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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?.

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Teaching ethics in a multicultural environment an organ donation perspective

Teaching Ethics in a Multicultural Environment: An Organ Donation Perspective

Life Alliance

Organ Recovery Agency

University of Miami


Why is organ donation important
Why is Organ Donation important? Donation Perspective

-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
Newsroom Facts - UNOS Donation Perspective

  • 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
State of Donation/Transplantation Donation Perspective


New federal requirements
New Federal Requirements Donation Perspective

  • 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
Morality Donation Perspective

  • The “rightness” or “wrongness” of an act or thought

  • Widely shared beliefs in a particular culture or subculture


Ethics
Ethics Donation Perspective

  • 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
Major Legislation Donation Perspective1968 Uniform Anatomical Gift ActRevised 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
How does one express voluntary donation wishes? 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.

  • Registries: DMV

  • Donor cards

  • Advance directives aka, Living Wills

  • Sharing your thoughts and decisions with your family


Major legislation 1984 national organ transplant act
Major Legislation 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.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

Brain death is the irreversible cessation of the entire brain, including brain stem

Determination of death must be made by two board eligible or certified physicians

1987Florida Brain Death Law


Opo responsibilities
OPO Responsibilities brain, including brain stem

  • 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
Medical Staff Ethical Dilemmas brain, including brain stem

  • Admitting failure: A patient has died

  • Stepping aside

  • Supporting or Obstructing Patient Management


South florida communities
South Florida Communities brain, including brain stem

  • Haitian

  • African American

  • Hispanic


Informed decision to informed consent
Informed Decision to Informed Consent brain, including brain stem

  • 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
Pediatric Ethical Considerations brain, including brain stem

  • 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
Acceptable Donors brain, including brain stem

  • 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 vs. Coma? brain, including brain stem


Brain death criteria harvard medical school
Brain Death Criteria brain, including brain stemHarvard 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
Brain Death brain, including brain stem

  • 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
Cardiac Death brain, including brain stem

  • 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
What’s the difference from a coma? brain, including brain stem

  • Coma entails some lower level of brain electrical activity, however absence of any cortical activity

  • Coma does NOT equal Brain Death


Categories of donation
Categories Of Donation brain, including brain stem

  • 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
Donation after Cardiac Death brain, including brain stem

  • 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
How Does It Work? brain, including brain stem

Donors

Recipients

Organ

Procurement

Agency

Transplant

Center

UNOS Organ Center


Organ matching
Organ Matching brain, including brain stem


Ethical issues of transplant recipients
Ethical Issues of Transplant Recipients brain, including brain stem

  • 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
Does being a celebrity or being rich influence listing? brain, including brain stem

  • 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
Nurses’ Role in Donation brain, including brain stem

  • 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
Goals of Donor Care brain, including brain stem

  • 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 brain, including brain stem

  • 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
Errors to Avoid With Families brain, including brain stem

  • 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 families1
Errors to avoid with families brain, including brain stem

  • Showing an unwillingness to spend time to answer questions

  • Giving the option of organ donation before knowing if the patient is a candidate


Jackson brain, including brain stem

Liver Transplant Recipient


Liver, stomach, pancreas, brain, including brain stem

small bowel and piece

of colon recipient


Liver and small bowel brain, including brain stem

recipient


heart brain, including brain stem

recipient


Trine brain, including brain stem

Liver Recipient


Oneisha and Missick brain, including brain stem

Liver Transplant Recipients


Erik, brain, including brain stem

heart

transplant


Life alliance organ recovery agency 1 800 255 4483
Life Alliance Organ Recovery Agency brain, including brain stem 1-800-255-4483


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