The Imminently Dying Donor

2021 ◽  
pp. 261-284
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Organ Donation ◽  
Living Donor ◽  
Organ Procurement ◽  
Extreme Case ◽  
Living Donation ◽  
Ethical Norm ◽  
Dead Donor Rule ◽  
Healthy Donors ◽  
Donation Process ◽  
The Individual

As the supply-demand gap for organs for transplantation grows, transplant programs are more accepting of less healthy donors. This chapter focuses on the extreme case: whether and when individuals who have life-limiting conditions (LLC) should be considered for living organ donation. Two types of cases are examined: living donation by individuals with advanced progressive severe debilitating disease for whom there is no ameliorative therapy; and pre-mortem living donation by individuals who are imminently dying or would die of the donation process itself. With appropriate safeguards, some donations by individuals with LLC could be ethical. Pre-mortem donations challenge the dead donor rule (DDR), an ethical norm that prohibits organ procurement until after the individual is dead. The chapter argues that attempts to circumvent the DDR fail to respect the living donor as a patient in his or her own right.

scholarly journals Living Donation by Individuals with Life-Limiting Conditions

2019 ◽  
Vol 47 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Lainie Friedman Ross ◽  
J. Richard Thistlethwaite
Keyword(s):  
Organ Donation ◽  
Living Donor ◽  
Ethical Issues ◽  
The Other ◽  
Living Donation ◽  
Living Organ Donation ◽  
Healthy Donors ◽  
Donation Process

The traditional living donor was very healthy. However, as the supply-demand gap continues to expand, transplant programs have become more accepting of less healthy donors. This paper focuses on the other extreme, asking whether and when individuals who have life-limiting conditions (LLC) should be considered for living organ donation. We discuss ethical issues raised by 1) donation by individuals with progressive severe debilitating disease for whom there is no ameliorative therapy; and 2) donation by individuals who are imminently dying or would die by the donation process itself.

Family perspectives on organ and tissue donation for transplantation: A principlist analysis

2017 ◽  
Vol 25 (8) ◽  
pp. 1041-1050
Author(s):  
Marcelo José dos Santos ◽  
Lydia Feito
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Sao Paulo ◽  
Tissue Donation ◽  
São Paulo ◽  
Ethical Considerations ◽  
Donation Process ◽  
The Family ◽  
Organ Procurement Organizations ◽  
Family Interview

Background: The family interview context is permeated by numerous ethical issues which may generate conflicts and impact on organ donation process. Objective: This study aims to analyze the family interview process with a focus on principlist bioethics. Method: This exploratory, descriptive study uses a qualitative approach. The speeches were collected using the following prompt: “Talk about the family interview for the donation of organs and tissues for transplantation, from the preparation for the interview to the decision of the family to donate or not.” For the treatment of qualitative data, we chose the method of content analysis and categorical thematic analysis. Participants: The study involved 18 nurses who worked in three municipal organ procurement organizations in São Paulo, Brazil, and who conducted family interviews for organ donation. Ethical considerations: The data were collected after approval of the study by the Research Ethics Committee of the School of Nursing of the University of São Paulo. Results: The results were classified into four categories and three subcategories. The categories are the principles adopted by principlist bioethics. Discussion: The principles of autonomy, beneficence, non-maleficence, and justice permeate the family interview and reveal their importance in the organs and tissues donation process for transplantation. Conclusion: The analysis of family interviews for the donation of organs and tissues for transplantation with a focus on principlist bioethics indicates that the process involves many ethical considerations. The elucidation of these aspects contributes to the discussion, training, and improvement of professionals, whether nurses or not, who work in organ procurement organizations and can improve the curriculum of existing training programs for transplant coordinators who pursue ethics in donation and transplantation as their foundation.

Increasing Referrals and Donations Using the Transplant Center Development Model

1996 ◽  
Vol 6 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Mark T Gravel ◽  
Penelope Szeman
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Medical Center ◽  
Development Model ◽  
Tissue Donation ◽  
Staff Education ◽  
Organ Procurement Organization ◽  
Organ And Tissue Donation ◽  
Transplant Center ◽  
Donation Process

Although transplantation centers directly benefit from organ and tissue donation, they continue to yield low organ and tissue referral and donation rates. Our medical center and organ procurement organization developed a model to increase referral and donation rates. This model, called the Transplant Center Development Model, facilitates the donation process, specializes staff education, and promotes administrative involvement. After it was was implemented at our medical center in 1991, the referral and donation rates from 1988 to 1990 were compared with those from 1991 to 1993. The results showed that after implementation of the model, the organ referral mean increased 47%; the organ donation mean, 50%; and the tissue donation mean, 117%. These findings suggest that this model may be a valuable tool in transplant center development.

