Life Alliance Organ Recovery

Agency

1-800-255-4483

Teaching Ethics in a Multicultural

Environment: An Organ Donation
Perspective
Life Alliance
Organ Recovery Agency
University of Miami

Why is Organ Donation important?

-There are more than 87,000 patients listed
awaiting an organ transplant.
-Organ transplants come from Cadaveric
donors and by Living donors.
However, the issue that exists is a Supply &
Demand Problem.

Newsroom Facts - UNOS

On average, 115 people are added to the nations organ
transplant waiting list each day ONE 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.

State of Donation/Transplantation
30000
25000
20000
donors
organs transplanted

15000
10000
5000
0

1988 1992 1995 1999 2001 2002 2003

New Federal Requirements

Hospitals must have working relationships
with their areas OPO, Tissue and Eye Bank.
Hospitals must report ALL deaths and
imminent deaths to the OPO.
Reporting is required for hospital
accreditation and Medicare reimbursement.
All OPOs must audit all deaths in their
catchment area.

Morality
The rightness or wrongness of an act or
thought
Widely shared beliefs in a particular culture
or subculture

Ethics
The why or the actual underpinning for the
act or thought.
Perspectives that allows one to examine or
understand something

Major Legislation
1968 Uniform Anatomical Gift Act
Revised 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.

There is no national registry of organ

donors. Even if you have indicated your
wishes on your drivers license or a donor
card, be sure you have told your family as
they will be consulted before donation
takes place.

How does one express voluntary

donation wishes?
Registries: DMV
Donor cards
Advance directives aka, Living Wills
Sharing your thoughts and decisions with
your family

Major Legislation
1984 National Organ Transplant Act
Established a national
Organ Procurement
and Transplantation
Network (OPTN)
Prohibited sale of
human organs
Established the
Scientific Registry of
Organ transplantation

1987
Florida Brain Death Law
Determination of death must be made
by two board eligible or certified
physicians
Brain death is the irreversible
cessation of the entire brain,
including brain stem

OPO Responsibilities
Evaluation of all potential donors
Obtaining family consent
Maintain the donor after Brain Death
has been declared
Allocation of the organs
Recovery of the organs
Aftercare of the donor family

Medical Staff Ethical Dilemmas

Admitting failure: A patient has died
Stepping aside
Supporting or Obstructing Patient
Management

South Florida Communities

Haitian
African American
Hispanic

Informed Decision to Informed

Consent
Does a family need to know what organs and
tissues can be donated?
Do they need to know the size of the
incision?
Do they need to know how the body will look
after donation?
Do they need to know about the various
donor suitability tests?

Pediatric Ethical Considerations

What about children who want to be organ
donors?
What about adolescents between 16 and
almost 18 years old?
Can people younger than 18 give consent?

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)

Brain death vs.

Coma?

Brain Death Criteria

Harvard Medical School

Absence of spontaneous movement

and response to stimulus
Absence of spontaneous
respiration
Absence of brain stem reflexes
Reversible etiology must be
considered and excluded prior to
the diagnosing of Brain Death

Brain Death
Patient maintained on
ventilator, Heart beating
Organs are removed in the
operating room while the
patient is maintained on a
ventilator.
Tissue recovery follows
organ donation

Cardiac Death
Patient has no cardiac
or respiratory activity
Acceptable donations:
Tissue & Eyes
Body must be kept cool
before tissues are
removed
Removal within12 to 24
hours

Whats the difference from a coma?

Coma entails some lower level of brain
electrical activity, however absence of any
cortical activity
Coma does NOT equal Brain Death

Categories Of Donation
Brain Dead Donor
Can donate organs, eyes, bone, & tissue
Has beating heart, on ventilator
Cardiac Arrest Donor
Eye, bone, & tissue only: NO organs can be
donated
Donation After Cardiac Death:
Immediate rescue of organs after cardiac death
(OPO on Site) Asystole occurs within 30 min of
extubation

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.

How Does It Work?

Donors

Recipients

Organ
Procurement
Agency

Transplant
Center

UNOS Organ Center

Organ Matching

Ethical Issues of Transplant

Recipients
Retransplantation: How many times can a
person be transplanted when others are also
waiting?
Prisoners: Before and now with todays DNA
evidence?
Non-resident aliens?
Multiple Listing: Being registered at more
than one transplant center?

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 would
help an individual but not change their place
on the waiting list.

Nurses Role in Donation

Early identification
Referral of potential donors
to OPO
Support the families right
to donate
Assist in donor
management
Comfort grieving families

Goals of Donor Care

Maintain cardiac output
Maintain tissue perfusion
Maintain fluid and electrolyte balance
Ensure adequate ventilation and
pulmonary stability
Prevent infection
Control diabetes Insipidus
Regulate body temperature

The Medical Examiner

The Medical examiner
has legal jurisdiction
over the body, in the
county where the injury
occurred.
Being a Medical
Examiners Case does
not prevent a patient
from being an organ
donor.

Errors to Avoid With Families

Giving false hope
Using highly technical
medical terms
Approaching too early, not
allowing the death to be
accepted
Being stone cold, uncaring,
abrupt or pompous

Errors to avoid with families

Showing an
unwillingness to spend
time to answer questions
Giving the option of
organ donation before
knowing if the patient is
a candidate

Jackson
Liver Transplant Recipient

Liver, stomach, pancreas,

small bowel and piece
of colon recipient

Liver and small bowel

recipient

heart
recipient

Trine
Liver Recipient

Oneisha and Missick

Liver Transplant Recipients

Erik,
heart
transplant

Life Alliance Organ Recovery

Agency
1-800-255-4483