Abstract
Brain death, as the irreversible cessation of brain function, provides the possibility of organ donation, yet the consent rate among families in Iran remains low. Transplant coordinators, mostly nurses, play a crucial role in communication, emotional support, and trust-building, while facing significant psychological and professional challenges. The aim of this descriptive qualitative study was to describe transplant coordinators’ experiences and needs in the consent process, with the goal of enhancing performance and ultimately increasing organ donation rates. A purposive sample of 20 transplant coordinator nurses was selected to capture a diverse range of experiences relevant to the study aims, and participants took part in semi-structured interviews. Using inductive content analysis, six main themes were developed to reflect nurses’ experiences in obtaining informed consent for organ donation: professional duality in balancing emotional sensitivity with procedural responsibilities; managing emotional and moral complexities; communication challenges with patients’ families; work-related and psychological pressures during the consent process; the influence of individual values and cultural beliefs; and the need for psychological and organizational support. The findings show that obtaining consent for organ donation is a complex, multi-layered experience beyond simple communication skills, involving moral responsibility, emotional conflicts, cultural beliefs, and severe psychological pressures. Coordinating nurses face professional duality, communication challenges, and a lack of support. The findings highlight the need for supportive, educational, and policy programs to improve care quality and the success of organ donation.
Introduction
Organ donation following brain death is recognized worldwide as a critical strategy for addressing the growing demand for transplantable organs (Arrigo et al., 2025). Brain death is one of the definitive definitions of death in which the function of the cerebral cortex and brainstem irreversibly ceases (Starr et al., 2024). Organ transplantation may occur from living donors (ex vivo transplantation) or from deceased donors (ex mortuo transplantation). While both forms of donation are important sources of transplantable organs, ex mortuo transplantation involves distinct clinical, ethical, and communicative complexities because it usually occurs after the determination of brain death and requires timely family consent under emotionally distressing circumstances. In such situations, transplant coordinators must navigate sensitive discussions with bereaved families, address uncertainty and mistrust, respond to cultural and emotional concerns, and facilitate decision making within a limited time frame (Vincent et al., 2024). The present study focuses specifically on ex mortuo organ donation, as the process of requesting family consent after brain death raises unique challenges that differ substantially from those involved in living donation.
Organ donation after brain death can provide several transplantable organs including the heart, liver, kidneys, lungs, pancreas, and small intestine. In addition to solid organs, various tissues such as corneas, heart valves, skin, and bone can also be donated and used for therapeutic purposes. The availability and frequency of transplantation of these organs may vary across countries depending on medical infrastructure, legal frameworks, and national donation systems (Lewis & Zirpe, 2025; Silva et al., 2024aSilva, Benites, et al., 2024).
The organ donation process is complex and emotionally demanding, particularly for the families of brain-dead patients who must make critical decisions during a time of grief and shock. Transplant coordinators, who are often nurses, play a key role in this process by informing families of brain-dead patients, providing emotional support, and facilitating decision-making regarding organ donation (Manzari et al., 2014; O'Leary, 2018; Zamani et al., 2016). Establishing effective communication, building trust, demonstrating empathy and compassion, and respecting the possible wishes of the brain-dead person are important responsibilities of these coordinators (López et al., 2018). At the same time, families are often confused and uncertain when faced with this crisis, and the lack of effective communication with the healthcare team can complicate this situation(Martínez et al., 2008; Mostafavi et al., 2023). A study conducted in Spain reported that transplant coordinators face considerable emotional, ethical, and professional challenges when discussing organ donation with grieving families (Fernandez-Alonso et al., 2020).
