Evidence map›Paper›PMID 41805432›Full record

ArticleNursing ethics2026

Navigating ethical challenges in donation after circulatory death: Nurses' perspectives.

Emilie Gripewall, Janet Mattsson, Lisbeth Fagerström, Gunilla Björling, Linda Estman

Abstract read
In one paragraph

Article in Nursing ethics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Emilie GripewallFaculty of Science and Engineering, Department of Natural and Health Sciences, Åbo Akademi University, Vaasa, Finland.ORCID 0009-0002-5029-8645
Janet MattssonDepartment of Health Science, Linneus University, Växjö, Sweden.ORCID 0000-0002-4091-3432
Lisbeth FagerströmFaculty of Science and Engineering, Department of Natural and Health Sciences, Åbo Akademi University, Vaasa, Finland.
Gunilla BjörlingDepartment of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Linda EstmanDepartment of Caring and Ethics, University of Stavanger, Stavanger, Norway.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BackgroundControlled Donation after Circulatory Death (cDCD) offers new opportunities but also new, demanding ethical challenges in the field of organ donation. The process requires navigating boundaries due to the transition from intensive care and life-sustaining treatment to the end-of-life care and a possible cDCD process. Previous research has mainly focused on medical aspects, leaving a gap regarding intensive care nurses' and their reflections of possible, ethical challenges during the cDCD process.AimTo explore ethical challenges intensive care nurses encounter when navigating life-sustaining treatment, its withdrawal, and potential organ donation in cDCD.Research designA qualitative design with an inductive approach was applied using Critical Incident Technique.Participants and research contextThe study was conducted at two Swedish ICUs and included multiple scenarios when cDCD was managed after withdrawal of life-sustaining treatment. Five experienced intensive care nurses were interviewed, yielding 142 critical incidents for analysis.Ethical considerationsThe study followed the Declaration of Helsinki and Swedish law on ethical vetting. Approval was obtained from the Swedish Ethical Review Authority (ref. 2017/1722-31-1).ResultsFive themes were identified: (1) Navigating Ethical Boundaries in End-of-Life Care and cDCD, (2) Safeguarding Autonomy in cDCD Decisions, (3) Balancing Emotional Presence and Ethical Practice, (4) Managing Ethical Uncertainty Through Knowledge and Team Support, and (5) Ensuring Ethical Responsibility Through Interprofessional Communication. Ethical challenges were linked to unclear procedures, limited training, and fragmented communication, while structured guidelines and collegial support enabled ethical coherence.ConclusionscDCD requires continuous negotiation between ethical-, professional-, and emotional dimensions. To ensure ethically sustainable practice, organisations need to strengthen ethical awareness, structured training, and interprofessional communication. Integrating both biomedical principles and caring ethics is crucial to safeguard patient autonomy, support relatives, and enabling healthcare professionals to act with confidence during end-of-life care and organ donation.

Indexed as

DeathNursesTissue and Organ ProcurementAdultAttitude of Health PersonnelEthical DilemmasFemaleHumansIntensive Care UnitsQualitative ResearchSwedenTerminal Carecaring ethicscritical Incident techniquedonation after circulatory deathintensive care nursingorgan donation

Identifiers

PMID41805432
PMCPMC13415897

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.