Double-Effect Donation Disputed

2021 ◽  
pp. 002436392110381
Author(s):  
Thomas A. Cavanaugh
Keyword(s):  
Organ Donation ◽  
Healthy Individual ◽  
Living Donor ◽  
Double Effect ◽  
Vital Organ ◽  
Dead Donor Rule ◽  
Knowing That ◽  
The Dead ◽  
Living Person ◽  
Do So

In “Double Effect Donation,” Camosy and Vukov argue that “there are circumstances in which it is morally permissible for a healthy individual to donate their organs even though their death is a foreseeable outcome”. They propose that a living donor could ethically donate an entire, singular, vital organ while knowing that this act would result in death. In reply, I argue that it is not ethical for a living person to donate an entire, singular, vital organ. Moreover, mutatis mutandis, it is not ethical for surgeons and others to perform such a deadly operation. For to do so is “intentionally to cause the death of the donor in disposing of his organs”. Such an act violates the dead donor rule which holds that an entire, singular, vital organ may be taken only from a corpse. Contrary to Camosy and Vukov’s claims, double-effect reasoning does not endorse such organ donation.

Join the Lone Kidney Club: incentivising live organ donation

2020 ◽  
pp. medethics-2019-105999
Author(s):  
Annet Glas
Keyword(s):  
Informed Consent ◽  
Organ Donation ◽  
Living Donor ◽  
Organ Procurement ◽  
Organ Transplant ◽  
Live Organ Donation ◽  
Regulatory Frameworks ◽  
Attractive Option ◽  
Patient Groups ◽  
Procurement System

Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option, and ethically permissible if informed consent is given and donor beneficence balances recipient non-maleficence. Only a few legal and regulatory frameworks incentivise LOD, with the key exception of Israel’s Organ Transplant Law, which has produced significant improvements in organ donation rates. Therefore, I propose an organ procurement system that incentivises LOD by allocating additional priority points to the living donor on any transplant waiting list. I outline benefits and challenges for potential recipients, donors and society at large, and suggest measures to ensure medical protection of marginalised patient groups.

A Qualitative Study of Turning Points or Aha! Moments in Older Adults’ Discussions About Organ Donation

2018 ◽  
Vol 28 (3) ◽  
pp. 207-212 ◽  
Author(s):  
Kimberly Downing ◽  
Linda L. Jones
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Organ Donation ◽  
Organ Procurement ◽  
Turning Points ◽  
Age Groups ◽  
Organ Donor ◽  
Younger Age ◽  
Donation Process ◽  
Dialogue Process

Introduction: Older adults (50-70 years old) have lower organ donor registration rates than younger adults. Older adults have different informational needs and donor registration behavior than younger age groups. Objective: The objective of this qualitative study was to understand insights of older adults about organ donation to effectively address the barriers to becoming an organ donor. This study identified turning points as “Aha!” moments that occurred during a dialogue intervention where older adults discussed benefits, barriers, and process to organ donation. Setting and Participants: Dialogues were held with small groups of older adults in 11 communities in a Midwestern organ procurement organization service area. Participants were positive to organ donation, but not registered as an organ donor. Methods/Approach: Qualitative analysis of verbatim comments from the dialogue and a follow-up survey were used to examine turning points or “Aha!” moments of participants’ decision-making about organ donation and organ donor registration. Findings: Twenty-one separate in-depth dialogues were conducted with 198 participants, with mean age of 60.57 years. There were 2757 separate comments coded with 465 of the comments (17%) identified as providing Aha! moments during the dialogue. Three themes include benefits of organ donation (30%), barriers about organ donation (39%), and organ donation process (31%). Discussion: The research identified moments in the dialogue where possible learning about organ donation may have occurred. After participation in the dialogue process, there was an increase in intent to register to be an organ donor, organ donation discussion with family and friends, and organ donor registration.

Chaplain “DOs and DON’Ts” on Organ Donation

2018 ◽  
Vol 43 (7) ◽  
pp. 1-2
Author(s):  
Jozef Zalot ◽  
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Family Members ◽  
Organ Donor ◽  
Organ Donors ◽  
Vital Organ ◽  
Course Of Action ◽  
Donation Process ◽  
Organ Procurement Organizations ◽  
The Relationship

This guide was developed in collaboration with LifeCenter Organ Donor Network (Cincinnati, OH) to offer chaplains a framework for the best possible course of action when they provide spiritual care to family members of patients who are potential vital organ donors. Some organ procurement organizations (OPOs) may want to control the donation process. They are thus hesitant to invite in—let alone collaborate with—any “outsiders” who they believe might undermine the likelihood of procuring vital organs. So how should a chaplain respond when ministering to potential vital organ donors and their families? Should they speak with family members about donation? What should they say? Do OPOs want chaplains to speak with family members? Should there be limits to these conversations? This can be a touchy area, because vital organ donation necessarily entails the death of the patient. This makes the relationship between chaplains and OPOs sometimes strained.

