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Life Alliance Organ Recovery Agency

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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Life Alliance Organ Recovery Agency

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  1. Life Alliance Organ Recovery Agency 1-800-255-4483

  2. Teaching Ethics in a Multicultural Environment: An Organ Donation Perspective Life Alliance Organ Recovery Agency University of Miami

  3. 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.

  4. 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.

  5. State of Donation/Transplantation

  6. 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.

  7. Morality • The “rightness” or “wrongness” of an act or thought • Widely shared beliefs in a particular culture or subculture

  8. Ethics • The “why” or the actual underpinning for the act or thought. • Perspectives that allows one to examine or understand something

  9. 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.

  10. 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.

  11. How does one express voluntary donation wishes? • Registries: DMV • Donor cards • Advance directives aka, Living Wills • Sharing your thoughts and decisions with your family

  12. 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

  13. 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

  14. 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

  15. Medical Staff Ethical Dilemmas • Admitting failure: A patient has died • Stepping aside • Supporting or Obstructing Patient Management

  16. South Florida Communities • Haitian • African American • Hispanic

  17. 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?

  18. 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?

  19. 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)

  20. Brain death vs. Coma?

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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.

  27. How Does It Work? Donors Recipients Organ Procurement Agency Transplant Center UNOS Organ Center

  28. Organ Matching

  29. 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?

  30. 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.

  31. 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

  32. 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

  33. 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.

  34. 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

  35. 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

  36. Jackson Liver Transplant Recipient

  37. Liver, stomach, pancreas, small bowel and piece of colon recipient

  38. Liver and small bowel recipient

  39. heart recipient

  40. Trine Liver Recipient

  41. Oneisha and Missick Liver Transplant Recipients

  42. Erik, heart transplant

  43. Life Alliance Organ Recovery Agency 1-800-255-4483

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