Running head: ORGAN DONATION CHALLENGES
Organ Donation Challenges
Lori Haugen
HCA/EN200A
Myra Adams
Warner Pacific College
Aug 9, 2013
1
ORGAN DONATION CHALLENGES
2
Abstract
There are many factors influencing the availability of organ donors. Many patients die while
awaiting a suitable donor, and the purpose of this paper is to look at the challenges of having
enough organs available when they are needed by critically ill patients. This paper will address
the varied and many reasons that people choose not to register as organ donors.
ORGAN DONATION CHALLENGES
3
Organ Donation Challenges
There are many patients who die while on the waiting list for a suitable organ donation.
There is a large disparity of patients on the waiting list to receive a life-saving organ and those
willing to donate. According to donatelifenw.org “In 2011 there were 120,000 people on the
waiting list for an organ and 112,766 deceased and living donors available” (donatelifenw.org,
2011). Kidney, liver and heart donors are the main focus of this paper. There are many reasons
why possible donors make the choice not to be donors, and those are going to be addressed and
explained.
According to Kylee Hawes, a hospital development coordinator for Community Tissue
Services, one of the reasons for reluctance to donate is the misunderstanding of the organ
donation process. She says that patients fear if they have a “D” on their driver’s license
designating them as an organ donor, that medical personnel will see the designation and not try
to save the patient’s life, so that needed organs can go to other patients in need. The medical
community’s first priority is always to try and save the life of the patient they are caring for
(personal communication, Kylee Hawes, 2013). Hawes assures that the organs would not be
attempted to be retrieved from a person until a number of things happen. First, they have to be
considered brain dead. There is a Glasgow Coma Scale, (GCS) that rates how much brain
function the patient has (personal communication, Hawes, 2013).
According to the site, brainline.org, there are scores attributed to a patient depending on
how the patient performs in three areas; eye opening, motor response, and verbal response In
other words, the medical professionals must assess whether or not the patient can open his eyes,
whether or not he can respond to painful stimulus or touch, and assess whether he is capable of
speech or making verbal sound (brainline.org, 2010). A patient has to fail in most of these areas,
ORGAN DONATION CHALLENGES
4
usually the score is less than five, before they are considered brain dead and the option of
investigating donation is broached with the medical personnel, and ultimately the family of the
patient (personal communication, Hawes, 2013).
Another reason people are reluctant to register as an organ donor is their perception that
they need to be “whole body” for burial (Hawes, 2013). In Clinical Transplantation, the authors
studied Chinese Americans to see why there was a low rate of Chinese organ donation. “The
Confucian concept of ‘filial piety’ dictates that individuals, out of respect for their ancestors, are
required to return their bodies in the same condition that they received them from their parents”
(Lam, McCullough, 2000, p. 450).
Hawes, 2013, explained that there was a Viking belief that if one when into death
without all of your organs, when one returns to the “next life”, the same organs will be missing
(personal communication, Hawes, 2013).
The religion most likely to have pre-conceived reluctance to organ donation in the
Portland area is Hispanic Catholics. It is the hope that since Pope John Paul II registered as an
organ donor during his lifetime, this will allay some of the Catholics fears (personal
communication, Hawes, 2013).
Dubois (2009) states some pro-life Catholics are reluctant to donate organs due to
questioning the brain-death criteria used in 90 percent of all cases of organ donation. They fear
that if brain-death defines death, that an unborn embryo would not be considered alive until it
formed a brain (Dubois, 2009). Dubois went on to say that the late Pope John Paul II would have
disagreed. According to the Catechism of the Catholic Church 2296,
Organ transplants are in conformity with the moral law if the physical and psychological
dangers and risks to the donor are proportionate to the good sought for the recipient.
ORGAN DONATION CHALLENGES
5
Organ donation after death is a noble and meritorious act and is to be encouraged as an
expression of generous solidarity. It is not morally acceptable if the donor or his proxy
has not given explicit consent. Moreover, it is not morally admissible to bring about the
disabling mutilation or death of a human being, even in order to delay the death of other
persons (Catechism of the Catholic Church, 2296).
