Organ Donation Simple

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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 DonationPerspective

    Life Alliance

    Organ Recovery AgencyUniversity 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 Cadavericdonors 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 organtransplant waiting list each dayONE 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

    5

    5

    2

    25

    3

    988 992 995 999 2 2 2 2 3

    donors

    organs transplanted

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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 andimminent deaths to the OPO.

    Reporting is required for hospital

    accreditation and Medicare reimbursement.All OPOs must audit all deaths in theircatchment area.

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    Morality

    The rightness or wrongness of an act or

    thought

    Widely shared beliefs in a particular cultureor subculture

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    Ethics

    The why or the actual underpinning for the

    act or thought.

    Perspectives that allows one to examine orunderstand something

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    Major Legislation

    1968 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 yourwishes 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 Legislation

    1984 National Organ Transplant Act

    Established a national

    Organ Procurement

    and Transplantation

    Network (OPTN)

    Prohibited sale of

    human organs

    Established theScientific Registry of

    Organ transplantation

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    1987

    Florida Brain Death Law

    Brain death is the irreversiblecessation of the entire brain,

    including brain stem

    Determination of death must be made

    by two board eligible or certifiedphysicians

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    OPO Responsibilities

    Evaluation of all potential donors

    Obtaining family consent

    Maintain the donor after Brain Deathhas been declared

    Allocation of the organs

    Recovery of the organsAftercare 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 andtissues can be donated?

    Do they need to know the size of theincision?

    Do they need to know how the body will look

    after donation?Do they need to know about the variousdonor suitability tests?

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    Pediatric Ethical Considerations

    What about children who want to be organ

    donors?

    What about adolescents between 16 andalmost 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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    Brain death vs.

    Coma?

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    Brain Death CriteriaHarvard Medical School

    Absence of spontaneous movementand response to stimulus

    Absence of spontaneousrespiration

    Absence of brain stem reflexes

    Reversible etiology must beconsidered and excluded prior tothe diagnosing of Brain Death

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    Brain Death

    Patient maintained onventilator, Heart beating

    Organs are removed in theoperating room while thepatient is maintained on aventilator.

    Tissue recovery followsorgan donation

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    Cardiac Death

    Patient has no cardiacor respiratory activity

    Acceptable donations:Tissue & Eyes

    Body must be kept cool

    before tissues areremoved

    Removal within12 to 24hours

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    Whats the difference from a coma?

    Coma entails some lower level of brain

    electrical activity, however absence of any

    cortical activityComa 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 ventilatorCardiac Arrest Donor

    Eye, bone, & tissue only: NO organs can bedonated

    Donation After Cardiac Death:Immediate rescue of organs after cardiac death

    (OPO on Site) Asystole occurs within 30 min ofextubation

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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?

    Organ

    Procurement

    Agency

    Donors

    Transplant

    Center

    Recipients

    UNOS Organ Center

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    Organ Matching

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    Ethical Issues of Transplant

    Recipients

    Retransplantation: How many times can aperson be transplanted when others are also

    waiting?Prisoners: Before and now with todays DNAevidence?

    Non-resident aliens?

    Multiple Listing: Being registered at morethan 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 wouldhelp 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 OPOSupport the families rightto donate

    Assist in donormanagement

    Comfort grieving families

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    Goals of Donor Care

    Maintain cardiac output

    Maintain tissue perfusion

    Maintain fluid and electrolyte balanceEnsure adequate ventilation and

    pulmonary stability

    Prevent infection

    Control diabetes Insipidus

    Regulate body temperature

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    The Medical Examiner

    The Medical examinerhas legal jurisdiction

    over the body, in thecounty where the injuryoccurred.

    Being a MedicalExaminers Case doesnot prevent a patientfrom being an organ

    donor.

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    Errors to Avoid With Families

    Giving false hope

    Using highly technical

    medical termsApproaching 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 anunwillingness to spend

    time to answer questionsGiving the option oforgan donation before

    knowing if the patient isa 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