Life Alliance Organ Recovery Agency

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Life Alliance Organ Recovery Agency

• 1-800-255-4483

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Teaching Ethics in a Multicultural Environment
An Organ Donation Perspective

• Life Alliance
• Organ Recovery Agency
• University of Miami

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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.

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Newsroom Facts - UNOS

• On average, 115 people are added to the nations
  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.

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State of Donation/Transplantation
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New Federal Requirements

• Hospitals must have working relationships
• with their areas 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 OPOs must audit all deaths in their
  catchment area.

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Morality

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

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Ethics

• The why or the actual underpinning for the act
  or thought.
• Perspectives that allows one to examine or
  understand something

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Major Legislation1968 Uniform Anatomical Gift
ActRevised 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.

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• There is no national registry of organ donors.
  Even if you have indicated your wishes on your
  drivers license or a donor card, be sure you
  have told your family as they will be consulted
  before donation takes place.

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How does one express voluntary donation wishes?

• Registries DMV
• Donor cards
• Advance directives aka, Living Wills
• Sharing your thoughts and decisions with your
  family

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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

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1987Florida 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

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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

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Medical Staff Ethical Dilemmas

• Admitting failure A patient has died
• Stepping aside
• Supporting or Obstructing Patient Management

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South Florida Communities

• Haitian
• African American
• Hispanic

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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?

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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?

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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)

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Contraindications for Organ Donors

• Age???
• Malignant Neoplasms (except Primary brain
  tumors)
• Transmittable diseases (Sepsis, Meningitis, HIV,
  Acute Hepatitis, TB)

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Contraindications for Organ Donation

• Current IV Drug abuse
• CNS Disease (Alzheimers, r/t Mad Cow Disease)
• Diseases of unknown etiology
• Sickle Cell (only if in crisis)

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Brain death vs. Coma?

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Brain Death CriteriaHarvard 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

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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

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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

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Whats 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

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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

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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.

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How Does It Work?
Donors
Recipients
Organ Procurement Agency
Transplant Center
UNOS Organ Center
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Organ Matching
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Ethical Issues of Transplant Recipients

• Retransplantation How many times can a person be
  transplanted when others are also waiting?
• Prisoners Before and now with todays DNA
  evidence?
• Non-resident aliens?
• Multiple Listing Being registered at more than
  one transplant center?

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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.

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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

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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

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The Medical Examiner

• The Medical examiner has legal jurisdiction over
  the body, in the county where the injury
  occurred.
• Being a Medical Examiners Case does not prevent
  a patient from being an organ donor.

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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

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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

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Jackson Liver Transplant Recipient
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Liver, stomach, pancreas, small bowel and piece
of colon recipient
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Liver and small bowel recipient
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heart recipient
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Trine Liver Recipient
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Oneisha and Missick Liver Transplant Recipients
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Erik, heart transplant
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Life Alliance Organ Recovery Agency
1-800-255-4483