1. Life Alliance Organ Recovery Agency

2. Life Alliance Organ Recovery Agency University of Miami
Teaching Ethics in a Multicultural Environment: An Organ Donation Perspective
Life Alliance
Organ Recovery Agency
University of Miami

3. 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.

4. Newsroom Facts - UNOS
On average, 115 people are added to the nation’s 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.

5. State of Donation/Transplantation

6. New Federal Requirements
Hospitals must have working relationships
with their area’s 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 OPO’s must audit all deaths in their catchment area.

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

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

9. 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.

10. There is no national registry of organ donors
There is no national registry of organ donors. Even if you have indicated your wishes on your driver’s license or a donor card, be sure you have told your family as they will be consulted before donation takes place.

11. 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. 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

13. 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

14. 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

15. Medical Staff Ethical Dilemmas
Admitting failure: A patient has died
Stepping aside
Supporting or Obstructing Patient Management

16. South Florida Communities
Haitian
African American
Hispanic

17. 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?

18. 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?

19. 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. Contraindications for Organ Donors
Age???
Malignant Neoplasm’s (except Primary brain tumors)
Transmittable diseases (Sepsis, Meningitis, HIV, Acute Hepatitis, TB)

21. Contraindications for Organ Donation
Current IV Drug abuse
CNS Disease (Alzheimer’s, r/t Mad Cow Disease)
Diseases of unknown etiology
Sickle Cell (only if in crisis)

22. As many as 8 transplantable organs can be recovered from a single donor: 2 kidneys, 2 lungs, heart, liver, pancreas, and intestine.

23. Brain death vs. Coma?

24. 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

25. 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

26. 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

27. What’s 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

28. 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

29. 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.

30. How Does It Work? Donors Recipients Organ Procurement Agency
Transplant
Center
UNOS Organ Center

32. Organ Matching

33. Ethical Issues of Transplant Recipients
Retransplantation: How many times can a person be transplanted when others are also waiting?
Prisoners: Before and now with today’s DNA evidence?
Non-resident aliens?
Multiple Listing: Being registered at more than one transplant center?

34. 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.

35. 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

36. 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

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

38. 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

39. 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

40. Liver Transplant Recipient
Jackson
Liver Transplant Recipient

41. Liver, stomach, pancreas,
small bowel and piece
of colon recipient

42. Liver and small bowel
recipient

44. heart
recipient

45. Trine
Liver Recipient

46. Liver Transplant Recipients
Oneisha and Missick
Liver Transplant Recipients

47. Erik,
heart
transplant

48. Life Alliance Organ Recovery Agency 1-800-255-4483