scholarly journals How altruistic organ donation may be (intrinsically) bad

2018 ◽  
Vol 44 (10) ◽  
pp. 681-684 ◽  
Author(s):  
Ben Saunders
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Good Motive

It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good—either excessive or deficient—is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives—that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations.

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.

Comparison of 1 vs 2 Brain Death Examinations on Time to Death Pronouncement and Organ Donation

Neurology ◽  
2021 ◽  
Vol 96 (10) ◽  
pp. e1453-e1461
Author(s):  
Panayiotis N. Varelas ◽  
Mohammed Rehman ◽  
Chandan Mehta ◽  
Lisa Louchart ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Brain Function ◽  
Brain Injuries ◽  
Organ Procurement ◽  
Tertiary Hospital ◽  
Consent Rate ◽  
Organ Procurement Organization ◽  
Time To Death ◽  
Elapsed Time

ObjectiveTo fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.MethodsTwelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.ResultsA total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019).ConclusionsA single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.

scholarly journals Hospital-based organ donation memorial ceremony: a grounded theory pilot study

2015 ◽  
Vol 4 (3) ◽  
pp. 1
Author(s):  
Charles Calhoun Reed ◽  
Elma I Fonseca ◽  
Regina I Reed ◽  
Stacy Foremski ◽  
Sara L Gill
Keyword(s):  
Grounded Theory ◽  
Pilot Study ◽  
Organ Donation ◽  
Organ Procurement ◽  
Social Process ◽  
Organ Donor ◽  
Hospital Staff ◽  
Tree Planting ◽  
Individual Level ◽  
Organ Procurement Organizations

Objective: Various types of organ donation memorials, to include tree planting, rose garden memorials, candle lighting, donor memorial wall events are conducted throughout the year primarily by organ procurement organizations (OPOs). Although the benefits of such events have not been explored there has been continued interest by hospital staff and administrators to host such events. The purpose of this grounded theory pilot study was to describe the process of healing that a hospital-based organ donation memorial ceremony creates at the individual level and organ donation awareness and advocacy at the community level.Methods: The researchers interviewed nine organ donor family members who were invited to attend a hospital-based organ donation memorial ceremony at one Level I Trauma Center located in South Texas.Results: A 4-stage social process, “makes the hole in the heart smaller”, was identified from the qualitative interview data. Participants journeyed through a four stage process to make the hole in their hearts smaller. The four stages are: choosing to attend, being able to connect, keeping the memory alive and knowing something good came from it. As participants moved between stages their meaning for attendance changed. Families shifted from personal grieving and needing support to supporting other donor families and in the process became advocates for organ donation.Conclusions: The findings from this study validate the benefits of hospital-based organ donation memorial ceremonies. Families reported these ceremonies support their decision to donate, while also providing a means of continued emotional support throughout their grief process. The memorial event provides a safe venue for organ donor families to connect and share with others who have had a similar experience, while acknowledging their loved ones gift of life. Hospital-based organ donation memorial ceremonies and the permanent memorial structure increase awareness of organ donation for the community of donor families, hospital visitors and hospital staff.

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.

Imminent Death Donation: Ethical and Practical Policy Considerations

2018 ◽  
Vol 46 (2) ◽  
pp. 524-537 ◽  
Author(s):  
Jordan Potter
Keyword(s):  
Organ Donation ◽  
Cardiac Death ◽  
Organ Procurement ◽  
Donation After Cardiac Death ◽  
Live Organ Donation ◽  
Life Sustaining Treatment ◽  
Imminent Death

While the practice of organ donation after cardiac death has long been trending upwards in acceptance and use, it is still a highly controversial and practically inefficient method of organ procurement. One policy that has recently been proposed to try and alleviate some of the ethical and practical concerns with organ donation after cardiac death is the practice of imminent death organ donation. This type of live organ donation comes in patients at the end of their life who have decided to withdraw life-sustaining treatment, but still want to ensure that their organs are donated and not wasted, which isn't always the case with organ donation after cardiac death. This paper then gives some ethical and practical reflections and recommendations regarding the potential implementation of this controversial practice into regular transplant practice and policy.

scholarly journals LO66: Solid organ donation from the emergency department: A death review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S31-S32
Author(s):  
J. McCallum ◽  
R. Yip ◽  
S. Dhanani ◽  
I. Stiell
Keyword(s):  
Emergency Department ◽  
Organ Donation ◽  
Primary Outcome ◽  
Organ Procurement ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Solid Organ ◽  
Organ Donors ◽  
Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

Outcomes of organ donation in brain-dead patient's families: Ethical perspective

2017 ◽  
Vol 26 (1) ◽  
pp. 256-269 ◽  
Author(s):  
Shamsi Ahmadian ◽  
Abolfazl Rahimi ◽  
Ebrahim Khaleghi
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
Qualitative Content Analysis ◽  
Organ Procurement ◽  
Healthcare Providers ◽  
Traumatic Experience ◽  
Ethical Review ◽  
Ethical Perspective ◽  
Main Category ◽  
Brain Dead

Background: The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. Objective: The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. Methods: This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. Findings: The main category of the data was “Decision to organ donation: a challenge from conflict to transcendence.” This main category consisted of 10 subcategories and 3 general categories. The general categories were “challenging outcomes,” “reassuring outcomes,” and “transcending outcomes.” Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Conclusion: Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.

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.

Non-Heart-Beating Organ Donation: A Defense of the Required Determination of Death

1999 ◽  
Vol 27 (2) ◽  
pp. 126-136 ◽  
Author(s):  
James M. DuBois
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Function ◽  
Medical Treatment ◽  
Organ Donation ◽  
Organ Procurement ◽  
Determination Of Death ◽  
Heart Beating ◽  
The Family ◽  
Transplant Team

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved.Many people now consider such cases of non-heart-beating organ donation to be ethically permissible. However, widespread disagreement persists as to how such practices are to be justified and whether such practices are compatible with the Uniform Declaration of Death Act (UDDA). In this paper, I argue that non-heart-beating organ donation can be ethically justified, that in the justified cases the patients are in fact dead, and that the early declarations of death required for such donation do comply with the UDDA.

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