Organ donation is the donation of biological tissue of an organ of the human body, from a living or dead person to a living recipient in need of a transplantation.

Transplantable organs and tissues are removed in a surgical procedure following a determination, based on the donor's medical and social history, of which are suitable for transplantation

Organs and/or tissues that are transplanted within the same person's body are called autografts.Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, nerves and veins

The Need:Whats Being Transplanted?Organs:in adults & children with end-stage organ failureHeart Heart-LungLungsingle or doubleLiverKidneyKidney-PancreasPancreas onlyIntestine

Organ Donor DemographicsAGENOTE: Data subject to change due to future data submission or correction.

Organ Donor Demographic Data

ORGAN DONOR DEMOGRAPHICS

2000

AgeYTDJan-JunJulAugSeptOctNovDecJul - Dec

0 - 5311000012

6 - 10320000101

11 - 15330000000

16 - 201581111217

21 - 30741110003

31 - 401161101025

41 - 5018102131018

51 - 55960011103

56 - 60523000003

61 - 65530000112

66 - 70310001012

71 - 75000000000

Total824694655736

RaceYTDJan-JunJulAugSeptOctNovDecJul - Dec

White592984534630

Black16121002104

Other750010012

Total824694655736

SexYTDJan-JunJulAugSeptOctNovDecJul - Dec

Male372051142417

Female452643513319

Total824694655736

CODYTDJan-JunJulAugSeptOctNovDecJul - Dec

GSW1153200016

MVC15511222210

CVA452741432418

Head Trauma641000102

Anoxia330000000

Other220000000

Total824694655736

NOTE: Data subject to change due to future data submission or correction.

Age

3

3

3

15

7

11

18

9

5

5

3

0

82 recovered donors

YTD

January 2000 through December 2000

Race

59

16

7

NOTE: Data subject to change due to future data submission or correction.

82 recovered donors

YTD

ORGAN DONORS BY RACEJanuary through December2000

Gender

37

45

NOTE: Data subject to change due to future data submission or correction.

82 recovered donors

YTD

ORGAN DONORS BY GENDERJanuary through December2000

Male42%

COD

11

15

45

6

3

2

NOTE: Data subject to change due to future data submission or correction.

82 recovered donors

YTD

Cause of Death

Number of Donors

ORGAN DONORS BY CAUSE OF DEATHJanuary through December2000

MBD000E86EA.doc

Transplant waiting list as of February 24, 200380,432 patients are currently waiting nationwide for a live-saving organ transplant.

Over 2,000 patients are waiting here in Virginia.Three Virginians die each week waiting.The Problem:ORGAN DONATION AND TRANSPLANTATION STATISTICSThere are currently 123,193 people waiting for lifesaving organ transplants in the U.S. Of these, 101,662 await kidney transplants.

(as of 4/22/15)1The median wait time for an individuals first kidney transplant is 3.6 years and can vary depending on health, compatibility and availability of organs.2In 2014, 17,105 kidney transplants took place in the US. Of these, 11,570 came from deceased donors and 5,535 came from living donors.1

History of Human Organ TransplantThe first human organ transplant was a kidney transplant performed in 1954. The donor of the kidney was the identical twin of the recipient and therefore there was no immune rejection of the organ. The recipient lived for eight years following the transplant and the surgeon who performed the transplant, Dr. Joseph Murray, went on to win the Nobel Prize for this work.

The recipient of the first heart transplant, performed in 1967 by Dr. Christian Barnard, lived only 18 days. The patient did not die because the new heart failed, but because of pneumonia that the patient acquired due to the patients immune system being compromised by the anti-rejection drugs that the patient had to take.

These two cases illustrate both the promise and the challenges of organ transplantation: donor organs can greatly extend life, but there is a critical shortage of donors and, unless the donor is the identical twin of the recipient, the recipients body will always reject the donor organ.

In the 1960s, anti-rejection drugs were very poor and hence very few organ transplants took place.

In the 1970s, better anti-rejection drugs, particularly cyclosporine, were developed and by the late 1970s many heart transplant patients were living up to five years with their donor hearts.

In 1983, the FDA approved cyclosporine for use in organ transplantation, and the first lung transplant patient survived more than six years.

Although the improved anti-rejection drugs increased the life expectancy for patients receiving organ transplants, they came with harmful side effects that shortened the recipients natural life span.

