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 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.
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 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.
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 driver’s 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
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
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 today’s 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
Examiner’s 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