Course #332

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Hours
2
$18.95

Course Material Valid Through
March 2022

The Gift of Life: Organ and Tissue Donation

Disclosures

Description

The purpose and goal of this course is to educate healthcare workers in the fundamental aspects of organ and tissue donation.

Course objectives include:

  • Identify the various agencies and facilities involved in organ transplantation
  • Explain the process for screening for infection
  • Summarize the body’s tissue rejection process

Criteria for Successful Completion

After reading the material, complete the online evaluation. If you have a Florida nursing license or an electrology license you must also complete the multiple choice test online with a score of 70% or better. Upon completion of the requirements you may immediately print your CE certificate of completion.

Accreditation

  • American Nurses Credentialing Center's Commission on Accreditation (ANCC)
  • California Board of Registered Nursing Provider No. CEP 1704
  • This course has been approved by the Florida Board of Nursing No. 50-1408

Conflicts of Interest

No conflict of interest exists for any individual in a position to control the content of the educational activity.

Expiration Date

This course expires March 31, 2022.

About the Author/Editor

Diana Harland, BS, CCRC, received her degree in microbiology from the University of Texas at El Paso. She worked in preclinical research in retrovirology while in undergraduate school and again after graduation at the Texas Biomedical Research Institute (formerly Southwest Foundation for Biomedical Research) in San Antonio, Texas. While at the Southwest Foundation, she worked in the Department of Virology and Immunology at biosafety level 3-4 (BSL-3/BSL-4). She has extensive training in NIH, OSHA, and CDC guidelines for sterility and asepsis in tissue culture and retrovirology. She holds a certificate in bioterrorism from Tulane University School of Public Health and Tropical Medicine and the University of Alabama at Birmingham School of Public Health. She is a member of the Austin Disaster Relief Network (infrastructure for the city of Austin, Texas, disaster response) and the Association for Clinical Research Professionals.

Purpose and Goals

The purpose and goals of this course are to educate healthcare workers in the fundamental aspects of organ and tissue donation.

Learning Outcomes

Upon successful completion of this learning activity, a participant should be able to:

  1. Define organ donation.
  2. List the organs and tissues that are eligible for donation. 
  3. Identify the various agencies and facilities involved in organ transplantation.
  4. Outline the transplantation process.
  5. Explain the process for screening for infection.
  6. Summarize the body's tissue rejection process.
  7. Discuss the role of the transplant coordinator in organ/tissue donation.
  8. Articulate ethical considerations related to organ/tissue donation.

Introduction

Organ donation is the act of providing one or more organs or body tissues as a gift for transplantation into another person to be used in place of a diseased or nonfunctioning organ or body tissue. Donated organs include liver, kidney, kidney/pancreas, pancreas, heart, lung, heart/lung, and intestine. Tissue donations include bone, tendons, cartilage, ligaments, skin, corneas, and heart valves. Organs and tissues can be donated from deceased persons or from living persons. Each year, more than 30,000 organ donations and almost 1 million tissue and corneal transplants take place in the United States.

The need for organs far exceeds the availability of organs that are donated. Currently, the Organ Procurement and Transplantation Network (OPTN) has more than 114,000 candidates who are registered and waiting for an organ donation. Every 10 minutes, a new candidate is added to the waiting list. Statistics from the U.S. Department of Health and Human Services show that each day, around 80 people receive a transplanted organ, but at the same time an average of 20 people per day die while waiting for a needed organ. The demand for kidneys is especially high due to medical advances in dialysis.

A single person can save eight lives with vital organs and enhance the lives of many others with donated tissues. In all, one person can affect up to 50 lives. Organs can be placed with a needy candidate locally, regionally, or nationally.

Agencies and Facilities Involved in the Organ Transplant Process

The complexity of the entire transplant process is a focus of various different agencies. The following agencies are involved in the transplant process:

