1. The Ethics of Organ Transplant
Emma Broussard, Jackie Hirohama, Michelle Marks & Sheryl Sato

2. Organ Harvesting: the Ethical Dilemmas
ICU Patient declared brain dead. Patient was not designated as an organ donor and never expressed his beliefs on organ donation. Family is left to decide if the Patient’s organs will be donated or not.
Nurse’s Actions:
Encourage organ donation
Discourage organ donation
For every “…eight potential donors, only one donor is notified to a local Transplant Center, and only 20% of those become effective multiple organs donors, which has serious re- percussions for the already long waiting lists,” (Virginio 2014)

3. United Network for Organ Sharing
UNOS – private, non-profit organization, handles nation’s transplants
“Fair chance” to recipients (not based on age, sex, race, religion, lifestyle, financial/social status)
1. Recipient is added to UNOS database:
severity of illness, time spent waiting, blood type, other pertinent medical info
2. Match made based on door-recipient compatibility, creates a ranked list:
Tissue match, blood type, length of wait, immune status, distance between donor & recipient, (heart, liver, lung & intestines – degree of medical urgency)
3. Recipient must meet criteria at time of match:
Healthy for surgery, transported immediately, more extensive compatibility (antibodies)

4. The Ethical Principles at Play
Autonomy – To respect another’s right to independent decision-making.
Beneficence – To promote goodness, kindness, and charity; to provide benefits to others by promoting their good.
Nonmaleficence – A duty not to inflict harm.
Fidelity – A duty of loyalty and dedication to the patient.

5. Relevant Values Culture & Religion Morality: 3 Questions to Ask
values and beliefs of client, family members & RN.
Morality: 3 Questions to Ask
Is the donor patient’s death being hastened?
How well informed is the informed consent?
Is the family able to be with the patient donor at the moment of death?
Respect:
Definitions of Death: Brain & Cardiac
Brain Death

6. Rights Client & Family Rights Dignity of the client
Dignity of the body
Ethical aspects of consent

7. Laws in Hawaii
2012 Hawaii Revised Statutes TITLE 19. HEALTH 327C. Death 327C-1 Determination of death.
Organ Donor Center of Hawaii (ODCH)
The Uniform Anatomical Gift Act (2007, HI enacted) established that a signed organ donation card is sufficient to proceed with donation. The Revised Act intentionally disempowers families from making or refusing to make gifts in contravention to a donor’s wishes.

8. The Issues
Caring for and maintaining a cadaver that is a potential organ donor
A philosophical perspective on the dignity of the person and the dignity of the body
Ethical aspects of consent for organ donation
The perception that a client is being treated as a means, and not an end in and of himself

9. The Ethical Principles Violated
Autonomy – To respect another’s right to independent decision-making.
Beneficence – To promote goodness, kindness, and charity; to provide benefits to others by promoting their good.
Nonmaleficence – A duty not to inflict harm.
Fidelity – A duty of loyalty and dedication to the patient.

10. The Course of Action RN self-assessment Ethics Committee
Respecting patient’s original health care directive
Some RNs may choose to refuse care
Follow family decision
Follow state law

11. References
Cherry, B., & Jacob, S. R. (2014). Contemporary nursing: Issues, trends, & management (Sixth ed.). St. Louis, Missouri: Elsevier.
Hans Haddersa and Anne Hambro Alnæsb
Howard, R., & Cornell, D. (2005). Family disagreement over organ donation. AMA Journal of Ethics. 7 (9). Retrieved from:
Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway, Section for Medical Ethics, Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway. 17 April 2012 DOI: /j x
Monforte-Royo, C. and Roqué, M. (2012), The organ donation process: a humanist perspective based on the experience of nursing care. Nursing Philosophy, 13: 295–301. doi:  /j X x
The ethics of organ donation: what every nurse should know. (2011). Massachusetts Nurse Advocate. 82(3).
Virgínio BCAE, Escudeiro CL, Christovam BP, Silvino ZR, Guimarães TCF, Oroski G. Death and organ donation from the point of view of nurses: a descriptive study. Online braz j nurs [internet] March; 13 (1): Available from: