse, families always feel empowered.
Findings acknowledge donation refusals stem from varied roots, from spiritual views to systemic distrust. Professionals can respectfully navigate sensitive discussions by aligning with works exploring the complexity inherent in such choices. By comprehending diverse medical, psychological and cultural influences shaping stances, staff promote patient-centeredness through empathy, addressing underrepresented rationales with sensitivity (Pourhosein et al., 2022). Tailored caring embraces humanity across differences, empowering families even in sorrow. Compassion at each juncture honours all involved.
Additionally, findings uncover a sizable absence in works assessing strategies for limiting refusal impacts. Some studies probe initiatives, including awareness campaigns or consent resources, but evidence still needs clarification. This importance of further exploration emerges to appraise respectful, evidence-based practices facilitating donation willingness amid diverse perspectives. Sensitivity demands continuous assessment catering to cultural context to reinforce care quality. Empathy necessitates steady discovery across medical ethics, social work, and communities served.
Amidst PCC priorities, this work illuminates the value of valuing connected exchanges between all stakeholders. Actively participating families within caring discussions address concerns humanely, possibly easing donation challenges through alliance and respecting autonomy amid sorrow honours each member’s dignity. As research steadily enhances practices preserving humanity across diverse experiences, stakeholders strengthen sensitive collaboration, nurturing trust where grief might splinter hopes. Together, walking grief’s path, communities awakened to shared healing prevail. (Pourhosein et al., 2022)
While person-centred priorities prove paramount, contextual complexities inevitably arise. Deeply held spiritual traditions understandably shape stances, challenging open exchange. Moreover, providers navigate constraints of time and resources amid sensitive discussions warranting care tailored to each experience. However, with communities and staff cultivating cultural understanding through interactive learning and focused institutional support, respectful communication may blossom where distrust once constrained choice (Pourhosein et al., 2022). An equitable, empathic approach empowering diverse communities ultimately nurtures shared hopes.
Additionally, evidence implies that strategies addressing refusal factors necessitate nuanced adaptation aligning with diverse contexts. Success likely stems from harmonizing initiatives with organizational missions, policies and cultural diversity within served populations. A one-size-fits-all approach risks limitations. Thus, continued respectful study across differences cultivates an understanding of optimally supportive, community-inclusive practices. With guidance from varied stakeholders and perspectives, the policy may organically emerge, elevating person-centred care wherever hope might spread (Pourhosein et al., 2022). Through compassionate partnership, all communities feel empowered over solemn donated life-affirming choices.
This discussion underscores the necessity of a thoughtful, nuanced strategy for navigating donation declines and respecting person-centred priorities. Comprehending influences on viewpoint enables prudent interventions that are custom-fit for each patient, preserving patient autonomy. Staff empowered by deepening awareness facilitate willing participation, honouring humanity across diverse end-of-life stances. However, continued study across contexts cultivates an understanding of establishing caring alliances even in loss, where none feel unnamed (Pourhosein et al., 2022). Empathy warrants persistent exploration so communities worldwide may experience matched life unconfined by limits once prohibiting hope.
Conclusion:
This work illuminates donation refusal complexities and person-centred care priorities. Diverse findings uncover understanding and strategies, yet bias mitigation and fuller consent comprehension necessitate guidance. With policies centring on each experience and continuing respectful study across differences, professionals establish caring alliances so that through shared stewardship of life’s intimacies, no community stands estranged from hope. Sensitivity can strengthen systems where limitations are constrained through open-hearted listening and mutual understanding. Together, may more lives be empowered.
In conclusion, through garnering diverse understandings, the nuances of declining donations emerge, as does person-centred the importance of person-centred care. Although strategies, insight, and avenues for progress surface, biased barriers to comprehension and guidance implementation still need to be fulfilled. Continued respectful exploration across experiences cultivates awareness, empowering communities through shared stewardship of hope. With sensitivity always at the heart of the discussions, a collaborative trust may blossom where limits once constrained life-affirming kinship. Together, ensuring each voice feels heard, more lives may be enriched.
Reference list
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