Key Success Factors of Deceased Organ Donation in Hospitals of Ministry of Public Health, Thailand - ปัจจัยแห่งความสำเร็จ ของการรับบริจาคอวัยวะจากผู้ป่วยสมองตาย ในโรงพยาบาลสังกัดกระทรวงสาธารณสุข

บทคัดย่อ

         Transplantation had become a preferable alternative treatment to other replacement therapy because of its high cost effectiveness and the outcomes of longer living and good quality of life of patients. Major obstacle to transplantation has been organ-shortage, especially from deceased donors. Despite a large numbers of brain-death patients caused by head injuries and cerebro-vascular diseases, deceased organ donors were quite low in Thailand when compared to some other countries such as Belgium, Spain etc. The objectives of this study were to explore on measures to achieve sufficient numbers of brain-death donors in public hospitals under Ministry of Public Health (MoPH) and to develop an efficient deceased organ
donation system. It was conducted during February-September 2013 using quantitative and qualitative methods. For the qualitative part, purposive sampling was applied to recruit 34 MoPH hospitals with deceased organ donation experiences. Key informants in each hospital were director, doctors and nurses who were responsible for organ donation. Focus group discussions, structural and in-depth interviews were applied for data collection. Data saturation was reached at 27 key persons. Content analysis and thematic analysis were performed to ensure rigor and credibility of the study. For the quantitative part (descriptive study), cluster sampling was used to recruit executive nurses and transplant coordinator nurses in 64
MoPH hospitals registered to be members of the donor-hospital network. Purposive designed questionnaires were used for data collection. A total of 103 completed questionnaires returned for analysis (80.5% response rate). Demographic data was analyzed using descriptive statistics. It was found that key success factors influencing deceased organ donation system management in MoPH hospitals were (1) continuing policy for organ donation by MoPH and the hospitals, (2) definitive organization chart for the Organ
Donation and Transplant Center in the hospital, and (3) clear assignment for donor team , including chief of the Organ Donation and Transplant Center, transplant coordinator nurses, neurosurgeon and/or donor care doctors. The other major factors were socio-cultural believes and attitudes of the general public and health personnel that might influence the decision on donation. Meanwhile, hospital facilities needed to strengthen internal cooperation and their preparedness. The authors recommended that MoPH should strengthen
capability of hospital facilities to ensure effective management in achieving sufficient brain-death donors and effective deceased organ donation system.
Key words: barriers to organ donation, deceased donor, transplantation