Kontakt X:X | DOI: 10.32725/kont.2025.056

Determinants of nurses' distress during organ donation after circulatory deathNursing - Original article

Jana Křivková ORCID...1, 2, *, Jiří Šimek ORCID...1, Alena Lochmannová ORCID...3, Pavel Leden2, Tomáš Karel4
1 University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, České Budějovice, Czech Republic
2 University of West Bohemia, Faculty of Health Care Studies, Pilsen, Czech Republic
3 Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
4 Prague University of Economics and Business, Faculty of Informatics and Statistics, Department of Statistics and Probability, Prague, Czech Republic

Background: Organ donation after circulatory death (DCD) poses ethical, emotional, and procedural challenges for nurses at critical junctures of the donation pathway. Despite its growing adoption to address organ shortages, determinants of nurse distress in DCD remain underexplored - especially in Central Europe.

Aim: To quantify associations between nurse distress during key DCD phases and four factors: (1) perceived ethical dilemma, (2) level of personal participation, (3) perceived professional respect, and (4) cumulative DCD experience.

Methods: A cross sectional survey of Czech ICU nurses used a bespoke questionnaire to rate discomfort at twenty critical moments on a five point Likert scale. Associations between dichotomized distress (low vs. moderate-high) and each determinant were tested via Pearson's χ2 or Fisher's exact test.

Results: Distress varied significantly with the type of ethical dilemma, notably during terminal extubation and agonal breathing. Full pathway participation correlated with lower distress in the no touch interval, whereas perceived respect showed no significant effect in decision making phases. Greater DCD experience was linked to reduced discomfort in technical and emotionally charged stages.

Conclusion: Ethical framing, procedural immersion, and hands on experience chiefly drive nurse distress in DCD; professional respect plays a lesser role. Ethics focused debriefings, immersive simulations, and targeted coping strategies may enhance nurse resilience and care quality.

Keywords: End-of-life care; Ethical dilemmas; Nurse distress; Organ donation after circulatory death; Psychological well-being
Conflicts of interest:

The authors have no potential conflict of interest to declare with respect to the research, authorship, and/or publication of this article.

Received: August 15, 2025; Revised: October 21, 2025; Accepted: November 12, 2025; Prepublished online: November 19, 2025 

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