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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?

-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
  • 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.
new federal requirements
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
Morality
  • The “rightness” or “wrongness” of an act or thought
  • Widely shared beliefs in a particular culture or subculture
ethics
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
Major Legislation1968 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.
slide10
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?
  • 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 Legislation1984 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
  • 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
  • Admitting failure: A patient has died
  • Stepping aside
  • Supporting or Obstructing Patient Management
south florida communities
South Florida Communities
  • Haitian
  • African American
  • Hispanic
informed decision to informed consent
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
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
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 criteria harvard medical school
Brain Death CriteriaHarvard 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
  • 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
  • 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?
  • 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 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
  • 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?

Donors

Recipients

Organ

Procurement

Agency

Transplant

Center

UNOS Organ Center

ethical issues of transplant recipients
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
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
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
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
  • 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
  • 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
  • Showing an unwillingness to spend time to answer questions
  • Giving the option of organ donation before knowing if the patient is a candidate
slide38

Jackson

Liver Transplant Recipient

slide39

Liver, stomach, pancreas,

small bowel and piece

of colon recipient

slide42

heart

recipient

slide43

Trine

Liver Recipient

slide44

Oneisha and Missick

Liver Transplant Recipients

slide45

Erik,

heart

transplant

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