Module 6: Organ Donation Instructor Apryl S. Lewis RN, MSN CCTN, CPUR Unit 9: End of Life

Objectives Describe considerations related to organ donation and end of life Describe types of organ donation Describe donor concerns aspects Describe available resources related to organ donation as well as the best ways you can act as a resource to your patient during the end of life stage Unit 9: End of Life

Organ Donation History Solid Organ Donation has been in existence since 1953 Deceased Donor transplant during this same time period was associated with poor outcomes Early practice struggle factor within the medical professional of “primum non moncere”-first do no harm Unit 9: End of Life

Organ Donation discussions at end of life Is waiting to the end of a patient’s life the best time to offer them with education and information about being an organ donor? We don’t tend to talk about our own knowledge beliefs and attitudes related to death and dying Evaluate your medical center in which you practice Unit 9: End of Life

Organ Donation discussions at end of life Questions to consider when evaluating your center: Is there a noted/un-noted practice of waiting until the end of life to address information about organ donation? Who delivers information about organ donation? Unit 9: End of Life

Taking Steps in Organ Donation discussions and information for your patient and their families Collaborate with patients and families early with information on organ donation Consider ways to partner with the entire healthcare interdisciplinary team with the plan of how and when information about organ donation is shared with patients and their families Have a plan on who will be the person(s) that are a resource to the patient and their families for their questions about organ donation Unit 9: End of Life

Resources to Help You and Your staff table 1 resources related to end of life care: Daly, B. Critical Care Nursing 2006 Unit 9: End of Life

Help for evaluating your Institution practices related to organ donation. Table 2 Daly, B.Critical Care Nursing 2006 Unit 9: End of Life

Organ Donation Types Deceased Donor Brain dead donor Donation after cardiac death Living Donor Paired exchanges Indirect exchange Non-directed donation Unit 9: End of Life

Other Donation Types Stem Cell and Bone Marrow Tissue donation (hand transplant, etc) Unit 9: End of Life

Brain Dead Donors Donor Act 1968: Uniform Anatomical Gift Act passed, creating the "Donor Card" and allowing families to consent to or refuse donation. It also prohibited doctors attending the donor from participating in organ removal or transplantation. 1978: Uniform Brain Death Act passed, expanding for the first time the traditional definition of death. "Brain death" IS death. Unit 9: End of Life

Brain Dead Donors Donor Act Not a large amount of brain dead donors Consider Emotional Challenges for the Families In order to deem someone as brain dead the following has to occur: *EEG *Radiologic assessment of absence of blood flow to the brain *No gag reflex *No blink reflex when an object is placed on the eye ball and no pupil dilatation *Two physician to deem patient at brain dead Living Donor Paired exchanges Indirect exchange Non-directed donation Unit 9: End of Life

Brain Dead Donors Don’t confuse this with a person who is in a Coma A patient in a coma is not brain dead Unit 9: End of Life

Donation After Cardiac Death Organ donation from a person who has a sudden cardiac death Prior to Brain Dead Donor Act-used very commonly When it is known a person will not recover after cardiac death they may be approached about organ donation DCD is expected to possible increase the supply of organs by 30% Unit 9: End of Life

Living Donation Living Donor Paired exchanges Indirect exchange Non-directed donation 9: End of Life

Living Donation Living Donor Related or Unrelated Who Match with their recipient Paired exchanges Indirect exchange Non-directed donation 9: End of Life

Living Donation Living Donor Paired exchanges-non matched pairs or multiples who swap donors 9: End of Life

Living Donation Living Donor Indirect exchange-no one to swap with so donor donates to list and intended recipient they wanted to help goes to the top of the transplant list 9: End of Life

Living Donation Living Donor Who pays for it? What can be donated? What are some of the challenges that living donors face? What are the risks associated with organ donation? 9: End of Life

Living Donor Information Who pays for it? Recipient Insurance Transplant organization may absorb some of the cost Laws Related to organ donation and selling organs in US 9: End of Life

Living Donor Information-Laws 1983: Cyclosporine, a revolutionary anti-rejection drug, approved for commercial use, sparking a huge increase in transplants. 1984: National Organ Transplant Act passed, prohibiting the sale of human organs and setting up a national transplant network to procure and distribute organs. The United Network for Organ Sharing received the federal contract to oversee the network starting in 1986. 1986: "Routine request" law passed, requiring hospitals to give families the opportunity to donate organs by asking them in appropriate cases. 9: End of Life