  • United Network for Organ Sharing (UNOS). This agency is a private, nonprofit organization that manages the U.S. transplant system under contract with the federal government. In 1984, the National Organ Transplant Act was enacted, which called for an Organ Procurement and Transplantation Network (OPTN) that would link all of the professionals involved with organ donation and transplantation. In 1986, UNOS was awarded the contract to operate the OPTN and has been the only organization to ever operate it. Today, UNOS provides the following services:
    • Management of the national transplant waiting list to match donors and recipients on a 24/7, 365-day basis
    • Maintenance of the database containing all organ transplant data for all transplants occurring in the United States
    • Development of policies that give every patient a fair chance of receiving a needed organ
    • Monitoring of organ matches to ensure organ allocation policies are followed
    • Assistance to patients, family, and friends
    • Education for transplant professionals regarding their roles in the transplantation process
    • Education of the public regarding the importance of organ donation
  • Organ Procurement and Transplantation Network *(OPTN*). This network is a nonprofit, private-sector entity whose members include all U.S. transplant centers, all organ procurement organizations, all histocompatibility laboratories, medical and scientific organizations, and members of the general public. The OPTN is governed by a Board of Directors and is operated by UNOS. It is a function of the Health Resource and Services Administration (HRSA), a division of the Department of Health and Human Services (HHS) to oversee the OPTN.
  • Organ procurement organizations (OPOs). There are currently 58 OPOs in the United States. They are nonprofit organizations that must be certified by the Centers for Medicare and Medicaid Services and must abide by their regulations. They must also be members of the OPTN and the Association of Organ Procurement Organizations. These OPOs have two main functions:
    • Increasing the number of registered donors. This may be done through a variety of community outreach activities.
    • Coordinating the donation process when actual donors become available. This involves evaluation of the potential donor, checking the deceased's state donor registry, discussing donation with family and offering bereavement support, contacting the OPTN and running a match list, and arranging for surgical recovery and transport of donated organs.
  • Transplant centers. Transplant centers are entities within hospital facilities that operate organ transplant programs. As of February 2019, there are 254 transplant centers in the United States. They must be members of the OPTN and must meet strict professional standards.
  • Histocompatibility laboratories. These labs are members of the OPTN and are certified to perform human leukocyte antigen (HLA) typing to determine the compatibility between a donor's organ or tissue and that of a recipient. Histocompatibility antigens are genetically determined antigens found on the cell membranes of the cells of most tissues. These antigens are responsible for the processes of tissue rejection when organs or tissues from a different individual are grafted to a host recipient. 
  • Medical and scientific organizations. Also members of the OPTN, medical and scientific organizations include such agencies as the Eye Bank Association of America and the American Society of Transplant Surgeons.
  • Local hospitals. Almost all deceased donor organs are from donors who died in a local hospital. Staff members from local hospitals play an instrumental role in making a patient's wishes for organ donation possible.
  • Centers for Disease Control (CDC). The CDC serves to provide assistance and expertise in investigating potential transmission of infections from organs or tissues. When there is suspected disease transmission, the CDC will assist state and local health departments to identify the transmitted pathogens and trace diseased organs back to the original donor in order to identify anyone who may have received an infected organ or tissue. Their findings are used to make regulatory decisions and guidance to reduce risk of disease from infected organs and tissues. Approximately 50 cases are referred to the CDC for investigation each year.

Types of Transplants (grafts)

  • Allogeneic transplant or allograft is an organ or a tissue that is transplanted from a genetically non-identical donor of the same species.
  • Vascular composite allografts (VCAs) include the transplantation of multiple structures. These structures could be a combination of skin, bone, muscles, and connective tissue, along with their associated blood vessels and nerves. Examples of VCAs are hand transplants and face transplants.
  • Isogeneic transplant or isograft (syngraft) is an organ or a tissue that is transplanted from an identical twin.
  • Autologous transplant or autograft is tissue that is transplanted from another site in or on the body of the same individual.
  • Xenogeneic transplant or xenograft is an organ or tissue that is transplanted from another species.

Determining if an Organ is Suitable for Transplantation

When a potential organ donor has been identified, he or she must be evaluated for suitability as an organ donor. A comprehensive review of the donor’s age, medical history, social history, hospital admission, patient chart, physical exams, and any history of malignancy or malignancy testing is performed. The functioning of specific organs is also reviewed. An ideal organ is young and has no history of end-organ disease. Although carcinoma will exclude donors, no disease alone is a contraindication for organ donation.

The length of time a donated organ can be kept alive outside the human body is very brief. In this small time interval, the organ must be recovered from the donor and transported to the transplant hospital to be given to the recipient. The following are transplant time intervals for specific organs:

  • Heart: 4–6 hours
  • Lung: 4–6 hours
  • Combined heart/lung: 4–6 hours
  • Liver: 12–24 hours
  • Kidney: 48–72 hours

The Transplantation Process

The transplant evaluation process is very complex. When a patient becomes a candidate for an organ transplant, he or she is referred by his or her physician to a transplant center. The transplant center conducts various tests to assess both the physical and mental health of the patient as well as the patient's social support structure. If the patient is accepted as a candidate, the patient's name and all appropriate information is added to the national waiting list for organ transplantation. All patient data is kept current during this waiting period.

