Pro-Position Paper
Instructions
For this assignment, complete the following:
Review the Toulmin-model outline (Week 2 Lesson) and your completed Week 1 Assignment (Pro-Position Proposal). Assess any feedback provided by the professor and/or your peers.
Compose a position paper representing the pro side of your topic. (See the Pro-Paper Template). The paper should include approximately 6 developed paragraphs:
Introduction (with thesis statement)
Context paragraph
3 body paragraphs (focusing on 3 pros)
Conclusion
Apply a formal tone appropriate for academic audiences, maintaining an objective 3rd person point of view – no 1st person (I, me, my, we, our, us, mine) or 2nd person (you, your). Avoid contractions, clichés, and slang terminology.
Use the provided template to assist in formatting the title page and headers.
Incorporate at least 3 scholarly sources into the paper. Cite all sources in APA format, both parenthetically and on a reference page.
Before submission, proofread and edit carefully for spelling, punctuation, and grammar. Not every error will be flagged automatically in word-processing programs, and some that are flagged as errors are actually correct.
Writing Requirements (APA format)
Length: 2-3 pages (not including title page or references page)
1-inch margins
Double spaced
12-point Times New Roman font
Title page
References page (minimum of 3 academic articles)
Grading
This activity will be graded using the Pro-Position Paper Grading Rubric.
Course Outcomes (CO): 3, 6
Due Date: By 11:59 p.m. MT on Sunday
Family Perspectives on Deceased Organ Donation: Thematic Synthesis of Qualitative Studies
A. Ralph1,2,*, J. R. Chapman3, J. Gillis4,5, J. C. Craig1,2, P. Butow6,7, K. Howard2, M. Irving1,2, B. Sutanto1,2 and A. Tong1,2
1Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia 2Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia 3Centre for Transplant and Renal Research, Westmead Hospital, NSW, Westmead, Australia 4Centre for Values, Ethics and Law in Medicine, The University of Sydney, Sydney, NSW, Australia 5Paediatrics and Child Health, The Children’s at Hospital, Westmead, NSW, Australia 6Psycho-Oncology Co-Operative Research Group, The University of Sydney, Sydney, NSW, Australia 7Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, Australia �Corresponding author: Angelique Ralph, angelique.ralph@sydney.edu.au
A major barrier to meeting the needs for organ transplantation is family refusal to give consent. This study aimed to describe the perspectives of donor families on deceased donation. We conducted a systematic review and thematic synthesis of qualita- tive studies. Electronic databases were searched to September 2012. From 34 studies involving 1035 participants, we identified seven themes: comprehen- sion of sudden death (accepting finality of life, ambiguity of brain death); findingmeaning in donation (altruism, letting the donor live on, fulfilling a moral obligation, easing grief); fear and suspicion (financial motivations, unwanted responsibility for death, medi- cal mistrust); decisional conflict (pressured decision making, family consensus, internal dissonance, reli- gious beliefs); vulnerability (valuing sensitivity and rapport, overwhelmed and disempowered); respecting the donor (honoring the donor’s wishes, preserving body integrity) and needing closure (acknowledgment, regret over refusal, unresolved decisional uncertainty, feeling dismissed). Bereaved families report uncertainty about death and the donation process, emotional and cognitive burden and decisional dissonance, but can derive emotional benefit from the ‘‘lifesaving’’ act of donation. Strategies are needed to help families under- standdeath in the context of donation, address anxieties about organ procurement, foster trust in the donation process, resolve insecurities in decisionmaking andgain a sense of closure.
Keywords: Deceased donor, family, organ and tissue donation, qualitative research
Abbreviations: CINAHL, cumulative index for nursing and allied health literature; COREQ, Consolidated Criteria for Reporting Qualitative Health Research; NHS, National Health Service
Received 07 November 2013, revised and accepted for publication 27 December 2013
Introduction
One of the major barriers to meeting the needs for organ
transplantation in more than 50 countries of the world,
including the United States, the United Kingdom and
Australia, is that the consent of families is required (1–3).
The family consent rate is 60% (4) in the United Kingdom
and 54% (5) in the United States.
