Ethics of Organ donation ppt

THE ETHICS OF ORGAN DONATIONAllin Varghese, Brenda Mayaka, Inas Mohamed

“A 46-year old man training for a marathon seemed in excellent

health yet suddenly collapsed. His training partner immediately

called 911 and initiated chest compressions. Emergency medical

services arrived within 3 minutes and placed an automatedexternal defibrillator (AED) that fired 2 times. There was no

return of spontaneous circulation. Paramedics continued chestcompressions and ventilation en route to your hospital. In theemergency department (ED), you exhausted all resuscitative

effortsfor 30 minutes and subsequently ordered termination of

resuscitation. When you notified the family, though distraughtover their unexpected loss, they informed you that the

deceased wasa registered organ donor and request that his wish be

honored.They anxiously wait for your response..”

OutlineDemographics of organ donation

Ethical analysis of organ donation

Legal analysis of organ donation

The uniform Anatomical Gift Act

Reflections and conclusions- nursing implications (moral distress).

Definition of TermsUDDA- Uniform Determination of Death Act

UAGA- Uniform Anatomical Gift Act

DNDD- Donation after Neurological Determinatin of Death

DCDD- Donation after Circulatory Determination of Death

cDCDD- Controlled Donation done in controlled settings

uDCDD- uncontrolled Donation done outside the hospital and emergency departments.

Criteria For Organ Donationperson has to be declared dead by circulatory determination of death (DCDD)person has to be declared by neurological determination of death (DNDD)person has to die in a controlled setting, and cannot die in an Emergency Department, or outside the hospital- one of the reasons there might be shortages in organ donationsconsent for organ donation has and for removal of life support has to be given.

Increase in Demand with Low supply

Shortages of donors12000 people die each year, or are extremely ill for transplants, and another 115,000 are on

a wait list

cDCDD and uDCDD• uDCDD is a program that was implemented in

Spain and France to resolve the problem of shortages in organ donation, and has proved to be successful.

• difference between cDCDD and uDCDD is that the latter is done even in uncontrolled settings like the emergency room and outside of the hospital, while the former is in controlled setings such as ICU.

• The USA is against such a program as it violates the Dead Donor Rule.

The Dead Donor RuleThe dead donor rule states that a person’s vital organs can only be donated when they are

declared dead, either neurologically or circulatory.

Organ Donation Ethical Issues

IN THE NEWS

Parents of a young girl's wish to donate her organs denied after she does not die quickly enough following the removal of life supportA man who spent his life advocating for organ donation finds himself brain dead. The family decide they want to honor his wish. They donate his vital organs before the removal of his life support. His organs are denied....A 21 yr old man who is an organ donor is declared legally dead. his family unaware of his decision figh to keep him alive, but unsuccessful..... "he does not deserve to die like this"

Denver children's hospital's cDCDD program under attack in 2008- hearts from children who were declared dead started beating in recipients' bodies. How come the hearts started beating in the recipients’ bodies after the donor was declared dead. Were they dead to begin with?

Denver’s children’s hospital defended their decisions based on the fact that they followed protocol. Other ethicists disagreed with this and suggested the heart should be excluded from the vital organs to be donated

Ethical Principles

Autonomy-implies that a person should be given choices in regards to the situations involved in their dyingNon-maleficence-protects the patient from more harm. A patient can donate their vital organs for as long as it does not cause further harm

Legal AnalysisThe National Organ Transplant act (1984): this act provides for the establishment of a task force on organ transplantation, organ procurement and transplantation network, and authorizes financial assistance for organ procurement organizations (Westrick, S. J., Dempski, k., 2009).

The Omnibus Reconciliation Act (1986): this is an act that specifies standards and protocol for organ procurement. Hospitals that are participating in Medicare and Medicaid programs are needed to establish written standards to recognize organ donors. The health care facility has to make sure that the potential organ donors are aware of their options to donate or decline to donate organs. Secondly motivate discretion and sensitivity with respect to the situations, views, beliefs of the families of the donors and finally notify an organ procurement organization about the potential organ donors (Westrick, S. J., Dempski, K., 2009).

