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Organ Donation

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					Life Alliance Organ Recovery
            Agency

   1-800-255-4483
Teaching Ethics in a Multicultural
Environment: An Organ Donation
         Perspective
           Life Alliance
      Organ Recovery Agency
           University of Miami
   Why is Organ Donation important?

-There are more than 87,000 patients listed
        awaiting an organ transplant.
 -Organ transplants come from Cadaveric
        donors and by Living donors.
However, the issue that exists is a Supply &
              Demand Problem.
      Newsroom Facts - UNOS
On average, 115 people are added to the nation’s organ
transplant waiting list each day – ONE EVERY 13
MINUTES
On average, 66 people receive transplants every day
from either a living or deceased donor.
More than 2,200 children under the age of 18 are on the
transplant waiting list.
         State of Donation/Transplantation
30000

25000

20000

15000                                        donors
                                             organs transplanted
10000

 5000

    0
        1988 1992 1995 1999 2001 2002 2003
  New Federal Requirements

Hospitals must have working relationships
with their area’s OPO, Tissue and Eye Bank.
Hospitals must report ALL deaths and
imminent deaths to the OPO.
Reporting is required for hospital
accreditation and Medicare reimbursement.
All OPO’s must audit all deaths in their
catchment area.
                 Morality

The “rightness” or “wrongness” of an act or
thought
Widely shared beliefs in a particular culture
or subculture
                    Ethics

The “why” or the actual underpinning for the
act or thought.
Perspectives that allows one to examine or
understand something
               Major Legislation
        1968 Uniform Anatomical Gift Act
                       Revised 1987



Authorizes the gift of all or
part of the after death for
transplants, research,
education, or other therapies.
Describes who may donate,
how to execute the donation,
and who may receive the gift.
There is no national registry of organ
 donors. Even if you have indicated your
 wishes on your driver’s license or a donor
 card, be sure you have told your family as
 they will be consulted before donation
 takes place.
 How does one express voluntary
       donation wishes?
Registries: DMV
Donor cards
Advance directives aka, Living Wills
Sharing your thoughts and decisions with
your family
         Major Legislation
1984 National Organ Transplant Act

                     Established a national
                     Organ Procurement
                     and Transplantation
                     Network (OPTN)
                     Prohibited sale of
                     human organs
                     Established the
                     Scientific Registry of
                     Organ transplantation
          1987
Florida Brain Death Law

Determination of death must be made
by two board eligible or certified
physicians
Brain death is the irreversible
cessation of the entire brain,
including brain stem
  OPO Responsibilities
Evaluation of all potential donors
Obtaining family consent
Maintain the donor after Brain Death
has been declared
Allocation of the organs
Recovery of the organs
Aftercare of the donor family
    Medical Staff Ethical Dilemmas

Admitting failure: A patient has died
Stepping aside
Supporting or Obstructing Patient
Management
South Florida Communities

          Haitian
    African American
         Hispanic
     Informed Decision to Informed
               Consent
Does a family need to know what organs and
tissues can be donated?
Do they need to know the size of the
incision?
Do they need to know how the body will look
after donation?
Do they need to know about the various
donor suitability tests?
 Pediatric Ethical Considerations

What about children who want to be organ
                donors?
 What about adolescents between 16 and
          almost 18 years old?
Can people younger than 18 give consent?
       Acceptable Donors

        Severe Head Injuries
  Cerebral Insults (SAH,SDH,CVA)
       Primary Brain Tumors
Cerebral Anoxia (Near-drowning, Drug
             ODs,MIs,)
         Homicides/Suicides
     Metabolic Disorders (DKA)
Brain death vs.
   Coma?
     Brain Death Criteria
       Harvard Medical School


Absence of spontaneous movement
and response to stimulus
Absence of spontaneous
respiration
Absence of brain stem reflexes
Reversible etiology must be
considered and excluded prior to
the diagnosing of Brain Death
Brain Death
     Patient maintained on
     ventilator, Heart beating
     Organs are removed in the
     operating room while the
     patient is maintained on a
     ventilator.
     Tissue recovery follows
     organ donation
Cardiac Death

       Patient has no cardiac
       or respiratory activity
       Acceptable donations:
       Tissue & Eyes
       Body must be kept cool
       before tissues are
       removed
       Removal within12 to 24
       hours
 What’s the difference from a coma?

Coma entails some lower level of brain
electrical activity, however absence of any
cortical activity
Coma does NOT equal Brain Death
            Categories Of Donation
 Brain Dead Donor
   Can donate organs, eyes, bone, & tissue
   Has beating heart, on ventilator
 Cardiac Arrest Donor
   Eye, bone, & tissue only: NO organs can be
    donated
 Donation After Cardiac Death:
   Immediate rescue of organs after cardiac death
    (OPO on Site) Asystole occurs within 30 min of
    extubation
 Donation after Cardiac Death

Informing ICU and OR staff that after
disconnecting the patient from the respirator
will result in Cardiac Death.
Donation follows pronouncement of patient
by the attending physician.
              How Does It Work?
  Donors                              Recipients




   Organ                              Transplant
Procurement                             Center
  Agency


                  UNOS Organ Center
Organ Matching
       Ethical Issues of Transplant
                Recipients
Retransplantation: How many times can a
person be transplanted when others are also
waiting?
Prisoners: Before and now with today’s DNA
evidence?
Non-resident aliens?
Multiple Listing: Being registered at more
than one transplant center?
  Does being a celebrity or being rich
          influence listing?
UNOS allows for multiple listing for certain
organs, i.e. Liver, however having available
money to travel at a moments notice would
help an individual but not change their place
on the waiting list.
 Nurses’ Role in Donation

Early identification
Referral of potential donors
to OPO
Support the families’ right
to donate
Assist in donor
management
Comfort grieving families
   Goals of Donor Care
Maintain cardiac output
Maintain tissue perfusion
Maintain fluid and electrolyte balance
Ensure adequate ventilation and
pulmonary stability
Prevent infection
Control diabetes Insipidus
Regulate body temperature
     The Medical Examiner

The Medical examiner
has legal jurisdiction
over the body, in the
county where the injury
occurred.
Being a Medical
Examiner’s Case does
not prevent a patient
from being an organ
donor.
 Errors to Avoid With Families
Giving false hope
Using highly technical
medical terms
Approaching too early, not
allowing the death to be
accepted
Being stone cold, uncaring,
abrupt or pompous
  Errors to avoid with families

Showing an
unwillingness to spend
time to answer questions
Giving the option of
organ donation before
knowing if the patient is
a candidate
         Jackson
Liver Transplant Recipient
Liver, stomach, pancreas,
small bowel and piece
of colon recipient
Liver and small bowel
recipient
heart
recipient
Trine
Liver Recipient
   Oneisha and Missick
Liver Transplant Recipients
Erik,
heart
transplant
Life Alliance Organ Recovery
            Agency
         1-800-255-4483

				
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