In addition to communication-related challenges, organ donation after brain death may generate significant moral and professional dilemmas for healthcare professionals involved in the care of potential donors. These dilemmas often arise from the tension between the professional duty to preserve life and the practical reality of preparing a brain-dead patient for organ procurement. For transplant coordinators, this tension is particularly acute as they must simultaneously provide compassionate care to grieving families while fulfilling procedural responsibilities that ultimately lead to the cessation of life-sustaining support (Mollazadeh et al., 2024). In some contexts, the “conscience clause” is recognized as an ethical and legal basis for refusing participation in medical procedures that are perceived to be in conflict with personal moral, religious, or professional values. The conscience clause refers to formal legal provisions that grant healthcare professionals the right to refuse certain procedures within a regulated healthcare system, distinguishing it from the broader concept of conscientious objection, which relates to an individual’s moral decision to decline participation in actions perceived as conflicting with their core ethical or religious beliefs (Czekajewska et al., 2025a; 2025b). In the context of ex mortuo organ donation, such moral conflicts may arise during multiple stages of the process, including: (a) the diagnosis of brain death, where professionals may question the adequacy of diagnostic criteria or the ethical implications of discontinuing life-sustaining treatment; (b) the maintenance of the donor’s body, which may raise concerns about the objectification of the patient and the perceived violation of bodily integrity; and (c) the organ procurement process itself, particularly when healthcare professionals experience uncertainty about the moral status of the brain-dead patient or tension between institutional expectations and deeply held personal beliefs. These challenges are not merely theoretical. Studies conducted among practicing transplant coordinators have documented high levels of moral distress, with 70% of coordinators in a Canadian national study reporting that they had seriously considered leaving their jobs due to work-related issues (Silva, Silva, et al., 2024).
These ethical concerns are not limited to physicians and may be particularly salient for nurses and transplant coordinators, who are closely involved in the continuous care of brain dead patients and in communication with their families. Previous studies have shown that nurses may experience moral distress (Flodén & Forsberg, 2009; Moghaddam et al., 2018), emotional burden, and internal conflict while caring for brain dead patients, especially when sustaining physiological functions in patients who are legally dead but still appear biologically alive. Such experiences may influence professionals’ attitudes toward organ donation and their interactions with families. Therefore, attention to these ethical tensions is important for understanding the broader context in which transplant coordinators seek family consent for organ donation.
Various countries have developed different organizational approaches to improve organ donation outcomes. Among these, Spain is frequently cited in the organ donation literature not as a cultural comparator but as an organizational model illustrating how structured coordination systems, continuous professional training, and clearly defined communication pathways can improve donation outcomes (Matesanz et al., 2017). Referring to the Spanish model in this context therefore serves to highlight the importance of system-level support in facilitating coordinators’ work, rather than to draw direct comparisons with Iran.
Despite the global importance of organ donation, obtaining family consent remains challenging in many countries. Although organ transplantation has expanded globally, a substantial gap remains between the demand for transplantable organs and their availability. Many countries continue to experience shortages of donor organs despite advances in transplantation systems. Countries with well-established coordination systems such as Spain have achieved some of the highest deceased organ donation rates worldwide (Matesanz et al., 2017). Many countries continue to experience shortages of donor organs despite advances in transplantation systems. According to international reports (Martin et al., 2026), countries with well-established coordination systems such as Spain have achieved some of the highest deceased organ donation rates worldwide, whereas many developing countries report considerably lower rates (Parsa et al., 2019). These differences highlight the importance of organizational structures, public awareness, and effective communication with donor families in improving donation outcomes. In Iran, despite significant advances in the field of organ transplantation, the number of consents to organ donation remains relatively low; out of approximately 2,500 to 4,000 cases of brain death annually, only about 900 families consented to organ donation in 2017 (Shadnoush et al., 2023). Cultural beliefs, emotional distress among families, and communication challenges within healthcare settings may influence this decision-making process (Mollazadeh et al., 2024).
Given the complexity and sensitivity of the consent process, there is a pressing need to describe how transplant coordinators navigate the emotional, ethical, and communicative demands embedded in these interactions. While Iran has developed an organized national donation system, contextual challenges—such as family hesitancy, sociocultural beliefs, and variability in institutional support—continue to influence donation outcomes(Sadeghi et al., 2020). Understanding the experiences of coordinators, who serve as the primary link between healthcare teams and bereaved families, can offer valuable insights for improving policies, enhancing training programs, and strengthening family-centered communication. Therefore, this study aimed to describe the experiences of transplant coordinators during the process of obtaining family consent for organ donation in the Iranian healthcare context.