Uniform Anatomical Gift Act

The act requires written documentation of the donors’ intention for organ donation. One of the limitations of this act is getting consent from minors and mentally disabled donors. The health care provider gets the permission of family members in such situations. The amendment included in the uniform anatomical gift act, 1987 version has a controversial provision that gives permission to medical examiners and public health examiners for removing body parts from a cadaver if there is no knowledge about dead persons qualifying relative objection. There are some other provisions in this act that permits routine inquiry about organ donation for patients admitted in the hospital. Also another provision allows hospital representatives to talk to dying patients about organ donation.

Nursing Considerations

Nurses are always caught in the middle of ethical dilemmas when taking care of patients nearing death, and the families grieving, and also thinking about the recipients’ family that are also desperately waiting for a chance for survival for their family member. It is documented that critical care nurses always face emotional and moral distress

Reflections and Conclusions

Ethically, it is our duty as nurses to respect the body integrity and human life of each patient we encounter.

The process of organ donation harvesting is a very complex topic for health professionals involved in caring for a potential donor. Since it mobilizes feelings, cultural

beliefs, and religious values regarding mortality and death, and nurses have to develop a principled approach

to support potential donors.

“You reluctantly tell the family of the marathoner who diedunexpectedly, “As of now, he may only be a tissue donor.” Youwonder whether you should explain that because our society cannot agree on when the patient is dead and because he did not die in theright way, either brain death or removal from life support, nor in theright location, the ICU, he cannot fulfill his dying wish. “Whatabout his organs?” the family asks. Their words are gut wrenching,reminding you of the incredible mismatch of needs, in which willingdonors cannot donate because of mystifying fears they are not dead,whereas those in need of transplants die on the ever-expandingwaiting list. You think about live donation risks that could beprevented with a more rational understanding of death. Nonetheless,you maintain your composure and say, “I’m sorry.”

References Bortz, A. P., Ashkenazi, T., Meinikov, S. (2014). Spirituality as a predictive factor for signing an organ donation card. Journal of Nursing Scholarship, 47(1) 25-33. doi: 10.1111/jnu.12107

Jacoby, L., & Jaccard, J. (2010). Perceived Support Among Families Deciding About Organ Donation for Their Loved Ones: Donor Vs Nondonor Next Of Kin. American Journal Of Critical Care, 19(5), e52-e61. doi:10.4037/ajcc2010396

Linde, E. B. (2009). Consider the ethical issues raised by organ donation, such as how to define death. Then examine your own opinions. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?article_id=835990

Lockwood, w. (2013). Organ and Tissue Donation What Every Nurses Need to Know. Retrieved from http://www.rn.org/courses/coursematerial-10014.pdf

Truog, R., Miller, F., & Halpern, S. (2013). The Dead-Donor Rule and the Future of Organ Donation. New England Journal Of Medicine, 369(14), 1287-1289. doi:10.1056/nejmp1307220

Walker, R., Juengst, E., Whipple, W., & Davis, A. (2014). Genomic Research with the Newly Dead: A Crossroads for Ethics and Policy. The Journal Of Law, Medicine & Ethics, 42(2), 220-231. doi:10.1111/jlme.12137

Wall, S., Munjal, K., Dubler, N., & Goldfrank, L. (2014). Uncontrolled Organ Donation After Circulatory Determination of Death: US Policy Failures and Call to Action. Annals Of Emergency Medicine,63(4), 392-400. doi:10.1016/j.annemergmed.2013.10.014

Westrick, S. J., Dempski, K. (2009). Organ and tissue donation and transplantation. In Essentials of nursing law and ethics (1st ed., pp.131-136). Sudbury, MA: Jones and Barlett