Organ Donation Simple

8/10/2019 Organ Donation Simple

1/46

Life Alliance Organ Recovery

Agency

1-800-255-4483


2/46

Teaching Ethics in a Multicultural

Environment: An Organ DonationPerspective

Life Alliance

Organ Recovery AgencyUniversity of Miami


3/46

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.


4/46

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.


5/46

State of Donation/Transplantation

5

5

2

25

3

988 992 995 999 2 2 2 2 3

donors

organs transplanted


6/46

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.


7/46

Morality

The rightness or wrongness of an act or

thought

Widely shared beliefs in a particular cultureor subculture


8/46

Ethics

The why or the actual underpinning for the

act or thought.

Perspectives that allows one to examine orunderstand something


9/46

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.


10/46

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.


11/46

How does one express voluntary

donation wishes?Registries: DMV

Donor cards

Advance directives aka, Living Wills

Sharing your thoughts and decisions with

your family


12/46

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


13/46

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


14/46

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


15/46

Medical Staff Ethical Dilemmas

Admitting failure: A patient has died

Stepping aside

Supporting or Obstructing Patient

Management


16/46

South Florida Communities

Haitian

African American

Hispanic


17/46

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?


18/46

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?


19/46

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)


20/46


21/46

Brain death vs.

Coma?


22/46

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


23/46

Brain Death

Patient maintained onventilator, Heart beating

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

Tissue recovery followsorgan donation


24/46

Cardiac Death

Patient has no cardiacor respiratory activity

Acceptable donations:Tissue & Eyes

Body must be kept cool

before tissues areremoved

Removal within12 to 24hours


25/46

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


26/46

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


27/46

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.


28/46

How Does It Work?

Organ

Procurement

Agency

Donors

Transplant

Center

Recipients

UNOS Organ Center


29/46


30/46

Organ Matching


31/46

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?


32/46

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.


33/46

Nurses Role in Donation

Early identification

Referral of potential donors

to OPOSupport the families rightto donate

Assist in donormanagement

Comfort grieving families


34/46

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


35/46

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.


36/46

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


37/46

Errors to avoid with families

Showing anunwillingness to spend

time to answer questionsGiving the option oforgan donation before

knowing if the patient isa candidate


38/46

Jackson

Liver Transplant Recipient


39/46

Liver, stomach, pancreas,

small bowel and piece

of colon recipient


40/46

Liver and small bowel

recipient


41/46


42/46

heart

recipient


43/46

Trine

Liver Recipient


44/46

Oneisha and Missick

Liver Transplant Recipients


45/46

Erik,

heart

transplant


46/46

Life Alliance Organ Recovery

Agency

1-800-255-4483

Documents

Organ Donation Simple