There are many legal and ethical issues that contribute to the shortage or organs in our country. The way that organs are distributed is a decision that can ultimately result who will live and who will die. Some believe that length of time one is expected to survive and the degree to which they can be rehabilitated should be a determining factor.
Perhaps the most common misconception is the belief that medical personel will not make every effort to save the life of the donor. An organ can only be procured after brain death occurs. There is both medical and legal criteria that muct be followed before a person is declared dead.
Many believe that a market for selling organs would drastically increase the amount of organs needed for transplantation. The buying and selling of organs is illegal and is surrounded by ethical issues. There have been proposals to simply change the federal lay governed by the National Organ Transplant Act (NOTA) that mans organ sales. Another strategy that was suggested is a regulated market. In this case, "the government would purchase the organs, set a fixed price, and determint the conditions of sale."
Presumed consent is an option that would most likely increase the number of donors. This option has never been practiced in the united States, but is successful in "some European countries, such as Spain, Belgium and Austria," to name a few. With this system, everyone is a donor unless appropriate measures are taken to reverse the donation. There is a 25% higher donation rate in Europe that in the U.S. using this system.
Many question whether or not multiple listings are ethical. "Approximately 10% of patients on the current national waiting list are in multiple transplanbt centers." While patients increase their chance of receiving a transplant, some say it is not fair to those without the financial resources. Each evaluation can result in a cost of "tens of thousands of dollars."
Senior Vice President and Corporate Compliance Officer, LifeLink Foundation
Dalton Yezovich's insight:
1. What type of safety screening is used prior to transplantation?
When a potential organ donor is referred to us (from a hospital environment) we first review the patients chart to determine the circumstances leading to brain death. We try to uncover any events that would render a specific organ untransplantable first. From here we look at the patients labs, recorded social history as well as any infectious disease testing that may have been performed. One we have cleared the patient at this stage we then approach the next of kin for consent. The performance of a medical and social history interview is now performed. We also inquire if there is an individual more knowledgeable to answer these questions. We want to know about sexual history, drug use and abuse, tattoos, travel and much more. At the same time we perform various infectious disease tests.
2. What are the costs to the donor/recipient?
Once the next of kin of the donor consents to organ donation all medical costs from that point forward are the responsibility of the organ recovery agency. The family or next of kin is still responsible for the final disposition of the donor (ie funeral expenses).
3. What is the time frame in which organs can be removed from a deceased donor?
First you must understand the difference from a deceased person and a brain dead person. All organ donors are brain dead being artificially supported by life support measures that have limitations. Each donor situation is different and is entirely dependent on the health status of the donor before and during the hospital stay. It is rare that once brain death has been declared that a patient remains in the ICU longer than 12 hours before organs are recovered.
4. How are organs kept viable during transport?
If kept chilled in preservation solution and ice, donated organs can remain viable for transplantation for a duration ranging from a few to many hours, although it is best if they are transplanted as quickly as possible after the donation surgery. Typical storage times are 30 hours or less for a kidney, less than 12 hours for a pancreas or liver, and less than 6 hours for a heart or lungs. These times vary because of the relative speed at which deterioration begins in the organs' tissues.
5. There are many misconceptions regarding life saving measures, can you explain what protocol is taken to determine brain death?
All states have statutes governing brain death criteria. They all have components of the following;
Brain death will be confirmed by two physicians licensed in the State of Florida
The determination of brain death is made by a combination of clinical
neurologic examination and apnea test. Confirmatory tests may be performed at the
discretion of the physicians involved.
Documentation of brain death includes the following information:
1. Etiology and irreversibility of the patient’s coma and overall clinical condition
2. Absent pupillary light response
3. Absent corneal reflexes
4. Absent oculovestibular reflexes
5. Absent gag reflex
6. Absent motor response or grimace to a noxious pain stimulus
7. Absent spontaneous respiration despite a PaCO2 ≥ 60 mmHg
8. Justification for and result of additional confirmatory test(s)
9. Findings of repeat neurologic examination
6. Can you briefly explain the selection process?
Many of the elements considered in matching organs from deceased donors to patients on the waiting list are the same for all organs. These usually include: blood type, body size, severity of patient's medical condition, distance between the donor's hospital and the patient's hospital, the patient's waiting time, and the availability of the potential recipient (e.g., the patient can be contacted and has no current infection or other temporary reason that transplant cannot take place).