Donation Education for Medical Students: Enhancing the Link between Physicians and Procurement Professionals

2005 ◽  
Vol 15 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Christian C. Essman ◽  
Daniel J. Lebovitz
Keyword(s):  
Medical Students ◽  
Organ Donation ◽  
Ethical Issues ◽  
Organ Procurement ◽  
Tissue Donation ◽  
Current Crisis ◽  
Educational Approach ◽  
Organ And Tissue Donation ◽  
Donation Process ◽  
Organ Procurement Organizations

Purpose Increasing healthcare professionals' knowledge about organ and tissue donation; the national mandates regarding referral compliance; and the effect on donors, donor families, and transplant recipients is a challenging task. Physicians not routinely involved in organ donation or transplantation are some of the most difficult professionals for organ procurement organizations to access. A course for medical students was developed to initiate the transfer of information, comfort, and familiarity with the organ and tissue donation process. Methods Discussions with a local medical school revealed that little organized education on organ and tissue donation existed. An elective course was developed consisting of 2-hour lectures, once a week for 6 weeks. Topics included an overview of tissue and organ donation, history and significance of the current crisis, determination of brain death and its role in organ donation, tissue donation, pretransplant and posttransplant processes, ethical issues, and the donor family and recipient experience. Results A thorough course proposal was presented to the medical school's Chairman of Surgery and Chairman of Transplantation. The proposal was approved for first- and second-year medical students. Conclusion Offering medical students a unique and comprehensive course may attract curious students who could become future champions for donation. This type of educational approach may significantly influence future interactions between physicians and organ procurement organizations. If more organ procurement organizations implement this type of program, the medical students' knowledge of donation will not only affect and benefit the local organ procurement organization's service area but other procurement organizations throughout the country as well.

scholarly journals Equity or Equality? Which Approach Brings More Satisfaction in a Kidney-Exchange Chain?

2021 ◽  
Vol 11 (12) ◽  
pp. 1383
Author(s):  
Arian Hosseinzadeh ◽  
Mehdi Najafi ◽  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
Mahdi Fathi
Keyword(s):  
Living Donor ◽  
Organ Procurement ◽  
Indirect Costs ◽  
Allocation Of Resources ◽  
Governmental Organization ◽  
Kidney Exchange ◽  
Exchange Program ◽  
Donation Process ◽  
The U.S

In United States (U.S.), government-funded organizations, such as NLDAC, reimburse travel and subsistence expenses incurred during living-organ donation process. However, in Iran, there is a non-governmental organization called Iranian Kidney Foundation (IKF) that funds the direct and indirect costs of donors through charitable donations and contributions from participants in the exchange program. In this article, for countries outside the U.S. that currently use an equality approach, we propose a potential new compensation-apportionment approach (equitable approach) for kidney-exchange chains and compare it with the currently available system (equality approach) in terms of the apportionment of compensation in a kidney-exchange chain to cover the expenses incurred by the initiating living donor of the chain in the act of donation. To this end, we propose a mechanism to apportion compensation among all participating pairs based on the equity approach by utilizing a prediction model to calculate the probability of graft survival in each transplant operation. These probabilities are then used to define the utility of any transplantation, considering the quality of each pair’s donated and received kidney in the chain. Afterward, the corresponding cost is apportioned by a mechanism based on the normalized differences between the utility of donated and received kidneys for each incompatible pair of the chain. In summary, we demonstrate that by utilizing the equitable approach, there is more fairness and equity in the allocation of resources in organ-procurement systems, which results in more satisfaction among incompatible pairs. Additional future prospective studies are needed to assess this proposed equitable approach for kidney-exchange chains in countries outside the U.S., such as Iran, that currently use an equality approach.

Organ Donation

2019 ◽  
pp. 545-551
Author(s):  
Lissi Hansen ◽  
Lauren F. Dunn
Keyword(s):  
Palliative Care ◽  
Brain Death ◽  
Organ Donation ◽  
Organ Procurement ◽  
Federal Regulations ◽  
Donation After Circulatory Death ◽  
Bedside Nurse ◽  
Donation Process ◽  
Organ Procurement Organizations ◽  
Circulatory Death

This chapter examines the organ donation process from the time the bedside nurse recognizes that a patient should be referred for organ donation until organ procurement has been completed. It also discusses when to speak with families about organ donation, how to address family concerns, the clinical triggers for organ donation, differences between brain death donation and donation after circulatory death (DCD), and palliative care for patients who are candidates for DCD. State and federal regulations related to prospective donors and safeguarding standards that are in place for organ procurement organizations (OPO) and hospitals are also included.

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