{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:56:31Z","timestamp":1790650591909,"version":"4.1.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":92,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Ethics"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Deceased donor organ procurement presents distinct ethical challenges for transplant teams, yet moral distress among these professionals remains understudied, particularly in low-donation settings. This study measured moral distress levels among organ procurement team members at a Serbian tertiary centre and examined factors associated with distress intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study administered a transplantation-adapted Moral Distress Scale-Revised (MDS-R) to 22 active transplant team members at the University Clinical Centre of Vojvodina in 2023 (response rate 78.6%, 22\/28). The adapted Serbian-language instrument demonstrated excellent internal consistency (Cronbach\u2019s \u03b1\u2009=\u20090.89); however, it has not undergone full psychometric validation for transplantation contexts. We analysed MDS-R total composite scores (frequency \u00d7 intensity, range 0\u2013336) across professional groups and examined correlations with demographic and professional variables using non-parametric statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean MDS-R total composite score was 82.4\u2009\u00b1\u200931.8 (range 38\u2013132), suggesting substantial moral distress in this sample. Compared with published point estimates from ICU (69.5) and emergency settings (71.2), our estimate was numerically higher, but the 95% CI overlapped both reference values; cross-study comparisons are descriptive only. Significant differences emerged across professional groups (Kruskal\u2013Wallis H\u2009=\u20098.73, df\u2009=\u20094,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013, \u03b7\u00b2 = 0.28): vascular surgeons reported the highest observed scores (96.4\u2009\u00b1\u200927.3), though with only four participants this finding requires cautious interpretation. Post-hoc analysis revealed a significant difference between vascular surgeons and transplant coordinators (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018). Years of transplantation experience correlated negatively with distress (Spearman\u2019s \u03c1 = \u2212\u20090.47, 95% bootstrap CI [\u20130.73, \u2212\u20090.12],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Highest-intensity distress items in the full sample were family communication dilemmas (3.5\u2009\u00b1\u20090.8) and donor body objectification concerns (3.4\u2009\u00b1\u20090.9). Nearly 60% of participants reported having considered leaving transplantation; intention to leave correlated with MDS-R scores (Spearman\u2019s \u03c1\u2009=\u20090.52, bootstrap 95% CI [0.18, 0.76],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), although reasons for considering departure were not systematically collected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Organ procurement team members in this low-donation setting reported substantial moral distress. While vascular surgeons had the highest observed scores, this finding may reflect role-specific factors, demographic differences, or other unmeasured confounders, and requires confirmation in larger samples. The association between moral distress and self-reported intention to leave transplantation, though exploratory, highlights the need for further investigation of retention-focused support strategies in procurement teams.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12910-026-01533-0","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:28:04Z","timestamp":1782743284000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral distress and turnover intention in deceased donor organ procurement teams in Serbia: a cross-sectional study"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3602-3522","authenticated-orcid":false,"given":"Dragan","family":"Nikoli\u0107","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janko","family":"Pasternak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Manojlovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slavko","family":"Budinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijana","family":"Basta Nikoli\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Batini\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"1533_CR1","volume-title":"Nursing Practice: The Ethical Issues","author":"A Jameton","year":"1984","unstructured":"Jameton A. 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