Methods
Research Design
This study utilized a qualitative descriptive design, which is particularly well-suited for nursing research when the goal is to provide a comprehensive, straightforward descriptive summary of an event or experience in everyday terms (Sandelowski, 2010). Since the aim was to describe the experiences of organ transplant coordinator nurses regarding the complex process of obtaining consent for organ donation, this approach allowed for a deeper understanding of the phenomenon from the participants’ perspectives. No pre-existing theoretical framework was imposed, as the purpose was to capture participants’ perspectives without forcing the data into predetermined categories.
Study Setting
This study was conducted at organ procurement units (OPUs) affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. TUMS is the largest and oldest medical university and leading transplant center in the country. Within this university system, the Network for Organ and Tissue Procurement of TUMS operates under the High Council of Transplantation, responsible for policy-making, management, and supervision of organ procurement activities. The network coordinates several hospital-based procurement satellites that identify potential brain-dead donors, obtain consent from families, and organize the retrieval and transfer of organs for transplantation. This setting provides a rich clinical context where nurse transplant coordinators play a key professional role.
Participants
Participants were registered nurses working as organ transplant coordinators in organ procurement centers affiliated with TUMS. Eligibility criteria included: (a) at least one year of experience in this role; (b) direct experience with the organ donation and consent process; and (c) willingness to provide informed consent. Purposive sampling was used to ensure the inclusion of participants with direct experience, and sampling continued until data adequacy was achieved. To achieve maximum variation, efforts were made to recruit participants with diverse characteristics, including differences in age, gender, years of experience, and workplace settings.
Data Collection
The interview guide was developed by the research team based on their clinical experience in organ donation coordination and a review of relevant literature. Semi-structured, in-depth, face-to-face interviews were used for data collection. A short questionnaire was administered at the beginning to obtain demographic information (age, gender, marital status, education level, place of employment, and work experience). All interviews were conducted individually by the corresponding author (FBN) in a private room chosen by each participant, after obtaining written informed consent. Each interview lasted approximately 45 to 90 minutes. With participants’ permission, interviews were audio-recorded and transcribed verbatim. Field notes were also taken to capture non-verbal cues.
Interviews began with open-ended questions such as “Please tell me how you came to be part of the transplant team” and “Describe your experience of dealing with a brain-dead patient.” More focused questions followed, including “How did you feel when informing the patient’s family?” and “What challenges did you experience in obtaining family consent?” Probing questions such as “Could you elaborate?” or “Can you give an example?” were used to facilitate deeper reflection.
Data Analysis
Data were analyzed using conventional content analysis according to Graneheim and Lundman (2004). Analysis began immediately after the first interview and continued concurrently with data collection. Each interview transcript was read repeatedly to achieve immersion in the data. Meaning units relevant to the study aim were identified, condensed, and abstracted into codes. The codes were then compared for similarities and differences and grouped into subcategories and categories. Through continued reflection and interpretation, themes were developed to capture the latent content of the data. The initial coding was conducted by the corresponding author (FBN), and the analytic process was continuously reviewed by the co-authors. Any discrepancies in interpretation were resolved through discussion until consensus was reached.
Trustworthiness
Trustworthiness was ensured based on Lincoln and Guba’s (1980) criteria (credibility, dependability, confirmability, and transferability). Credibility was supported through prolonged engagement with the data (repeated reading and immersion) and member checking with several participants to verify the accuracy of interpretations. Dependability was enhanced by maintaining a detailed audit trail documenting all stages of the research process, making the process traceable and transparent. Confirmability was strengthened through careful documentation of analytic steps and by having a portion of the transcripts independently reviewed and coded by another researcher not involved in the initial analysis; discrepancies were discussed until consensus was reached. Transferability was supported by providing rich descriptions of the study context, participant characteristics, and the analytical process, as well as including participants with variation in age and sex to capture diverse experiences.
Ethical Considerations
Demographic Characteristics of the Participants
Note. Total Successful Consents (N) represents the total number of successful consents obtained by each coordinator throughout their entire work period as a transplant coordinator.