In addition to the side effects, the anti-rejection drugs are also very expensive and can cost $20,000 to $30,000 per year and must be taken for as long as the patient lives.

Amendment to RA 7170 - Organ Donation Act of 1991 AN ACT TO ADVANCE CORNEAL TRANSPLANTATION IN THE PHILIPPINES, AMENDING FOR THE PURPOSE REPUBLIC ACT NUMBERED SEVEN THOUSAND ONE HUNDRED AND SEVENTY (R.A. NO. 7170), OTHERWISE KNOWN AS THE ORGAN DONATION ACT OF 1991

On average:Over3,000new patients are added to the kidney waiting list each month.112people die each day while waiting for a life-saving kidney transplant.1Every14minutes someone is added to the kidney transplant list.1In 2014,4,270patients died while waiting for a kidney transplant. Another,3,617people became too sick to receive a kidney transplant.1

Organ Donor CriteriaAge is generally less than 80, but is based on patients current medical historyDead by Neurologic CriteriaBrain DeadMedical history is examined at the time of deathFree of HIV all serologies are examined at time of death

Death by Neurological CriteriaAn individual with irreversible cessation of all functions of the entire brain, including the brainstem, is dead.JAMA 246:2184-2186, 1981

Arrival at HospitalEMS Recognition asPotential DonorBrain DeathReferral to LifeNetfor Initial EvaluationAuthorizationDonor Management with LifeNetOrgan Resuscitation(Enhance organ oxygenation& perfusion)Organ PlacementSerologyLab resultsOR timeCoordinateteamsOrgan Recoveryin ORTransplantOrgan Donor Case Overview

Tissue Donor CriteriaDonation occurs after cardiac deathCriteria:Age < 70Recovered within 24 hours after death if body is cooled in the first 12 hoursNo active, transmissible diseaseNo autoimmune disorder

The Need: Whats Being TransplantedHeart valvesPericardiumSkinBone -Whole or processed graftsVeinsFasciaLigaments/Tendons

Eye Donor CriteriaDonation occurs after cardiac deathCriteria:No upper age limit1 year to 68 yearscornea transplantLess than 1 year or greater than 68 years researchHistory of cancer is acceptableOther research for patients with history of glaucoma, diabetes, etc.

The Need:Whats Being Transplanted?Eyes:Cornea, ScleraWhole Eyes for Research

The Donor CardA donor card is now recognized as a legally binding document and cannot be overturned by the family.Amendment is possibleDonation by Donor Designation

Common Concerns About DonationDisfigurementFuneral ArrangementsFinancial ResponsibilityReligious BeliefsI cannot be a donor because of my medical history.If I want to be a donor, they wont try and save me!

Some Donation ControversiesWho should be transplanted? Smokers? Alcoholics? The very young or old?The rich or the poor? Those in prison? Only those who have agreed to be donors themselves?

Some Donation ControversiesHow should organ donation be increased?Financial IncentivesMore Public Education? Presumed Consent?

AS NURSES, WE FACE TOUGH ethical dilemmas as we provide end-of-life care, especially when our patients are candidates for organ donation.

Nurses must consider respect for life and bodily integrity in light of the procedure for recovering organs. Nursing is primarily grounded in beneficence (doing good) and nonmaleficence (not doing harm)

Some, believing that removing vital organs is what kills the patient

1Others suggest that organ donation is a "moral duty, an obligation," considering society's lack of alternative healthcare resources

Brain death. The Uniform Determination of Death Act provided the legal articulation of the whole-brain criterion of death: "irreversible cessation of all functions of the brain, including the brainstem."6

Issues surrounding brain death

But defining death as brain death also presents ethical quandaries. Robert D. Truog, MD, director of clinical ethics at Harvard Medical School in Boston, Mass., writes that using brain death as the standard legitimatizes organ removal from bodies that continue to have circulation and respiration (usually sustained by mechanical ventilation), and this "fails to correspond to any coherent biological or philosophical understanding of death."13

The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation.

The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation.

The best interests standard for incompetent or incapacitated persons of all ages.

When making decisions for adults who lack decision-making capacity and have no discernable preferences, widespread support exists for using the Best Interests Standard. This policy appeals to adults and is compatible with many important recommendations for persons facing end-of-life choices.

**