Approaching grieving families with requests to donate
organs from a recently deceased relative require families to
make the difficult decision under very distressing circum-
stances (6). In spite of support for donation in principle in the
general community, this is not always reflected in the actual
rates of donation (7). Consent to donation is less likelywhen
there is family conflict (8); where there is a lack of rapport
with healthcare providers; where requests are ill-timed; and
where families are dissatisfied with care (9–12).
Review of the families’ perspectives in deceased organ
donation has usually focused on themeaning of brain death
andmodifiable factors influencing the decisions of relatives
to agree to the donation of their deceased family member’s
organs (13–16). We undertook a systematic review and
thematic synthesis of qualitative studies of the experi-
ences, attitudes and beliefs of families on organ donation
(17). A broad understanding of family perspectives may
help inform best practice service, end-of-life care and
contribute to improve the donation process.
Materials and Methods
Data sources and searches
The search strategy is provided in Table S1. The searcheswere conducted in
MEDLINE, Embase, CINAHL and PsycINFO from inception to September 3,
American Journal of Transplantation 2014; 14: 923–935 Wiley Periodicals Inc.
�C Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons
doi: 10.1111/ajt.12660
923
2012. We also searched Google Scholar, PubMed and reference lists of
relevant articles and reviews. One author (AT) screened the titles and
abstracts and excluded those who did not meet the inclusion criteria. Full
texts of potentially relevant studies were obtained and assessed for
eligibility.
Study selection
Qualitative studies that examined the perspectives of family members on
deceased organ and tissue donation for transplantation were included.
Studies that involved family members (parents, spouses, siblings, close
relatives and friends) whose relative had died and were approached about
organ donation were included. Articles were excluded if they used
structured surveys, or were epidemiological studies, editorials or reviews.
Non-English articles were excluded due to lack of resources for translation
and limited feasibility in understanding and synthesizing cultural and
linguistic nuances; and to avoid potential misinterpretation of the author’s
study.
Data extraction and quality assessment
For each study, we assessed the transparency of reporting as this can
provide contextual details for the reader to evaluate the credibility,
dependability and transferability of the study findings to their own setting.
We adapted the Consolidated Criteria for Reporting Qualitative Health
Research (COREQ) framework, which included criteria relating to the
research team, study methods, context of the study, analysis and
interpretations (18). Authors AR and BS independently assessed each
study and met regularly to resolve any differences.
Synthesis
Thematic synthesis is used to integrate the findings of multiple qualitative
studies that address questions about people’s perspectives and experi-
ences. Thismethodology involves the translation of concepts across studies
to develop descriptive and analytical themes grounded in qualitative data
(17). We extracted all text under the ‘‘results/findings’’ or ‘‘conclusion/
discussion’’ section of the article (17,19). These were entered verbatim into
HyperRESEARCH (ResearchWare, INC.2009, version 3.0.3; Randolph,MA),
software for coding textual data. To allow interpretation of data in its context
and generation of analytical higher-order themes, AR performed line-by-line
coding of the findings of the primary studies and identified preliminary
concepts inductively by coding text that focused on family experiences and
perspectives on organ donation. Similar concepts were grouped into
themes. To ensure that the coding framework and themes captured all the
relevant data from the primary studies, this was discussed with AT, who
reviewed the articles independently. Relationships between themes were
identified, examined and mapped to develop an overarching analytical
framework to extend findings reported by the primary studies.
Results
Literature search and study characteristics Our search yielded 2043 citations. Of these, 34 articles
involving at least 1035 family members were included (two
studies did not report the number of participants) (Figure
S1). At least 672 of the families had consented to donation
and 244 had not consented to donation. The study
characteristics are summarized in Table 1. The studies
were conducted across 13 countries listed in Table 1. Data
were collected using semi-structured interviews, focus
groups and open-ended surveys.
Comprehensiveness of reporting Comprehensiveness of reporting was variable with studies
reporting 6–18 out of the 27 possible items included in the
COREQ framework (Table S2). Twenty-four studies re-
ported the participant selection strategy. A description of
the sample was provided in 25 studies. Almost half of the
primary studies reported the use of member or…