Organdonor.gov, (2011) found that there is an assumption that Jehovah’s Witness’ would
object to organ donation due to the church’s belief of not accepting blood transfusions. However,
the church does not object to organ donation as long as all of the blood is removed from the
organs or tissues being transplanted.
Another reason that people are reluctant to become organ donors is a fear of not being
respected in the retrieval process. It was a fear that I had in the past. I have been involved in the
organ procurement process while working as a certified surgical technologist. I had wondered
previously about the process and how cold and unfeeling the staff may be for such a procedure. I
was very impressed, on the two occasions I was fortunate enough to assist on organ procurement
surgeries, how professional and grateful the entire team was to the patient for giving such a
generous gift. On both occasions, the patients donated their hearts, livers, and kidneys. The mood
in the operating room during these two surgeries was one of calm respect and gratitude, and I
was thankful for the opportunity to witness it. While the surgeries were commencing, the patients
were treated with the same amount of sterile technique and care that we afforded all of your
patients. I designated myself an organ donor after witnessing these two surgeries.
Another barrier to becoming an organ donor maybe an assumption that the organs are not
healthy enough to donate. For example, prospective donor patients who were positive for the
Hepatitis-B and C viruses have historically been rejected to donate (personal communication,
ORGAN DONATION CHALLENGES
6
Hawes, 2013). Hepatitis-B patients’ organs have been being transplanted into hepatitis-B
positive recipients for about two years, (the transplant recipient consents to the hepatitis positive
transplant first). In the last few months, though, hepatitis-C positive patients have been able to
donate their organs to hepatitis-C positive recipients, thus making it possible to have more
organs available than ever before (Morales, et al. 2010).
Some people fear that the disease they are dying from will preclude them from being able
to donate after death. It is always a case by case basis, but even cancer and sepsis patients have
been able to donate tissue or their corneas, if not their organs. Studies and lab tests will be
performed to insure no disease process will be transferred to the transplant recipient (personal
communication, Hawes, 2013).
Each donor has the capacity to contribute 50 gifts of transplantation through donation.
Not only are organs gifts of donation, but corneas, bone grafts, skin grafts, and soft tissues such
as patellar tendon or Achilles tendon grafts are used to reconstruct burned or injured patients
(fiftylives.org, 2013)
Hyde and White (2011) found in a study in Australia comparing the perceptions of
registered and unregistered donors’ perceptions of transplant recipients. In the study, the authors
found that whether or not a possible donor chose to register to be a donor depended on their
attitude of “deservedness” of the possible transplant recipient. Preconceived ideas of why a
person needed an organ contributed to whether or not the donor registered to be one. The study
found that many people judge the possible transplant recipients as smokers, alcohol abusers, and
drug abusers and did not feel that such recipients were worthy of donations, (Hyde, White, 2011)
Organdonor.gov (2011) found that minorities are three times more likely to have endstage kidney disease. This is due to these particular minorities suffering more often from high
ORGAN DONATION CHALLENGES
7
blood pressure as well as much higher rate of diabetes, (a leading risk factor of kidney failure),
(organdonor.gov, 2011). According to a study in the Journal of Behavioral Medicine, African
Americans spend more than twice the amount of time on the donor waiting list than any other
race (Robinson, Perryman, Thompson, Amaral, and Arriola, 2012).While the need for organ
transplants, particularly kidneys, is greater for African Americans, these minorities are less likely
to be on the registered donor list. Brown, (2012) determined in her study of African American
perceptions on organ donation that there are five main reasons that the community is less likely
to donate: lack of trust of the medical profession, fear of premature death, lack of awareness,
discrimination, and religious beliefs and misconceptions.
Having people of the same ethnicity become organ donors can be critically important to
improving the odds of a successful outcome of the transplantation.
Although organs are not matched according to race/ethnicity, and people of different
races frequently match one another, all individuals waiting for an organ transplant will
have a better chance of receiving one if there are large numbers of donors from their
racial/ethnic background. This is because compatible blood types and tissue markers—
critical qualities for donor/recipient matching—are more likely to be found among
members of the same ethnicity. A greater diversity of donors may potentially increase
access to transplantation for everyone (Organdonor.gov. para4).
