Análise fenomenológica das vivências psicológicas quem motivaram a não doação de órgãos no Brasíl como variável para a gestão

Abstract

Introduction: The Brazilian transplant system, composed of the donation, procurement and transplant subsystems, presents itself as a complex structure to be managed. The donation subsystem is the critical point because it is the input of the system and family refusal of donation has been presented as a national problem. The reasons ostensibly reported by family members have been studied by several researchers, without explaining the psychological motivations. Which are they? What is their origin? What is the cause and effect relationship with the non-authorization of donation? Objectives: The general objective of this study was to understand the psychological subjective experiences that motivated the refusal to donate organs for transplants. The specific objectives were to describe the experiences during the hospitalization of the potential donor; to identify the invariant and variant meanings of the experiences; to identify the psychological experiences based on the meanings of the experiences; to establish, based on the meanings of the psychological experiences, the cause and effect relationship of the refusal to donate; and to identify the fundamental cause of the problem to be blocked. Method: This is a study with a qualitative approach in concomitant stages. In stage 1, an exploratory study was developed using Edmund Husserl's psychological-phenomenological method, using epoché and eidetic reduction to obtain the meanings of the participants' experiences. In the next stage, in order to address the psychological meanings in light of management, an explanatory study was developed using the Problem Analysis and Solution Method, with its first three stages being operationalized, consisting of identification, observation, and analysis of the problem, so as to identify the cause to be blocked; the strategic line of action to block the identified cause of the problem was presented. Data collection was carried out through recorded telephone interviews, from December 2023 to October 2024, with participants from the states of Amazonas, Bahia, Goiás, and the Federal District. To analyze the content of the interviews, from a psychological perspective, epoché and eidetic reduction were used in line with the psychological-phenomenological method. To analyze the psychological meanings of family members' experiences in light of management and to establish the cause and effect relationship between psychological contents and the problem of refusal to donate of organs, the steps of the Problem Analysis and Solution Method were applied. Results: The psychological meanings of the experience emerged from the analysis. Distrust in the transplant system was the invariant meaning attributed by all participants. The variant meanings were: Prolongation of family suffering, Insecurity in decision-making, Threat, Regret, Injustice, Disrespect, Psychological helplessness. The meanings experienced were analyzed using the psychological-phenomenological frameworks of Edmund Husserl, Maurice Merleau-Ponty, Edith Stein, and Abraham Maslow's theory of basic needs, which enabled the identification of the psychological experiences: Perceptual intentionality, Psychic causality and motivation, Protection impulse and affective-cognitive experience, which culminate in the refusal to donate. Conclusion: There seems to be a reputational crisis in the transplant system, fueled by the population's lack of knowledge on the subject, which negatively impacts the institutional image, with the lack of information being the fundamental cause to be blocked. This study fills a knowledge gap: the psychological one. The psychological experience was essentially affective-cognitive, and considering the negativity bias, a strategic action was suggested to block the fundamental cause.