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Slide 1
Slide 2
Catherine Alvarez, Rochelle Betton- Ford, Shelley Corp and
Crystal Davis
Slide 3
~Edward Everett Hale
Slide 4
According to the Organ Procurement and Transplantation Network
(OPTN,2014) the waiting list of candidates for organs in the United
States as of February 18, 2014 at 7:20 pm was 121, 260 people.
organ transplantation has evolved to the point where it is a safe
and effective treatment. However, there are many issues and
underlying ethical principles associated with the procedure. The
ethics of organ transplantation have been premised on the dead
donor rule (DDR), which states that vital organs should be taken
only from persons who are dead. There are others that suggest
certain living patients, such as those who are near death but on
life support, should be allowed to donate their organs, and by
doing so would benefit others and be consistent with their own
interests (Truog, Miller and Halpern, 2013).
Slide 5
Our position that the Dead Donor Rule should be upheld and
maintained in order to maintain public trust in the organ-
transplantation enterprise.
Slide 6
According to the National Institute of Health (2014) Organ
donation takes healthy organs and tissues from one person for
transplantation into another for the purpose of replacing organs
that are damaged or missing. Experts say that the organs from one
donor can save or help as many as fifty people. Organs that can be
donated include internal organs such as kidneys, heart, liver,
pancreas, intestines and lungs. As well as skin, bone, bone marrow
and corneas People of all ages and backgrounds can be organ donors.
Most organ and tissue donations occur after the donor has died. But
some organs and tissues can be donated while the donor is
alive.
Slide 7
In 1954, Massachusetts surgeon Joseph E. Murray performed the
first successful kidney transplant between identical twins at
Brigham and Womens Hospital in Boston. Although Dr. Murrays surgery
was a major breakthrough, it wasnt a solution, as very few people
have an identical twin they can rely on for organ donation (Watson,
2014). In the late 1960s, doctors utilized drugs to suppress the
immune system of recipients and were able to perform transplants
between nonrelatives and by the 1980s anti- rejection drugs had
improved to the point where transplantation surgery became pretty
routine and far less risky than it had been a few decades earlier.
Survival rates rose.
Slide 8
Allegiance to the DDR thus limits the procurement of
transplantable organs by denying some patients the option to donate
in situations in which death is imminent and donation is desired.
The DDR has required physicians and society to develop the concept
of brain death. Recovery of organs from a brain dead patient is
considered acceptable if organ donation is desired by the patient
or by the surrogate on the patients behalf. More recently, to meet
the ever growing need for transplantable organs, attention has
turned to donors who are declared dead on the basis of the
irreversible loss of circulatory function (Truog, Miller and
Halpern, 2013) here again, there is a struggle with the need to
declare death when organs are still viable for transplantation.
This requirement has led to rules permitting organ procurement
after the patient has been pulseless for at least 2 minutes. For
many patients, circulatory function is not irreversibly lost within
the two minutes-cardiopulmonary resuscitation could restore
it.
Slide 9
First person authorization and advanced directives should be
considered because these honor the wishes of the patient. The Organ
Procurement Organization (OPO) confirms that the healthcare team
has assessed the patients competency and capacity to make
withdrawal/support and other medical decisions. The OPO must
confirm that consent has been obtained for any DCD related
procedures or drug administration that occur prior to patient
death.