Deceased Donors

When an organ from a deceased donor becomes available, a transplant coordinator from an OPO enters the information regarding the donor into the national database maintained by the OPTN. Patients on the waiting list are then matched against the donor organ, and a computer-generated list of potential recipients is created. The candidates are ranked in an order that is determined by OPTN organ allocation policies, acceptance criteria of the transplant center, and local variances that are OPTN-approved variations of national allocation policies. Factors that affect how a candidate is ranked include tissue match, blood type, immune status, body size, height, weight, the length of time the candidate has been on the waiting list, the medical urgency of the patient's condition, and the distance between the candidate's hospital and the donor's hospital.

The donated organ is offered to the transplant center for evaluation of the first person on the generated list. Candidates must be immediately available and willing to accept the donated organ. They must be healthy enough for major surgery, and they must be able to pass any compatibility tests necessary between candidate and donor organ to ensure that the organ will not be rejected by the candidate's immune system. The decision to accept an organ is made by the candidate's transplant team. The transplant team has one hour to make a decision. If a decision is not made within that time, or if the transplant team decides not to accept the organ, the organ is offered to the transplant center of the next person in ranking order on the list. This process continues until a candidate is found who meets all the necessary criteria.

If all testing is successful, and the organ is accepted, a transplant team recovers the organ from the donor. The organ is then transported to the recipient's transplant center. Immediate surgery is scheduled for the recipient, and the organ is transplanted by the candidate's transplant surgeons. The recipient then begins the recovery period and must take immunosuppressant medications to prevent rejection of the organ.

Living Donors

A living donor is a healthy person who volunteers to donate a whole organ (usually a kidney) or an organ segment (from the liver, lung, pancreas, or intestine) to a transplant recipient. Persons who have a history of high blood pressure, diabetes, cancer, or hepatitis cannot become living donors. However, in 2013, the HIV Organ Policy Equity Act or HOPE Act was passed, which enabled people living with HIV to donate organs to HIV positive persons who are awaiting an organ transplant. This must be done in the context of a clinical research study that is approved by an Institutional Review Board (IRB). Under the HOPE Act, physicians are called to develop and publish research on HIV positive donations to HIV positive transplant recipients. At this time, only HIV positive livers and kidneys can be donated and transplanted. A list of participating transplant hospitals and more information is available at: https://optn.transplant.hrsa.gov/learn/professional-education/hope-act/

A transplant center makes the decision to accept a person as a living donor. For living donors, a multidisciplinary team working on the transplant may consist of a living donor coordinator, a physician specializing in the organ to be donated (e.g., a nephrologist), a transplant surgeon, a psychiatrist, a social worker, and a nutritionist.

Screening Donors for Potential Infections

Providing guidelines for testing of organs and blood vessel conduits from organ donors is a function of the Health Resources and Services Administration (HRSA), an agency of the U.S. Public Health Services (PHS). The testing of human cells and tissue products for donation is overseen by the U.S. Food and Drug Administration.

Reports of donor-derived infection from transplanted organs and tissues are infrequent and the CDC considers the risk of these infections to be very low; however, potential infections are still an important cause for public health concern. The CDC has reported that viruses such as HIV, HBV, HCV, rabies virus, and West Nile Virus (WNV); bacteria such as mycobacterium tuberculosis (tuberculosis) and treponema pallidum (syphilis); and parasites such as amoebas (granulomatous amebic encephalitis) have all been transmitted through transplanted organs and tissues. Undetected infections have the potential to cause serious illness, loss of the transplanted graft, and death. For these reasons, it is important to be vigilant in testing of donors, and identifying donor risk factors by a thorough assessment of medical and behavioral history.

