Psychosocial, legal, ethical, and cultural aspects of organ donation and transplantation.

Organ donation is largely dependent on the attitude and timing of health care professionals working with donor families. Critical care nurses are in a unique position to increase the supply of organs for donation, and they must assume some professional responsibility for the existence of the current supply and demand disparity. The transplant recipient and his or her family undergo extraordinary stresses in dealing with the uncertainty generated by this desperate situation. Various mechanisms exist to at least partially allay the fears and anxiety of this period, generally through the use of a multidisciplinary approach. Because organ transplantation is a relatively new field, national standards have not yet been established. Although this helps decrease the risk of malpractice in this arena, it contributes to the ethical controversy associated with organ transplantation. It is certain that transplantation will be scrutinized ever more closely owing to the current crisis in health care coverage. Racial and cultural differences do appear to exist in regard to organ donation and transplantation. Further study of HLA antigens and possible differences in immunoreactivity in nonwhites may narrow the gap in both graft and patient survival. Aggressive educational efforts to increase organ donation in blacks and Hispanics need to be undertaken to better serve the needs of their transplant populations.