Results
A total of 20 organ transplant coordinator nurses participated in the study. The median age of participants was 37 years (range: 28–42 years). The median length of professional service was 11 years (range: 5–14 years), while the median duration of experience as an organ transplant coordinator was 4.5 years (range: 1–7 years).
The sample included 12 female and 8 male participants. Participants held diverse educational qualifications, including bachelor’s, master’s, and doctoral degrees in nursing, and represented a wide range of professional backgrounds and levels of experience in organ donation coordination.The demographic characteristics of selected participants are presented in Table 1.
Themes, Subthemes, Condensed Meaning Units, and Representative Quotations Derived From Data Analysis
The resulting themes reflect emotional tensions, moral dilemmas, psychological pressures, cultural and religious considerations, as well as the communication skills and psycho-organizational support required when interacting with families of brain-dead patients. These findings provide a comprehensive understanding of the complex and demanding role of transplant coordinators in the organ donation process.
Theme 1: Professional Duality
Participants described their role as positioned at the intersection of loss and hope, where they simultaneously navigated the emotional atmosphere of grieving families and the life-saving potential of organ donation. They reported that this duality shaped their daily experiences, requiring them to balance emotional sensitivity with procedural responsibilities. This balance often generated mixed feelings, including professional satisfaction, sadness, and moral tension.
On one hand, nurse coordinators explained that perceiving their work as contributing directly to saving recipients’ lives gave them a sense of professional meaning and motivation. They viewed successful consent as a moment in which their efforts translated into tangible hope for others. One participant shared, “The moment the family gives consent, it feels like we have saved a few more lives with this work. That is where I feel like being a coordinator is about making a life” (Participant 2). On the other hand, participants emphasized that empathic engagement with families was an integral but emotionally taxing aspect of their role. Witnessing intense grief and distress led many to internalize the family’s emotional state. One nurse noted, “When his mother was crying, I couldn’t help but worry. It was as if I felt a shared pain” (Participant 5). Several nurses further described struggling with the tension between advancing the consent process and responding to their own emotional reactions, reporting moments of guilt and moral discomfort when procedural demands felt misaligned with the family’s emotional readiness. As one participant explained, “On the one hand, I have to move the process forward, on the other hand, I feel like I am adding to the family’s pain” (Participant 5). Thus, professional duality was not merely a static condition but a dynamic tension that required continuous negotiation between competing emotional and professional demands.
Theme 2: Dealing With Emotional and Moral Complexities
Participants portrayed the consent process as emotionally intense and ethically challenging, requiring ongoing emotional regulation while simultaneously supporting families during a highly sensitive and uncertain period. The moral weight of decisions—particularly when families were undecided or distressed—added to their psychological burden and shaped their professional experiences.
A central difficulty reported by nurses was maintaining professional composure during interactions with grieving families. Emotional closeness, physical contact, and expressions of distress often challenged their ability to follow procedural requirements. One participant recalled, “When the patient’s mother was crying and holding my hand, I didn’t feel like saying anything about brain death, but I had to do my job” (Participant 7). Compounding this challenge, participants described feeling accountable not only to donor families but also to potential recipients awaiting transplantation. This dual responsibility created a significant ethical and emotional load, as they perceived the outcome of each case as potentially life-altering. One nurse stated, “I felt like everything depended on me; if the family was not satisfied, how many patients might lose the opportunity to live” (Participant 11). Additionally, some participants reported that physiological signs such as warmth or a beating heart made it challenging for families—and at times for themselves—to fully internalize the finality of brain death. These situations required both emotional management and sensitive explanation. As one participant expressed, “When his heart is still beating, it’s hard to accept that he’s really dead. How do you tell the family that?” (Participant 9). These emotional and moral complexities were not isolated but rather interconnected, with each aspect intensifying the others.
Theme 3: Communication Challenges With the Patient’s Family
Participants emphasized that communication with families was a central and demanding aspect of their role, requiring them to adjust their language, tone, and timing to address families’ emotional states, build trust, and introduce the concept of organ donation appropriately. These communication efforts demanded advanced interpersonal skills and heightened sensitivity.
