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Helping loved ones understand and honor your gift of life
Donorspeak Helping loved ones understand and honor your gift of life Michael C. Johns March 10, 2010
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U.S. Organ Transplant History
1954 kidney transplant 1968 Uniform Anatomical Gift Act 1983 FDA approves Cyclosporin 1984 United Network for Organ Sharing (UNOS) & US Nat. Organ Transplant Act made sale illegal 1986 Required Request law & Paired kidney 1994 transplantation of Human Organ Act (THO) passed in India – Brain death accepted 1998 Legislation requires hospitals to report all deaths and imminent deaths to Organ Procurement Organization (OPOs)
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Recent Global Grafting History
1999 Joint Commission International – Accreditation 2004 Indian Ocean Tsunami & World Health Allience (WHO) launches World Allience for Patient Safety Change in family communication perspective - VA 2006 Iran is only country to allow kidney sales 2007 Presumed Consent disputed & Public grants 2008 Mandated Choice policy suggested 2009 UNet – Uploaded data to Donornet 2010 NacTel & ShoreTel connect NY Organ donors Next: Limb transplants with feeling?
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Global Initiatives Japan – next of kin Karachi, Cairo – Curb trafficking Presumed consent Mandated choice Thaler, R. H., & Sunstein, C. (2008) Modified - Chouhan, P. (2003). Selection criteria – urgency, blood & size compatibility – not race, sex or creed
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Kidney Paired Exchange
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Will sell organs for food
Poverty as a contraindication for organ transplantation, Southern India Tsunami - 40,000 rupees or $900 per kidney Pakistan $2500 for a kidney, but…1/2 price… Ross, L. F. et al., Ethics of a paired kidney exchange program. N Engl J Med 1997; 336: Delmonico, F. L. (2002). Ethical incentives -- not payment -- for organ
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Global Travesty Tsunami victims Shroff, S. (2009). Legal and ethical aspects of organ donation and transplantation Indian Journal of Urology, 25(3), 348. Asia, South America, Africa, Brazil, India, Moldava – World health trafficking focus (2004)
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Innovative Approaches
Xenotransplant - Nature 413, 415, 445 (2001). American Journal of Critical Care. (Nov 2003, Vol. 12, No. 6, ). Nactel and Shoretel. (6 Jan 2010).
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Critical Communication
Roles & responsibilities Steinman, T. +. (2001). Family communication - Siminoff, L. A. (2001). Pilot model - Guadagnoli, E et al (1999) Proposed Local Media Definitions Who are the donors? Brain death - Bell, M. D. (2005).
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US Organ transplant waiting list
Candidates as of 3/7/2010 # Waiting All 106,264 Kidney 83,747 Pancreas 1,485 Kidney/Pancreas 2,223 Liver 15,864 Intestine 236 Heart 3,143 Lung 1,855 Heart/Lung 71 Source:
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National Foundation for Transplants
Established in 1983, in Memphis, TN. Founded by three caring and compassionate women after they read about a young girl who needed a liver transplant but could not afford the procedure. Other transplant candidates soon began contacting the organization for assistance, and it became evident that transplant candidates across the country would benefit from such an organization. What began as a local endeavor has evolved into an organization benefiting thousands of organ transplant candidates and recipients. NFT's fundraising campaigns have generated nearly $56 million to assist patients during their transplant journey, and NFT assists more than 1,000 patients.
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The Nielsen Organ Transplant Foundation (NOTF)
Non-profit organization founded in 1981 in Jacksonville, Florida as a result of a fundraising campaign for Cheryl Nielsen, a young woman in need of a heart transplant. Programs include financial assistance, donor awareness, mentoring, information and resources. Relies on community support to continue its mission.
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Glascow Coma Scale (modified)
Response Amount Points Eye Opening Response Spontaneous 4 points Opens to pain 2 points None 1 point Verbal Response Oriented 5 points Incomprehensible speech 1 point Motor Response Obeys commands for movement 6 points Extensor (rigid) response, decerebrate posture Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84.
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