Moral distress and turnover intention in deceased donor organ procurement teams in Serbia: a cross-sectional study

BACKGROUND: 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. METHODS: 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's α = 0.89); however, it has not undergone full psychometric validation for transplantation contexts. We analysed MDS-R total composite scores (frequency × intensity, range 0-336) across professional groups and examined correlations with demographic and professional variables using non-parametric statistics. RESULTS: Mean MDS-R total composite score was 82.4 ± 31.8 (range 38-132), 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-Wallis H = 8.73, df = 4, p = 0.013, η² = 0.28): vascular surgeons reported the highest observed scores (96.4 ± 27.3), though with only four participants this finding requires cautious interpretation. Post-hoc analysis revealed a significant difference between vascular surgeons and transplant coordinators (adjusted p = 0.018). Years of transplantation experience correlated negatively with distress (Spearman's ρ = - 0.47, 95% bootstrap CI [-0.73, - 0.12], p = 0.02). Highest-intensity distress items in the full sample were family communication dilemmas (3.5 ± 0.8) and donor body objectification concerns (3.4 ± 0.9). Nearly 60% of participants reported having considered leaving transplantation; intention to leave correlated with MDS-R scores (Spearman's ρ = 0.52, bootstrap 95% CI [0.18, 0.76], p = 0.01), although reasons for considering departure were not systematically collected. CONCLUSIONS: 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.