Nurses reported that families often struggled to accept brain death due to visible physiological signs maintained by life support technologies. Participants described the challenge of balancing clinical explanation with emotional sensitivity. One nurse noted, “Once the patient’s mother said: ‘So just because the brain image is blurred, you mean he’s no longer alive?… They can’t deal with death when the body is still warm'” (Participant 6). In many cases, participants encountered families who resisted accepting the diagnosis of brain death, often invoking religious beliefs, faith in miracles, or shock. Such resistance sometimes delayed or inhibited discussions about donation. One participant shared, “Their father would say, ‘I believe in miracles.’ … He wouldn’t even let us talk about organ donation” (Participant 16). Consequently, nurses emphasized the importance of communication skills such as active listening, emotional regulation, and using empathetic language to convey difficult information. They noted that introducing organ donation prematurely could erode trust. Several coordinators commonly described this need for patience and timing; one of them termed the appropriate moment a “golden moment”:”If you bring up the topic of organ donation too early, the family will think you are seeking material gain or disrespect. You have to be patient until that golden moment arrives” (Participant 19). These communication challenges were thus deeply intertwined with both the emotional and moral complexities described earlier.
Theme 4: Experiencing Work and Psychological Pressure in the Consent Process
Participants described the consent process as highly stressful, shaped by time-sensitive clinical demands, fear of negative consequences, and limited institutional support. These pressures compounded their emotional workload and created a sense of vulnerability in challenging situations.
Nurses reported that organ viability created unavoidable time constraints. While families needed emotional space to process their grief, clinical urgency forced rapid decision-making. One participant explained, “Time was against us. Every minute later, it meant losing a kidney or a liver… We had to do something right away” (Participant 9). Alongside time pressure, participants expressed significant anxiety about potential consent refusals, emphasizing the impact such decisions could have on patients awaiting transplantation. One nurse stated, “I was stressed; if the family gave up, several people on the waiting list might not survive. This thought would not leave me for a moment” (Participant 18). Perhaps most concerning, several nurses described experiencing emotional isolation, noting the absence of structured psychological or professional support systems during or after difficult cases. One participant expressed, “There was no psychologist to support us. It was like it was just us with our own pain and the pain of the patient’s family. I felt really alone” (Participant 4). These three sources of pressure—time constraints, anxiety about outcomes, and lack of support—interacted synergistically, each amplifying the negative effects of the others.
Theme 5: The Role of Individual Values and Cultural Beliefs
Participants highlighted that personal values and cultural beliefs deeply influenced their approach to the consent process. These internal frameworks shaped their motivations, communication styles, and responses to families’ concerns, often serving as both a source of strength and a lens for navigating difficult situations.
For some nurses, religious beliefs provided emotional strength and helped them find meaning in organ donation. One participant commented, “I used to say to myself, maybe this organ that is being transferred will allow someone else to pray and live” (Participant 13). Beyond religious faith, participants described organ donation as a profound human and moral act, which reinforced their commitment to the process despite its emotional difficulties. One nurse shared, “I believe this is one of the most humane things a person can do” (Participant 16). However, nurses also encountered families whose cultural or spiritual beliefs created hesitancy or resistance toward donation. Navigating these concerns required sensitivity and respect. One participant noted, “One family said we are afraid that if we donate the organs, his soul will suffer” (Participant 17). Thus, the role of values and beliefs was bidirectional: participants’ own beliefs sustained them, while families’ beliefs often posed additional challenges that required careful navigation.
Theme 6: The Need for Psychological and Organizational Support
Participants described cumulative emotional strain resulting from repeated exposure to death and grieving families. They emphasized the lack of institutional support mechanisms and the urgent need for formal psychological and educational resources to sustain their well-being and professional performance.