Slide 10
For the purpose of obtaining authorization for a DCD recovery,
legal next of kin can include any of the following: 1.The patient
who authorizes deceased donation 2.Persons defined by state/local
laws to authorize organ donation. When the Living, Deceased Don't
Agree on Organ Donation (2013) stated, all 50 states and the
District of Columbia have adopted the 2006 Revised Uniform
Anatomical Gift Act (UAGA) Similar legislation giving individuals
the "First Person Authorization" (FPA) to consent to organ donation
after death via a signed donor card or driver's license, or by
enrollment in a donor registry
Slide 11
US does not have presumed consent legislation Presumed consent
would almost certainly lead to an increase in rates of donation
Opt-out system and means that unless the deceased has expressed a
wish in life not to be an organ donor then consent will be assumed
The current opt-in system of either registration on the organ
signed donor card, driver's license, donor register or obtaining
consent from the families is different from presumed consent
Slide 12
Ohio Case involved a 21 year old declared legally dead but was
on artificial life support Organs donated under court order over
his familys objections Deceased wanted to be an organ and tissue
donor when he applied for a drivers license, but the family was
unaware of his wishes Lifeline filed a complaint in the Franklin
County Probate Court, seeking a court order to allow them to
proceed with the removal and transplantation Ohio law bars anyone
other than the donor from amending or revoking an organ
donation
Slide 13
According to Steinbrook (2007) DCD is a donor who has suffered
devastating and irreversible brain injury and may be near death
Donor does not meet formal brain death criteria Donor is declared
dead following irreversible cessations of circulatory and
respiratory function Cessation of functions is determined by an
absence of responsiveness; heart sounds, pulse and respiratory
effort Once the heart stops beating, blood ceases to circulate
through the body resulting in loss of oxygen to the organs and
causes immediate deterioration of the tissues (Night, 2007).
Slide 14
According to Night (2007) A transplant surgeon and his team
were in the operating room before a Sierra Vista physician had
arrived Transplant surgeon ordered staff to administer sedatives
and pain medication to donor to make sure patient did not suffer
when life support was withdrawn Cessation of cardiopulmonary
function did not occur when donor was removed from the ventilator
Organs deteriorated beyond use Transplant Surgeon was accused of
hastening death of donor
Slide 15
The coroner ruled patient died from natural causes (Night,
2007) According to Brande (2009) there were no policies in the
state of California for DCD organ procurement Standard practice
provides a separation of duties between the transplant team and the
care providers for the withdrawal of life-sustaining measures
California has since systemized a standard protocol for recovering
organs using the DCD Transplant Surgeon was acquitted (Brande, V.
2009).
Slide 16
Slide 17
State laws Federal laws Federal regulations The policies of the
United Network of Organ Sharing (UNOS)
Slide 18
State laws primarily cover the issues pertaining to the
donation process such as the criteria for declaring death, the
consent requirements of being a donor, the scope of public
education programs, and the composition of donor registries (Crowe
& Cohen, 2006, p. 3). Federal laws deal mainly with organ
procurement, allocation and transportation of donor organs and
tissues.
Slide 19
Federal regulations explains the framework of the OPTN and its
relationship with its member organ procurement organizations (OPO)
and transplant centers, this regulation is only a small portion of
the policy that dictates the responsibility and action of the OPTN
and its members (Crowe & Cohen, 2006, p. 7).
Slide 20
United Network for Organ Sharing (UNOS) UNOS rules further
define the functions of the OPTN, and describe the policies OPOs
and transplant hospitals must follow in order to be members of the
OPTN. Controlled Donation after Circulatory Death (2.13) Protocol
The OPTN policy 2.13 Requirements for Controlled Donation after
Circulatory Death (DCD) Protocol define the necessary guidelines
for hospitals that participate in organ donation. These policies
will help OPOs and transplant hospitals develop necessary DCD
protocols (UNOS, 2014).
Slide 21
The US is facing a disproportion between the supply of donor
organs and the demand for transplants. Some people feel Death after
Circulatory Death which is declared in accordance with hospital
policy and applicable under state and local statutes or regulation
is the solution to increase the donor supply. The ethical and legal
foundation of organ donation has been based on the dead donor rule
which states that the removal organs must not precede the death of
the organ donor. The ethical and legal issue of DCD is the timing
of death after patients have been removed from life support.
Finally, we believe the Dead Donor Rule should be upheld and
maintained in order to maintain public trust in the organ-
transplantation.