Brown addresses the subject of organ donations among ethnic groups in her study. Brown
found that a way to increase organ donation registry among African Americans is to provide
them with better education about organ donation. She suggests a good place for reaching the
community is through the clergy, or houses of worship. This may help dispel the myth that the
body needs to be whole after death for burial (Brown, 2012).
ORGAN DONATION CHALLENGES
8
In a study in the journal, Clinical Transplant, the authors found that there was a lower
rate of African Americans donating a kidney while living than the Caucasian population. The
study also showed that while Caucasians were more likely to donate to un-related friends, and
strangers, as well as family members; the African American subjects usually only donated to
family members. An interesting difference found in the study was that African Americans were
much more likely that Caucasians to donate to their parents, while Caucasians were more likely
to donate to their children. This was due to the average age of the African Americans on the
waiting list being younger than their Caucasian counterparts (Reeves-Daniel, et al. 2011).
One of the solutions to the shortage of organ donors nationally is the use of living
donors. Donate Life.net states that a living organ donor is just what it sounds like; a living person
donates one or part of one of his organs to a recipient who is a good tissue match. For example, if
a husband in renal failure needed a kidney and the wife was determined to be a good tissue
match, she could donate one of her kidneys to her husband as a living donor. Blood relatives are
often found to be a good match, tissue wise. Siblings, parent/child, cousins, aunts/uncles,
nieces/nephews, and even half- siblings are examples of types of blood relatives who are able to
be living donors. Living tissue donors are usually between the ages of 18-60 years, and race is
not a factor (donatelife.net, 2013).
According to donatelife.net (2013) kidneys are the most common organ donated while
the donor is living, but partial lung, liver, pancreas and intestine transplants have also occurred.
The most common example of non-related living donation is spouse to spouse donation.
They are emotionally close but do not share DNA. Another form of this type of donation occurs
between in-laws (donatelife.net, 2013).
ORGAN DONATION CHALLENGES
9
There is no need for there to be a shortage of organs in the United States, or the world for
that matter. With the living donor program, the inclusion of recovering and transplanting
hepatitis B and C- positive organs, and with greater education of all minorities, especially
African American, there should be enough organs for those in need. Even if a patient passes
away from cancer or some other disease process, there is still life saving tissue that could be
harvested and given to someone in need.
ORGAN DONATION CHALLENGES
10
References
Brainline.org/content/2010/what-is-glasgow-coma-scale.html
Brown, ER. (2012). African American Perception of Organ Donation: A Pilot Study ABNF
Journal pg. 29-33
Donatelife.net/understanding-donation/living- donation. (2013).
Donatelifenw.org/content/about-donation. (2011).
Dubois. (2009). Brain Death and Organ Donation. America Magazine. 200 (3) p.19-22.
Hyde, MK. White, KM. (2011). A Comparison of Registered and Unregistered Organ Donors’
Perceptions of Organ Transplant Recipients. Clinical Transplant 14 (5) pg. 444-449
Lam, W. McCullough, L. (2000). Influence of religious and spiritual values on the willingness of
Chinese–Americans to donate organs for transplantation. Clinical Transplantation, (14)
p. 449-456
Morales, J. Campistol, J., Dominguez-Gil, B., Andres, A., Esforzado, N., Oppenheimer, F. . .
Praga, M. (2010). Long-Term Experience with Kidney Transplantation from Hepatitis
C-Positive Donors into Hepatitis C-Positive Recipients. American Journal of
Transplantation. 10 (11), p2453-2462.
Organdonor.gov/why-minority-donors-are-needed. (2011). US Department of Health and Human
Services.
ORGAN DONATION CHALLENGES
11
Robinson, D., Perryman, J., Thompson, N., Amaral, S.. & Arriola, K. (2012). Testing the Utility
of a Modified Organ Donation Model among African American Adults. Journal of
Behavioral Medicine. 35 ( 3) p.364-374
Scborromeo.org/ccc/para/2296.html. Catechism of the Catholic Church.
Reeves-Daniel, A., Bailey, A., Assimos, D., Westcott, C., Adams, P.L. . . . Friedman, B.I.
(2010). Clinical Transplantation. 10, p.2453-4562.