Table 1 below lists the risk factors associated with an increased likelihood of HIV,HBV, or HCV infection, as per PHS guidelines:

Risk Factors for HIV, HBV, and HCV
  • Anyone who has had sex with a person known or suspected of having HIV, HBV, or HCV in the previous 12 months

  • Men who have had sex with men (MSM) in the previous 12 months

  • Women who have had sex with a man who has had MSM behavior in the previous 12 months

  • Anyone who has had sex in exchange for drugs or money in the previous 12 months

  • Anyone who has had sex with a person who had sex in exchange for drugs or money in the previous 12 months

  • Anyone who has had sex with a person who has used drugs by intravenous, intramuscular, or subcutaneous routes for nonmedical reasons in the previous 12 months

  • A child ≤ 18 months of age who was born to a mother known to be infected with, or at an increased risk for HIV, HBV, or HCV infection

  • A child who was breastfed in the previous 12 months by a mother who is known to be infected with, or at increased risk for HIV infection

  • Anyone who has injected drugs by intravenous, intramuscular, or subcutaneous routes for nonmedical reasons in the previous 12 months

  • Anyone who has been in lockup, jail, prison, or a juvenile correction facility for more than 72 consecutive hours in the previous 12 months

  • Anyone who has been recently diagnosed with, or who has been recently treated for syphilis, gonorrhea, Chlamydia, or genital ulcers in the previous 12 months.

Source: Public Health Rep, 2013 Jul-Aug; 128(4): 247-343. Avail at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675207/

All deceased and living donors are screened for antibodies to HIV, HBV, and HCV, and an HCV nucleic acid test (NAT) is also performed. Additional testing for HIV by NAT or HIV antigen is performed when a risk factor is identified. As many test results as possible are made available before transplantation of deceased donor organs. Living donors are tested as close as possible to the date of surgery, but at least within the 28-day time period prior to surgery.

Unlike blood donation, most organs are not screened for West Nile Virus (WNV) at this time. Some transplant centers do test for WNV and others do not. At this time, however, organ donors do not have to be tested for WNV.

All living donors should be educated in the risk factors and modes of HIV, HBV, and HCV transmission. They should also be advised of their obligation to avoid behaviors that would place them at risk for acquiring infections before transplant surgery. For living donors with a history of high-risk behaviors identified during risk assessment, individual counseling and a detailed discussion of specific strategies to avoid high-risk behaviors should be provided.

Organ recipients must be counseled about the potential risks involved in organ transplantation. Documents and counseling information used in the recipient consent process should explain that organ transplantation carries a risk for transmission of HIV and other pathogens because no available testing can completely eliminate the risk for transmission of all pathogens.

Organ and Tissue Rejection

In the 1940s, researchers discovered a set of genes that determined whether there was acceptance or rejection of grafted tissues. This group of genes was named the major histocompatibility complex (MHC). In humans, the MHC is called the human leukocyte antigen (HLA) system and is responsible for enabling the body to distinguish the presence of "self" from "foreign" at the molecular level. The HLA antigens expressed on the surface of lymphocytes are different for each individual, but they are alike in identical twins. For this reason, transplants between identical twins are rarely ever rejected. Corneal transplants are also rarely rejected because there is no blood supply to the cornea and antibodies and lymphocytes are unable to reach the cornea to cause rejection.

It is important to match the tissues of the donor and recipient with respect to HLA typing as much as possible to minimize rejection. The greater the number of identical HLA antigens, the greater the probability that a transplant will be successful. Donors and recipients are matched for ABO (blood) typing as well. In addition to the MHC, there are also minor histocompatibility antigens (MiHA) that are involved in rejection. These small peptides found on the cell surface can still trigger rejection even when the donor and recipient are well matched.

Graft rejection and the immune response is a function of the body's white blood cells. The body's humoral immunity occurs when B lymphocytes develop into antibody-producing cells, and these antibodies activate enzymes known as the complement system. The body's cellular immunity occurs when T lymphocytes develop into either helper T cells (Th) or cytotoxic T killer cells (Tc). Graft rejection occurs when T lymphocytes of the recipient recognize specific HLA antigens on the cells of the graft as "foreign." In a complex pathway, helper T cells induce cytotoxic T cells to attack and destroy the cells of the foreign graft.

After transplantation, the primary goal of the transplant team is to suppress the patient's immune system without putting the patient in jeopardy for increased risk of infectious disease, cancers, or toxicity of the immunosuppressive drugs that are used so that the newly transplanted graft can heal and survive as a properly functioning organ or tissue. By suppressing the immune system, the newly transplanted graft can heal and survive as a properly functioning organ or tissue. Immunosuppressive drugs such as Cyclosporine, Tacrolimus, and Prednisone have greatly enabled patients to survive rejection.

Two types of rejection may occur after transplantation. Acute rejection may occur within a year of transplantation. Chronic rejection occurs over time as the organ slowly loses its ability to function. Symptoms of organ rejection vary depending on the organ. Common symptoms may include pain at the location of the organ, fever, edema, malaise, flu-like symptoms, fatigue, decreased urine (kidney transplant), dyspnea (heart, lung transplant), and jaundice and bleeding (liver transplant). Rejection can be confirmed by biopsy. Routine biopsies may show organ rejection even before symptoms develop.