Living Donor Information What can be donated? The heart, two lungs, pancreas, liver, two kidneys, intestines, and stomach can be donated. Eyes, ligaments, tendons, bones, and skin are the tissues most often donated. One organ and tissue donor may help more than 50 people 9: End of Life

Living Donor Information What are some of the challenges that living donors face? Dealing with the feelings of their own family Some donors express feeling under appreciated- attention to the recipient If the transplant is not sucessful donor sometimes feels partially responsible 9: End of Life

Living Donor Information Documented reports of donors indicate a 70% sense of increased esteem, an increase in general feeling of happiness and increased self worth and a better quality relationship with the recipient 9: End of Life

Donor Complications This can vary by Organ Kidney is generally the safest with minimal to no complications reported a well as less than 1 death per 2000 Liver Donation-increased risk for complication and mortality demonstrated as one death to the donor to every 200-250 transplants Fewer than 1 % of pancreas transplants have come from living donors Lung –greater then 80% report no complications 9: End of Life

Resources you can offer patients Contact your state level OPO-organ procurement organization. It is their main purpose and responsibility to educate and create awareness about organ donation as well as act as an independent entity during the donation process (deceased donation) 9: End of Life

Resources you can offer patients Donate life website http://www.donatelife.net/CommitToDonation/ 9: End of Life

Resources Contact a transplant center that does living donation National Kidney Registry- http://www.kidneyregistry.org/index.php?cookie=1 National Kidney Foundation UNOS-United network for organ sharing-Living donor section under resources-donor pamphlets- http://www.unos.org/living_donation.asp National Living Donor Assistance Center- http://www.livingdonorassistance.org/resources/defaul t.aspx 9: End of Life

Resources you can offer patients Organ donor .gov- http://organdonor.gov/ Waiting list candidates 107,816 as of 06/02/2010 Transplants January - February 2010 4,282 as of 05/28/2010 Donors January - February 2010 2,221 as of 05/28/2010 9: End of Life

Resources you can offer patients Transplant Living- http://www.transplantliving.org/livingdonation/def ault.aspx Specific to Georgia- 9: End of Life

Resources you can offer patients Specific to Georgia GTF Georgia Transplant Foundation: http://www.gatransplant.org/ The Georgia Transplant Foundation supports the fundamental basis of altruism for living donation. The goal of the Living Donor Program is to provide assistance to living donors for financial hardships created as a result of their donation. Either the living donor or the transplant recipient must be a resident of Georgia. Assistance is available for hardship expenses directly created by donation. Applications are to be submitted prior to the treatment. The donor is expected to use all available sick days, but may retain up to two weeks of vacation time. Living donor applications are expected to show evidence of the patient/family’s support and financial planning for the surgery and recovery 9: End of Life

Keeping it all in perspective Organ Donation is a personal choice Each person has to decide whether it is a choice they want to make in considering deceased donation or living donation We can do our part by educating and providing resources before the choice for organ donation is available to be made When we have emergencies we can help to support our organizations to have a plan of who will provide information and how the information and access to the information will be available 9: End of Life

Stadium has a capacity of 64,450 Need for Organ Donation keeps rising 107,863 as of today 1:06pm for Transplantswww.unos.org Stadium has a capacity of 64,450

For those that are interested support them Why not consider becoming an organ donor? Your donation can change someone’s entire life and of course the life of that person’s family. Cancer may limit what the organs that can used, but some of your organs maybe reusable. Become an organ donor and make a last significant difference in the world. Unit 9: End of Life

For those that are NOT interested support them Organ donation is not for everybody Free will is essential Potential Coercion to donate may only cause regret Unit 9: End of Life

Organ donation video clip a picture speaks louder than words and a video can SHOUT the message. I will close with this video clip to show you what organ donation means to some Unit 9: End of Life

Organ donation video clip http://www.youtube.com/watch?v=s1Ky3rw3CRA&fe ature=player_embedded Unit 9: End of Life

references Daly, B. J. Critical Care Nurse. 2006;26: 78-86 End-of-Life Decision Making, Organ Donation, and Critical Care Nurses Marcos, A. Shapiro, R. Tan, H. 2007 Living Donor Transplantation. http://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation http://www.organtransplants.org/understanding/death/ Cupples, S. Ohler, L. Transplantation Nursing Secrets. 2003 Hanley and Belfus http://www.unos.org Unit 3: Major Cancers, Prevention, & Staging