Organ Donation Britta, Becky, Alex, Anne, Tuyen, Erin, & Angelica
Basic Donation List Info • United Network for Organ Sharing (UNOS) • Organ Procurement Organizations (OPOs) • 11 regions in US, each have many OPOs, therefore there are many waiting lists for same organ throughout the country
What happens when an organ becomes available? • Computer system generates list of potential candidates based on many factors • OPO finds match from UNOS list and contacts surgeon • If match can’t be made, expanded locally, then UNOS region, then nationally
Liver Lists as an Example • Placed on list depending on length of time and degree of illness • Degree of illness determined by status code • Status 1: in ICU, will live less than 7 days • Status 2: in hospital, can’t be discharged • Status 3: require frequent outpatient care • Status 4: in holding pattern
Organs that can be donated: Heart, lung(s), pancreas, intestines, bone, cornea, heart valves, stomach, and Liver.
Two general ways to donate/transplant organs 1.) Cadaveric Donor Organ Transplantation Dependant on many factors: ~ blood and tissue compatibility between donor and recipient, based on organ size and on ABO blood type ~ effective immunosuppression (explained later) ~ limited ischemia time; Both warm and cold.
2.) Living Donor Organ Transplantation - Usually genetically related (most commonly siblings) yields good results because of good tissue compatibility between donor and recipient.
Is there always equal treatment of who receive organs? • Ie: Should an alcoholic receive the same preference in receiving an organ donation as someone who has an genetic-uncontrollable cause of need for an organ?
Causes for Liver Transplants: Liver disease refers to any disorder of the liver • Non-Alcohol Related Liver Disease include: -Congenital Birth Defects -ex. Biliaryatresia in the #1 need for liver transplants in children -Metabolic Disorders -Viral or Bacterial Infections -ex: Hepatitis, bacterial peritonitis, complication of liver infection -Nutritional Deficiencies -Trauma or Injury • Alcohol Related Liver Disease include: -Fatty Liver Disease -Alcoholic Hepatitis -Alcohol Cirrhosis
Arguments For Equality: • Equality • Morality • Alcoholism is a disease • Causes of alcoholism • Statistics
Equality : • Every person should be treated equal no matter the condition or cause of the medical problem. • Patients with ARESLD (alcohol-related end-stage liver disease) should not be singled out when a large number of patients with health problems that can be considered self-afflicted are not. ~Patients such as smokers with chronic lung disease; individuals with multiple behavioral risk factors (inattention to blood pressure, cholesterol, diet and exercise) who develop coronary artery disease
Morality: • Moral evaluation is wisely and rightly excluded from all deliberation of who should be treated and how. ~Alcoholism is a not a moral failing but is consider a disease. ~Public reject organ donation to alcohol-related disease because they feel that excessive drinking is wrong- doing. However, the public does not consider other factors that contribute to the disease. ~There is absolutely no agreement about what constitutes moral virtues and vice and what rewards or penalties they deserve.
Alcoholism is a disease: Just as all other diseases alcoholism: • Has Hereditary, Environmental, and Lifestyle factors • Has psychological and physical symptoms • Can be treated as other chronic diseases
Causes of Alcoholism: • Genetic causes: researchers have identified clusters of genetic variations in 51 chromosomal regions that they believe play a role in alcohol addiction through cell-to-cell communication, control of protein synthesis, regulation of development, and cell-to-cell interactions. • Psychological causes • Cultural and Social causes
Statistics: • 61.4% of adults in America drink alcohol, 15% are former drinkers (some stats up to 90% adults drink) • About 14 million Americans abuse and/or are dependent on alcohol • On a daily basis only 700,000 (1/20th that abuse) are being treated • ARESLD patients represent over 50% of ESLD patients, though less than 10% get liver transplants
Alcoholics Should Not be considered Equally:
Alcoholics Should Not be considered Equally: Arguments: • Alcoholic related liver disease takes many years to develop • Many treatment/screening resources are available for alcoholics • Livers are a scarce commodity • Cessation of drinking can reverse liver disease • Society favors people with natural liver disease rather than alcoholics
Alcoholic related liver disease takes many years to develop: • Alcoholic related liver disease required 20-30 years of heavy drinking to develop. • Alcoholics have a lot of time to realize their dependency. • Should be held responsible for extensive abuse.
Many treatment/screening resources are available for alcoholics: • Many screening tools to identify alcoholism: CAGE, AUDIT • There are symptoms of liver disease: Edema of the legs, bruising and jaundice • There are numerous treatment facilities: Many are no cost to the client 114,000 AA groups in the world alone
Livers are a scarce commodity: • There were fewer than 2000 liver transplants in 1989 • Due to scarcity, natural liver disease clients should have a greater priority over those who caused their disease. • There is a high risk of relapse for alcoholics
Cessation of drinking can reverse liver disease: • The liver has the ability to regenerate new cells • Even once Cirrhosis has developed, cessation of drinking can reverse some of the damage and improve the condition • A person with natural liver damage does not have the opportunity to reverse the damage to their liver
Society favors people with natural liver disease rather than alcoholics: • Life saving procedures for children or natural disease clients was the highest priority of the public • Alcohol related liver disease was rated the lowest priority of the public • “Tax payers are less likely to support initiatives that do not take causation into account and demonstrate the common belief that ARESLD patients are responsible for the complications they inflicted upon themselves.”
The importance of equality of recipients as it pertains to Nursing: • Code of Ethics • Justice • Equality
Our Group Personal Opinion= There should be an inequality • As a nurse= We feel there should be equality for all.