Life Alliance Organ Recovery Agency

1-800-255-4483

Teaching Ethics in a Multicultural Environment: An Organ Donation

Perspective

Life Alliance

Organ Recovery AgencyUniversity 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

0

5000

10000

15000

20000

25000

30000

1988 1992 1995 1999 2001 2002 2003

donorsorgans transplanted

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 Legislation1968 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 Legislation1984 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

1987Florida Brain Death Law

Brain death is the irreversible cessation of the entire brain, including brain stem

Determination of death must be made by two board eligible or certified physicians

OPO Responsibilities

Evaluation of all potential donorsObtaining family consentMaintain the donor after Brain Death has been declaredAllocation of the organsRecovery of the organsAftercare 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 CriteriaHarvard Medical School

Absence of spontaneous movement and response to stimulusAbsence of spontaneous respirationAbsence of brain stem reflexesReversible etiology must be considered and excluded prior to the diagnosing of Brain Death

Brain Death

Patient maintained on ventilator, Heart beatingOrgans 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 activityAcceptable donations: Tissue & EyesBody must be kept cool before tissues are removedRemoval 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 DonorCan donate organs, eyes, bone, & tissueHas beating heart, on ventilator

Cardiac Arrest DonorEye, 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?

OrganProcurement

Agency

Donors

TransplantCenter

Recipients

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 identificationReferral of potential donors to OPOSupport the families’ right to donateAssist in donor managementComfort 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 questionsGiving 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 bowelrecipient

heart recipient

TrineLiver Recipient

Oneisha and Missick

Liver Transplant Recipients

Erik, heart transplant

Life Alliance Organ Recovery Agency

1-800-255-4483