Supporting ethical ICU nursing practice in organ donation: An analysis of personhood

Organ donation is critical to the survival of thousands of people waiting for an organ transplant. While nurses take responsibility for patient and family comfort and quality of dying whenever patients die in the intensive care unit (ICU), organ donation presents unique challenges to these ideals. Critical care settings are essential for organ donation, where candidates for donation are identified, referred, stabilized, and maintained until organs can be retrieved. Nurses may feel challenged in completing organ donation-related tasks without forsaking values and practices that are typically associated with a palliative nursing approach and the achievement of a ‘good death’ in the ICU. Further, the moral uncertainty in this context could be increasing, given the advent of a new pathway for organ donation in ICU: medical assistance in dying (MAiD). In this paper, we reflect on the ethical meanings, challenges and possibilities of a good death in the context of organ donation in ICU nursing. We argue that personhood—as a conceptual frame to guide nursing practice—offers one way of reconciling seemingly disparate values and practices. To illustrate the importance of integrating this concept, we draw on real-life case studies from clinical ICU nursing. These examples showcase the emotional engagement and moral tension that nurses could experience when caring for people who occupy a liminal space between life and death. Ultimately, we hope this paper will inspire and support ethical reflection and action among ICU nurses caring for organ donors.