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Unfortunately, twenty-two of these people die while waiting for an organ on a daily basis. We need a way to save these lives, and we have one: Organ donation.
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Controversy surrounds this option for many reasons, and some do not find this option to be ethical. One of the biggest ethical dilemmas regarding Organ and Tissue Donation is the requirements for determining a donor. Over time, there has been many different guidelines and regulations to follow in regard to determining death.
Their guidelines outlined the determinants of death: brain death and circulatory death, which always follows brain death. Although the NICE is focused on England and Wales, their guidelines on brain and circulatory death are parallel to american guidelines. Patients that have either suffered a catastrophic brain injury resulting in the loss of more than one cranial nerve reflexes, or perform lower than a four on the Glascow Coma Scale can be identified as potential donors NICE 5.
When caring for a patient that fills one of the requirements of brain death, the nurse on duty needs to be informed immediately. In some, cases a potential donor may have had wishes prior to their brain death that need to be upheld, these views and wishes need to be respected. The article was published recently in and is very similar to the protocol in the United States. Brain death is determined by whether or not the required preconditions have been met, a neurological exam, and extra testing including electroencephalography, transcranial doppler study and a CT angiography HCN A problem that possibly makes this protocol unethical, is that a proportion of patients who have these clinical trigger can still survive.
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When brain death is determined and the patient is legally considered a donor, the patient is taken off life support and circulatory death follows. Donation after circulatory death DCD is time sensitive, circulatory arrest needs to be determined and an observation period of five minutes after arrest with no intervention is required HCN Following this time, circulatory and respiratory arrest is irreversible and death is declared, if the patient was legally deemed a donor, organ procurement proceeds immediately to prevent viable tissue decay.
After a patient meets the physical requirements for donation, the legal requirements need to be met. This could be totally avoided if we considered changing our donor registration system. This system eliminates the need to consult a family when donor status is unsure, because it is assumed the patient is a donor.
Barker noted that although when asked, most people are in favor of donation, but in the UK only twenty-nine percent of the population are registered donors. There are two versions of this system: hard opt-out and soft opt-out. The hard opt-out system means the physician can remove organs even though the family knew the patient did not want to be a donor, and neglected to opt-out.http://pierreducalvet.ca/38802.php
Organ Donation Research Paper: Commercialization of Organ Transplants
In the soft opt-out system family consent is still sought out to reduce the burden on the family. This system was introduced in Belgium and donation rates went up by fifty-five percent. This system does not come without problems, if people are not properly educated and do not opt-out this could potentially result in retrieving organs from a patient without true informed consent, which is unethical. Pediatric patients would not be included in this, the family would always be sought after when considering donation because minors do not make their own medical decisions.
Laura Siminoff, Anthony Molisani, and Heather Traino compared the outcomes and request process in adult and pediatric organ donation, and their findings are alarming. According to Siminoff, Molisani, and Traino there is over one-hundred and twenty thousand patients on the transplant list, and one-thousand eight-hundred and thirty-nine of those are pediatric patients Siminoff, Molisani, Traino It would be assumed that because pediatric patients make up a smaller percentage of the donor list, that they would have a better chance of survival, but that is not true.
Twice as many pediatric patients will die on the waiting list, compared to adults Siminoff, Molisani,Traino After seeing this trend, it evokes curiosity towards what causes this trend. This negates the trend, if families of pediatric patients are more likely to consent to donation, why is there a shortage of pediatric organs for donation? Siminoff, Molisani, and Traino recognized that health care professionals attitudes towards families of pediatric patients differs from adult patients. Most families of pediatric patients see donation as a way for a child to live on, or prevent another family from enduring the same pain they are going through.
These authors expressed that failing to pursue potential donors is a significant factor in the shortage of procurement from potential donors Morris, Wilcox, Frist They estimate that twenty thousand children between the ages of one and sixteen that qualify to be an organ donor, will die each year without becoming donors Morris, Wilcox, Frist This is a shocking number to consider given the shortage of pediatric organs for donation. Both of these studies have proven that health care providers involved in this process need to be more fragile with families of pediatric patients, but the option of organ donation still needs to be discussed and this could slowly help decrease the number of children that die on the transplant list each year.
In the realm of pediatric organ and tissue donation, there is the topic of neonatal donation that will also help shed light on the ethicality of organ and tissue donation. Discussion surrounding whether organ and tissue donation is ethical in neonates is a very hot topic subject in the medical community. Presson, Richard Perez, and Robert DiGeronimo was recently published in July of and offers the protocol for determining neonatal donors and other insight.
Stiers et al. This trend is because of the same reasons that Siminoff, Molisani, and Traino found regarding the attitudes of the health care staff towards parents. This study found that most neonates who die in the NICU would be eligible to donate, because they meet the current criteria. To meet the criteria, a patient must weigh in over two kilograms, and the child must pass away within ninety minutes of removing life-sustaining interventions.
For the procurement process to be successful, the patient must be referred to the organ procurement organization OPO before ending life-sustaining care Stiers et al.
In this particular study, Stiers et al. This reiterates once again that it is key to discuss donation with the family because of the findings of previous studies that families of pediatric patients are more likely to consent to donation. Neonatal donation is just one of the many ethical dilemmas in organ and tissue donation, amongst these issues is how religion can affect donation.
Messina this past September of and outlines the most recent information on religion and its effect on organ donation. Essentially, Catholics support donation if the donor is pronounced dead before procurement. In my opinion this means that this church does not support donation after death if the patient did not indicate their donor status prior.
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Because that would require the doctor to talk to the family and the patient could no longer be involved, it also means the doctor will be involved in convincing the family which the church does not support. Islam has a lot of stipulations in regard to organ and tissue donation, they believe violating a body living or dead is forbidden, but saving a life is highly valued. Also, Muslims are traditionally buried within twenty-four hours which can present problems when considering long procurement surgeries Messina The Jewish faith is similar to Islam in that interfering with bodies after death is not accepted, but saving a live is valued, so Jewish law can be broken to save a life Messina To them, blood represents life, and only God can touch blood Messina This can cause lost opportunities, and has a negative effect on the supply and demand on donatable organs.
Another reason there is a large gap in organ donors and receivers is physician failure. Morris, Wilcox, and Frist discussed that one way a physician can fail is by not presenting the option of organ donation to their patients and families Morris, Wilcox and Frist If the doctor waits too long to discuss the option it may be too late. In Italy, there is similar problems in terms of lack of donors. Potenza, A. Guermani, M. Peluso, A. Casciola, I.
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Irrespective of the type of a donor for the body part, the donor should have a blood group suited for the patient. He or she should be of the same blood group as the patient or a universal donor. Once consent is given, an organ is removed and transplanted into the patient with a few hours. It cannot be stored.
Living donors can donate parts such as one of their kidneys or parts of a liver, a pancreas or intestines. A deceased person can donate the above organs and organs, heart, liver and pancreas. Other body parts that can be donated include tissues such as the skin and bone marrow, and blood and platelets. Organ donation is a very beneficial process. A person who is about to die because of organ failure is able to get a second chance at life due to the organ transplant.
Some of the organs that assist in saving lives are the heart and the liver. Another benefit with organ donation is in relation to the furthering of medicine through research. Some people donate their organs, as they approach their death, to medical institutions for purposes of research.