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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Resources to Help You and Your staff table 1 resources related to end of life care: Daly, B. Critical Care Nursing 2006
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8. Help for evaluating your Institution practices related to organ donation. Table 2 Daly, B.Critical Care Nursing 2006
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9. Organ Donation Types Deceased Donor Brain dead donor
Donation after cardiac death
Living Donor
Paired exchanges
Indirect exchange
Non-directed donation
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10. Other Donation Types Stem Cell and Bone Marrow
Tissue donation (hand transplant, etc)
Unit 9: End of Life

11. 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

12. 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

13. 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

14. 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

15. Living Donation Living Donor Paired exchanges Indirect exchange
Non-directed donation
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16. Living Donation Living Donor
Related or Unrelated Who Match with their recipient
Paired exchanges
Indirect exchange
Non-directed donation
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17. Living Donation Living Donor
Paired exchanges-non matched pairs or multiples who swap donors
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18. 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
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19. 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?
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20. 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
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21. 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.
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22. 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
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23. 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
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24. 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
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25. 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 transplants
Fewer than 1 % of pancreas transplants have come from living donors
Lung –greater then 80% report no complications
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26. 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)
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27. Resources you can offer patients
Donate life website
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28. Resources Contact a transplant center that does living donation
National Kidney Registry-
National Kidney Foundation
UNOS-United network for organ sharing-Living donor section under resources-donor pamphlets-
National Living Donor Assistance Center- t.aspx
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29. Resources you can offer patients
Organ donor .gov-
Waiting list candidates 107,816 as of 06/02/2010 Transplants
January - February ,282 as of 05/28/2010
Donors
January - February ,221 as of 05/28/2010
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30. Resources you can offer patients
Transplant Living- ault.aspx
Specific to Georgia-
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31. Resources you can offer patients
Specific to Georgia GTF Georgia Transplant Foundation:
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
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32. 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
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33. 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

34. 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

35. 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
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36. 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
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37. Organ donation video clip
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38. references
Daly, B. J. Critical Care Nurse. 2006;26: End-of-Life Decision Making, Organ Donation, and Critical Care Nurses
Marcos, A. Shapiro, R. Tan, H Living Donor Transplantation.
Cupples, S. Ohler, L. Transplantation Nursing Secrets Hanley and Belfus
Unit 3: Major Cancers, Prevention, & Staging