Britta, Becky, Alex, Anne, Tuyen, Erin,

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Organ Donation

• Britta, Becky, Alex, Anne, Tuyen, Erin, Angelica

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Basic Donation List Info

• United Network for Organ Sharing (UNOS)
• Organ Procurement Organizations (OPOs)
• 11 regions in US, each have many OPOs, therefore
  there are many waiting lists for same organ
  throughout the country

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What happens when an organ becomes available?

• Computer system generates list of potential
  candidates based on many factors
• OPO finds match from UNOS list and contacts
  surgeon
• If match cant be made, expanded locally, then
  UNOS region, then nationally

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Liver Lists as an Example

• Placed on list depending on length of time and
  degree of illness
• Degree of illness determined by status code
• Status 1 in ICU, will live less than 7 days
• Status 2 in hospital, cant be discharged
• Status 3 require frequent outpatient care
• Status 4 in holding pattern

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Organs that can be donated

• Heart, lung(s), pancreas, intestines, bone,
  cornea, heart valves, stomach, and Liver.

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Two general ways to donate/transplant organs

• 1.) Cadaveric Donor Organ Transplantation Dependan
  t on many factors
• blood and tissue compatibility between
  donor and recipient, based on organ size and
  on ABO blood type
• effective immunosuppression (explained later)
• limited ischemia time Both warm and cold.

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• 2.) Living Donor Organ Transplantation
• - Usually genetically related (most commonly
  siblings) yields good results because of
  good tissue compatibility between donor and
  recipient.

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Is there always equal treatment of who receive
organs?

• Ie Should an alcoholic receive the same
  preference in receiving an organ donation as
  someone who has an genetic-uncontrollable cause
  of need for an organ?

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Causes for Liver Transplants

• Liver disease refers to any disorder of the liver
• Non-Alcohol Related Liver Disease include
• -Congenital Birth Defects
• -ex. Biliary atresia in the 1 need for liver
  transplants in children
• -Metabolic Disorders
• -Viral or Bacterial Infections
• -ex Hepatitis, bacterial peritonitis,
  complication of liver infection
• -Nutritional Deficiencies
• -Trauma or Injury
• Alcohol Related Liver Disease include
• -Fatty Liver Disease
• -Alcoholic Hepatitis
• -Alcohol Cirrhosis

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• Arguments For Equality
• Equality
• Morality
• Alcoholism is a disease
• Causes of alcoholism
• Statistics

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Equality

• Every person should be treated equal no matter
  the condition or cause of the medical problem.
• Patients with ARESLD (alcohol-related end-stage
  liver disease) should not be singled out when a
  large number of patients with health problems
  that can be considered self-afflicted are not.
• Patients such as smokers with chronic lung
  disease individuals with multiple behavioral
  risk factors (inattention to blood pressure,
  cholesterol, diet and exercise) who develop
  coronary artery disease

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Morality

• Moral evaluation is wisely and rightly excluded
  from all deliberation of who should be treated
  and how.
  
• Alcoholism is a not a moral failing but is
  consider a disease.
• Public reject organ donation to
  alcohol-related disease because they feel
  that excessive drinking is wrong- doing.
  However, the public does not consider other
  factors that contribute to the disease.
• There is absolutely no agreement about what
  constitutes moral virtues and vice and what
  rewards or penalties they deserve.

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Alcoholism is a disease

• Just as all other diseases alcoholism
• Has Hereditary, Environmental, and Lifestyle
  factors
• Has psychological and physical symptoms
• Can be treated as other chronic diseases

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Causes of Alcoholism

• Genetic causes researchers have identified
  clusters of genetic variations in 51
  chromosomal regions that they believe play a
  role in alcohol addiction through cell-to-cell
  communication, control of protein synthesis,
  regulation of development, and cell-to-cell
  interactions.
• Psychological causes
• Cultural and Social causes

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Statistics

• 61.4 of adults in America drink alcohol, 15 are
  former drinkers (some stats up to 90 adults
  drink)
• About 14 million Americans abuse and/or are
  dependent on alcohol
• On a daily basis only 700,000 (1/20th that abuse)
  are being treated
• ARESLD patients represent over 50 of ESLD
  patients, though less than 10 get liver
  transplants

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• Alcoholics Should Not be
  considered Equally

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Alcoholics Should Not be considered Equally

• Arguments
• Alcoholic related liver disease takes many years
  to develop
• Many treatment/screening resources are available
  for alcoholics
• Livers are a scarce commodity
• Cessation of drinking can reverse liver disease
• Society favors people with natural liver disease
  rather than alcoholics

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Alcoholic related liver disease takes many years
to develop

• Alcoholic related liver disease required 20-30
  years of heavy drinking to develop.
• Alcoholics have a lot of time to realize their
  dependency.
• Should be held responsible for extensive abuse.

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Many treatment/screening resources are available
for alcoholics

• Many screening tools to identify alcoholism
• CAGE, AUDIT
• There are symptoms of liver disease
• Edema of the legs, bruising and jaundice
• There are numerous treatment facilities
• Many are no cost to the client
• 114,000 AA groups in the world alone

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Livers are a scarce commodity

• There were fewer than 2000 liver transplants in
  1989
• Due to scarcity, natural liver disease clients
  should have a greater priority over those who
  caused their disease.
• There is a high risk of relapse for alcoholics

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Cessation of drinking can reverse liver disease

• The liver has the ability to regenerate new cells
• Even once Cirrhosis has developed, cessation of
  drinking can reverse some of the damage and
  improve the condition
• A person with natural liver damage does not have
  the opportunity to reverse the damage to their
  liver

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Society favors people with natural liver disease
rather than alcoholics

• Life saving procedures for children or natural
  disease clients was the highest priority of the
  public
• Alcohol related liver disease was rated the
  lowest priority of the public
• Tax payers are less likely to support
  initiatives that do not take causation into
  account and demonstrate the common belief that
  ARESLD patients are responsible for the
  complications they inflicted upon themselves.

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The importance of equality of recipients as it
pertains to Nursing

• Code of Ethics
• Justice
• Equality

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• WhaT do YoU ThiNk?

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• Our Group Personal Opinion There should be an
  inequality
• As a nurse We feel there should be equality for
  all.

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• tHanK yOu!