Nurses reported symptoms of emotional exhaustion, such as sleep disturbance, reduced appetite, and persistent distress after difficult cases. One participant shared, “After that difficult case, I couldn’t sleep or eat properly for a week” (Participant 20). Despite these clear indicators of psychological burden, participants described limited access to counseling or debriefing sessions that could help them process emotionally challenging cases. One nurse stated, “We are also human; I wish there was someone who could talk to us, hear our pain” (Participant 3). Beyond psychological support, nurses emphasized the importance of ongoing training in communication, emotional regulation, and ethical decision-making to better manage the consent process. As one participant noted, “If training classes teach communication skills, it would reduce a lot of our stress, which would be better for us and our families” (Participant 19). These needs—for emotional support, psychological interventions, and skills training—were closely interconnected, and participants made clear that addressing only one would be insufficient to alleviate their overall burden.
Disscusion
This study described the experiences of organ transplant coordinator nurses in obtaining consent for organ donation from families of brain-dead patients, highlighting the emotional, moral, and sociocultural complexity of this professional process. The findings revealed that consent is not a merely technical or administrative act but rather a profoundly human experience located at the intersection of professional duty, ethical responsibility, empathy, and cultural context.
Consistent with previous international research, this study emphasizes that nurses occupy a unique position between the death of one person and the hope of saving another. However, unlike most prior studies that focused on communication barriers or family decision-making (De Moraes et al., 2014; Kentish-Barnes et al., 2019; Simonsson et al., 2020), the present research sheds light on the internal psychological and moral dimensions of the coordinator’s role. These findings deepen our understanding of how nurses manage emotional conflict, moral tension, and professional duality while maintaining their effectiveness in communication and coordination.
The concept of professional duality, identified here, aligns with Simonsson et al.’s (2020) findings that organ donation involves both fulfillment and emotional burden. Yet, the present study extends this understanding by showing how coordinators in Iran experience the coexistence of pride and grief as part of their daily reality. This simultaneous exposure to hope and sorrow fosters compassion fatigue and challenges their emotional resilience, underscoring the need for targeted support interventions.
Similarly, the study highlights nurses’ moral and emotional challenges in accepting and communicating the medical reality of brain death. Like Kentish-Barnes et al. (2019), participants described internal tension between professional knowledge and emotional acceptance, reflecting a universal difficulty in comprehending brain death even among health professionals. These insights emphasize the importance of integrating emotional training into professional education to help nurses manage both personal and family-level distress during consent conversations.
The discussion on communication with families suggests the critical role of timing and cultural sensitivity. Coordinators described a “golden moment” when families become emotionally ready to engage in conversations about organ donation. This culturally grounded concept complements Western models emphasizing psychological timing (de Groot et al., 2012; Siminoff et al., 2001). Effective communication thus depends not only on accurate explanation but also on empathy, patience, and recognition of the family’s grieving trajectory.
Another major contribution of the study concerns psychological and organizational pressures. In line with Drexler et al. (2022) and Silva e Silva et al. (2022), nurses reported emotional exhaustion and stress stemming from high workload and continuous exposure to grief (Drexler et al., 2022; Silva e Silva et al., 2022). However, a distinctive contextual insight from the Iranian setting is the absence of institutional support, such as counseling, debriefing sessions, or psychological services. Participants suggested that this lack of support has the potential to intensify burnout and feelings of isolation.Therefore, policy-level interventions incorporating structured emotional support systems are essential to safeguard nurses’ well-being and sustain their professional motivation.
Finally, the study underscores the dual role of individual values and cultural beliefs in shaping the consent process. Religious and humanitarian beliefs often act as moral resources that strengthen nurses’ resilience and sense of meaning (De Moraes et al., 2014), whereas family beliefs and cultural taboos may simultaneously hinder consent. Understanding these dynamics can help design culturally sensitive strategies for nurse training and family support.
Overall, this study contributes to a more holistic understanding of the consent process in organ donation. It highlights the need to move beyond technical training and communication guidelines toward emotional, ethical, and cultural preparation for nurses. By recognizing the multidimensional nature of coordinators’ experiences, health organizations can develop more comprehensive support programs — including psychological counseling, reflective practice sessions, and culturally adaptive communication models — to improve both professional well-being and the effectiveness of organ donation processes.