For certain organs, other factors must be considered. And, some of the common elements take on increased importance for specific organs. For example, thoracic organs such as the heart and lungs can survive outside the body for only 4-6 hours while kidneys can survive up to 36 hours and livers, up to 12. Therefore, distance between the donor's hospital and the potential recipient's hospital is more important for matching hearts and lungs than it is for kidneys or livers.
7. Do recipients have a right to refuse an organ based on moral issues, i.e. race, criminal records, disabilities?
With the exception of living kidney donors, no. The law currently protects the confidentiality of both the donor and their family and the transplant recipients.
8. Due to high medical costs and ethical issues, can prisoners be denied transplants?
This is again a question of ethics. A number of medical professionals share the responsibility of determining if a patient should be placed on waiting lists. No one individual is denied a transplant but other factors may play a role in candidate suitability.
9. What medical personnel are responsible for procuring and transplanting organs?
There are many people at the transplant center who work to make a transplant successful. Each person on the "transplant team" is an expert in a different area of transplantation. The transplant team includes all or some of the following professionals:
• Clinical transplant coordinators have responsibility for the patient's evaluation, treatment, and follow-up care. They are R.N.’s, ARNP’s, or PA’s.
• Transplant physicians are doctors who manage the patient's medical care, tests, and medications. He or she does not perform surgery. The transplant physician works closely with the transplant coordinator to coordinate the patient's care until transplanted, and in some centers, provides follow-up care to the recipient.
• Transplant surgeons perform the transplant surgery and may provide the follow-up care for the recipient. The transplant surgeon has special training to perform transplants.
10. How does LifeLink assist families of the donors and recipients?
LifeLink's relationship with donor families begins in the hospital, but doesn't end there. In the weeks and months following the death of their loved one, we remain available and connected to donor families, offering bereavement support resources, maintaining contact through letters and phone calls and providing emotional guidance. When appropriate, LifeLink also facilitates contact between donor families and transplant recipients. These acknowledgements can often provide comfort while creating a connection between transplant recipients and their donor families.
11. What part do regulatory agencies play?
United Network for Organ Sharing (UNOS) is the private, non-profit organization that manages the nation's organ transplant system under contract with the federal government (Department of Health and Human Services).
As organ transplant is the practice of medicine the U.S. Food and Drug Administration plays no role in the process.
UNOS is involved in many aspects of the organ transplant and donation process:
• Managing the national transplant waiting list, matching donors to recipients 24 hours a day, 365 days a year.
• Maintaining the database that contains all organ transplant data for every transplant event that occurs in the U.S.
• Monitoring every organ match to ensure organ allocation policies are followed.
United Network for Organ Sharing (UNOS) is the private, non-profit organization that manages the U.S. organ transplant system under contract with the federal government.
Dalton Yezovich's insight:
The United Network for Organ Sharing (UNOS) manages the nation's organ transplant system. It operates under the U.S. Department of Health and Human Services. They are respoinsible for coordinating policies and compliance. This ensures that the distribution of life saving organs is fair. The compliance process ensures the safety of patients while building trust in the existing transplant system. Due to those primary goals, transplant policy is both carefully monitored and strictly controlled, leaving no room for illegal actions or unethical practices.
Most major religions not only allow, but encourage organ donation. It is seen as a charitable act that can save or enhance a life. There are however, a few religions that do not stand behind this belief and still see it as unethical.
The Gypsies opposition has to do with their beliefs regarding the afterlife. Their belief is that "the soul retraces its steps for one year following their death." They also believe that in order for the soul to "maintain its physical shape", the body of the deceased must remain intact.
Many people assume that Jehovah Witnesses are opposed to donation. This is not the case, they are simply against blood transfusion. All this means is that all the blood must be removed from the organs and tissue before they can be transplanted.
The Shinto's believe that the body of the deceased is "dangerous and impure", leaving the body in a powerful state. According to "folk belief" bringing harm to a body for the purpose of donation is a severe crime. As a result ofthese beliefs, those of Shinto faith are not willing to give consent.
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