Ethical Issues in Organ Procurement and Organ Donation

1
Ethical Issues in Organ Procurement and Organ
Donation

• Mitchell Forman, DO, FACR, FACP
• Dean
• Touro University Nevada College of Osteopathic
  Medicine
• Weldon (Don) Havins, MD, JD, FACS
• Professor of Medical Jurisprudence
• Touro University Nevada

2
Current Status

• A new name is added to the national waiting list
  every 12 minutes
• Every day, 18 people die waiting for an organ
  that never comes
• The current waiting list exceeds 108,000 people
• 136 Patients waiting in NV (UMC) another 200
  waiting at other centers

3
List Jumper You Get What You Pay For
4
(No Transcript)
5
Organ Transplantation Laws

• National Organ Transplant Act (NOTA)
• Organ Procurement and Transplantation Network
• United Network for Organ Sharing (UNOS)
• NOTA prohibits the purchase or sale of organs
• Uniform Anatomical Gift Act (UAGA)
• Prohibits purchase or sale of organs
• gift or donation to a specified individual is
  okay

6
Cremation Story It Doesnt Pay to Be Generous
7
(No Transcript)
8
Living Will DPA

• Living Will
• Consent for the Withdrawal of Life Support
• Designating another to make the decision
• Durable Power of Attorney for Health Care
• Witnesses
• Notarized
• Much wider powers

9
Thats Not What I Want
10
(No Transcript)
11
Religious Consideration Is it Gods Will?
12
(No Transcript)
13
Ethical Issues Recipient Selection

• Who should receive a transplant?
• Alcoholics
• Smokers
• Drug abusers
• Convicted felons
• Non-compliant patients
• Patients who need multiple organs

14
(No Transcript)
15
UAGA 2007Consent Hierarchy

• An agent of the deceased
• Spouse
• Adult children
• Parents
• Adult siblings
• Adult grandchildren
• Grandparents
• An adult who exhibited special care or concern
  for the deceased
• Persons acting as guardians at the time of death
• Any other person authorized to dispose of the
  body

16
(No Transcript)
17
Majority Rule rules

• Old UAGA
• All family members of the same class must
  agree.
• New UAGA
• Decision rests with a simple majority of family
  members of the same class reasonably available

18
NRS 451.548

• Reasonably Available
• able to be contacted by a procurement
  organization without undue effort and willing and
  able to act in a timely manner consistent with
  existing medical criteria necessary for the
  making of an anatomical gift.

19
Organ Procurement

• Voluntary organ donor?

20
(No Transcript)
21
(No Transcript)
22
Organ Transplantation

• Outside U.S.
• Cost
• Availability
• Quality of care
• Within U.S. involving foreign donor
• Physicians ethical responsibility to inform
  patients?

23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)