Représentations des coordinateurs hospitaliers concernant la légitimité des proches à décider d'un don d'organes

Global organ shortage should decrease refusal rates of organ procurement, which limits organ donation in more than 33 % of the brain-dead in France. However, organ collection depends on presumed consent (opt-out). The ABM's data shows that 2/3 of refusals are due to next-of-kin. The objective of the study is to analyze the representations of professionals of organ procurement in Île-de-France, in order to understand reasons why they consider these decisions as legitimate, against principles of bioethical laws. The 24 professionals (7 physicians and 17 nurses) interviewed describe homogeneous practices, complying with ABM guidelines. While all professionals know the law and endorse opt-out conditions, they feel very ambivalent about applying them. They consider that they must create a dialogue space with families in bereavement, so as to provide proper support, whereas according to the law they should be focusing on information and collecting testimony. From dialog emerges communicative action, whose challenge is the shared decision of donation. Empathy is often stronger than the application of the law. Organ procurement professionals are so the pivot point between applying the law and families in mourning, and they are subjected to many ethical dilemmas. The strong decision-making power families have may be explained by the professionals' concern for supporting them.