Slide 22
Bernat, J.L. (2008). Perspective: The Boundaries of Organ
Donation after Circulatory Death. New England Journal of Medicine,
359, 669-671. doi:101056/NEJMp0804161 Beth Israel Deaconess Medical
Center. (2013). Donor criteria standard and extended criteria
Donors. Harvard Medical School Teaching Hospital. Retrieved
February 18, 2014 from
http://www.bidmc.org>...>WhereDoestheDeceasedDonorOrganComeFrom
Bramhall, S. (2011, May). Presumed consent for organ donation: a
case against. Retrieved from National Center for Biotechnology
Information: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363073/
Cohen, E. Crowe, S. (2006, September). Organ Transplantation
Policies and Policy Reforms.
https://bioethicsarchive.georgetown.edu/pcbe/background/crowepaper.html
https://bioethicsarchive.georgetown.edu/pcbe/background/crowepaper.html
Gift of Life. (2014). The gift of a lifetime: Understanding death
before donation. Organ Transplants. Retrieved from
www.organtransplants.org/understanding/death/Organwww.organtransplants.org/understanding/death/Organ
TissueTransplantationinAmerica. Gries, C. J., White, D. B., Truog,
R. D., DuBois, J., Cosio, C. C., Dhanani, S., & Chan, K. M.
(2013). Sharing Statement: Ethical and Policy considerations in
organ donation after circulatory determination of death. American
Journal respiratory Critical Care Medicine, 188(1), 103-109.
IMPORTANT POLICY NOTICE. (2013, December 12). Retrieved from United
Network for Organ Sharing:
http://optn.transplant.hrsa.gov/contentdocuments/policy_notice_11-2013.pdf
McCleskey, C. (2013, July 23). Legal Battle In Ohio Over Organ
Donation Highlights Controversy Over Defining Death. Retrieved from
Global Bioethics Initiative:
http://globalbioethics.org/news/legal-battle-in-ohio-over-organ-donation-highlights-
controversy-over-defining-death/http://globalbioethics.org/news/legal-battle-in-ohio-over-organ-donation-highlights-
controversy-over-defining-death/ National Institute of Health.
(2014). Organ Donation. In Medline Plus. Retrieved February 18,
2014, from http://www.nlm.nih.gov/medlineplus/organdonation.html
http://www.nlm.nih.gov/medlineplus/organdonation.html
Slide 23
Night, S.S. (2017). Arrest of Transplant Surgeon Raises Concern
Regarding Organ Donation After Cardiac Death Procedure. Retrieved
February 18, 2014 from
www.law.uh.edu/healthlaw/perspectives/2007/(SN)Organdon.pdf
Procter, E. (2012) Collaboration between the specialties in
provision of end-of-life care for all in the UK: reality or utopia.
International Journal of Palliative Nursing 18 (7), 330-347. In
Medline Plus. Retrieved February 18, 2014 from
www.ncbi.nim.nih.gov/pubwww.ncbi.nim.nih.gov/pub med/22885966.
Steinbrook, R. (2007). Organ donation after cardiac death. New
England Journal of Medicine. 357, 209-213. Retrieved from
doi:10.1056/NETMp078066 Truog, R. D., Miller, F. G., & Halpern,
S. D. (2013). The Dead-Donor Rule and the future of organ donation.
New England Journal of Medicine, 369(14), 1287-1289. United Network
for Organ Sharing. (2014). Retrieved
from:http://www.unos.org/donation/ indexphp?topic=history Watson,
S. (2014). How Face Transplants work. In How Stuff Works. Retrieved
February 18, 2014, from
http://science.howstuffworks.com/life/human-biology/face-transplant1.htm
http://science.howstuffworks.com/life/human-biology/face-transplant1.htm
When the living, deceased don't agree on organ donation. (2013,
November 26). Retrieved from Science Daily:
http://www.sciencedaily.com/releases/2013/11/131126092702.htm