Study Strengths and Limitations
One of the main limitations of the present study was the reluctance of some nurses to freely express their feelings during the interviews due to professional and legal concerns. To address this, the interviewer emphasized confidentiality and anonymity before and during the interviews and used open-ended, non-judgmental questions to create a trusting and supportive atmosphere.
Another limitation relates to the sampling framework. Although the study included participants with diversity in age, gender, educational level, total professional experience, and experience as transplant coordinators, not all potentially relevant dimensions of diversity were purposively targeted. For example, broader organizational variation (e.g., type of hospital or institutional culture) and cultural or social background were not systematically considered during sampling. This introduces a risk of systematic bias, as some subgroups of transplant coordinator nurses may remain underrepresented.
Additionally, the study was conducted within a single transplant center network affiliated with Tehran University of Medical Sciences, which may limit the transferability of the findings to other settings or to the national level. Nevertheless, the diversity that was present within the sample, along with the use of an in-depth content analysis approach—characterized by repeated reading of transcripts, detailed line-by-line coding, and constant comparison across participants’ accounts—contributed to the richness and depth of the data.
Despite these limitations, this study provided in-depth insights into the experiences of transplant coordinator nurses regarding the consent process for organ donation in Iran. The findings demonstrate that obtaining consent is a complex and multidimensional process extending beyond technical communication skills, encompassing moral responsibility, emotional conflict, cultural and religious considerations, and significant psychological pressure. A key strength of this study is its holistic understanding of the consent process, highlighting that in the absence of structured psychological and organizational support, these challenges may contribute to burnout, reduced well-being, and diminished effectiveness in the organ donation process.
Clinical Implications
The findings of this study highlight several practical implications for clinical practice in organ donation settings. Given the emotional and ethical challenges experienced by transplant coordinator nurses, transplant centers should consider implementing structured psychological support mechanisms such as counseling and debriefing sessions. In addition, continuous professional training focused on communication skills, emotional management, and ethical decision-making may strengthen coordinators’ ability to support families during the consent process. Adopting culturally and religiously sensitive family-centered communication strategies can also facilitate more effective interactions with families facing brain death decisions. Collectively, these measures may enhance both the well-being of transplant coordinators and the effectiveness of the organ donation process.
Conclusion
This study provided in-depth insights into the experiences of organ transplant coordinator nurses regarding the consent process for organ donation in Iran. The results underscore the need for comprehensive interventions at both institutional and societal levels. Establishing formal psychological support systems within transplant centers, developing continuous training programs focused on communication, ethical sensitivity, and emotional regulation, designing culturally and religiously sensitive family-centered protocols, and improving public awareness about brain death and organ donation are essential steps. Strengthening organizational support mechanisms is equally critical to safeguard nurses’ mental health and sustain the quality of care. By illuminating the multidimensional realities of transplant coordination, this study provides an evidence-based foundation for the development of supportive, educational, and policy initiatives aimed at enhancing both nurse well-being and the effectiveness of the organ donation system in Iran.
Footnotes
Acknowledgments
We acknowledge the financial support of the Research of the Tehran University of Medical Sciences and all the participants who helped us in this study.
Ethical Considerations
The present study was approved by the Ethics Committee of Research Center of Quran, Hadith and Medicine’s Sciences, Tehran University of Medical Sciences, with the ethical approval code of IR.TUMS.IKHC.REC.1404.010.
Consent to Participate
All research participants provided written consent to participate in this study.
Consent for Publication
Informed written consent for publication was obtained from all participants involved in the study by providing them with a comprehensive participant information sheet and asking them to sign a consent form.
Author Contributions
Study Design: FB, Data Collection: FB, MAM, Data Analysis: FB, MM, Study Supervision: FB, Manuscript Writing: MM, FB, MAM, Critical Revisions for Intellectual Content: FB.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors declared that this study was approved as a research project by the Tehran University of Medical Sciences, but no financial funding was received for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
Due to the risk of identification, the data from this study involving human participants are not shareable.