After an allogenic stem cell or bone marrow transplant, T lymphocytes in the graft may view the host tissue as foreign and produce an attack on the recipient. Known as graft-versus-host disease (GVHD), this potentially life-threatening condition can be acute or chronic. Acute GVHD will usually become apparent in the first three months after a transplant. Symptoms include diarrhea, abdominal pain and cramping, dryness and irritation of the eyes, skin rash, erythema, itching, and jaundice. Chronic GVHD occurs more than three months after transplant and can be a lifelong condition. Symptoms include chronic pain, muscle weakness, fatigue, dyspnea, dry mouth, skin rash and skin changes such as thickening or tightening, weight loss, and vaginal dryness.

Living Donation for Incompatibility

A kidney transplant candidate who has a medically able and willing living donor who is not compatible still has an option to receive a compatible kidney. This is known as kidney paired donation. Medical information for both donor and recipient is entered into the UNOS system, and they are matched across the U.S. with another incompatible donor and recipient pair so that the donors of each pair match the recipients of the opposite pair. A non-directed donor is a person who wishes to donate a kidney to a person they do not know. These donors can help match incompatible pairs that would not otherwise be matched, and can enable multiple candidates to receive a kidney transplant through the donation of only one kidney.

Another option for a non-matching kidney transplant is blood type incompatibility donation. This option allows recipients to receive a kidney from a donor with an incompatible blood type. A simple blood test will show how much antibody the recipient has to the donor. A two- step process that takes about two to three weeks to complete is then performed. First, existing blood group antibodies are removed by plasmapheresis. This is called desensitization and may take several sessions. Second, intravenous immunoglobulin (IVIG) is given in a process known as immune modulation. The IVIG contains antibodies of thousands of people along with medications that help the immune system turn off further antibody production. When the recipient’s antibodies are at an acceptable level, the transplant can be performed. After two weeks (and possibly several more plasmapheresis and IVIG sessions), the recipient can follow the same treatment as those for blood group compatible transplant recipients.

Cost of Organ Donation

Organ donation is free of charge to the donor or family of the donor. Costs for organ removal and transplantation are charged to the transplant recipient. Financial coordinators and social workers will assist transplant recipients with plans and strategies for affording transplant costs. The average cost of a kidney transplant can run upwards of $414,800; the average cost of a liver transplant can exceed $812,500; the average cost of a heart transplant can run upwards of $1,382,400; and the average cost of an intestinal transplant can exceed $1,147,300.

Under the National Organ and Transplant Act of 1984, it is illegal for a living donor to be paid for donating an organ; however, living donors can be reimbursed for certain expenses involved in the donation process.

The Role of the Healthcare Worker in Transplantation

There are many roles for healthcare workers in transplantation. In addition to physicians, there are organ procurement coordinators, transplant coordinators, staff nurses, clinical nurse specialists, and charge nurses. Each has a different role in the coordination of the transplant process.

The transplant coordinator, for example, may work with the living donor or the transplant recipient. Donors and recipients have separate transplant coordinators, allowing donors to make the decisions that are right for them, and having the transplant coordinator act as an advocate that is separate from the recipient. After a patient is referred for a transplant, the transplant coordinator will be involved in testing, evaluations, and listing of the patient on the national waiting list. When an organ is located, the transplant coordinator's duties may include ordering lab tests for organ matching, preparing living donors for transplant procedures, assisting during surgery, and providing monitoring and postoperative care of the recipient after surgery.

Myths Associated With Organ Donation

If I tell hospital personnel I want to be an organ donor or if emergency doctors know I want to be an organ donor, they will no longer try to save my life, or they will not try very hard.

Patients need to know this is absolutely not true. The greatest priority that physicians and healthcare professionals have is to save the lives of their patients, and organ donation will not be considered unless a person has been declared legally dead.

Organ donation is expensive, and it will leave my family with costly bills after I die.

There is no cost for organ donation to the donor's family or to his estate after death.

I am too old to be an organ donor. I have had health problems, and no one will want my organs.

Organs can be donated by people of all ages and various medical histories. A person's medical condition and medical history at the time of death will determine what organs can be donated. Only certain medical illnesses, such as cancer that is actively spreading or certain systemic infections, prevent organ donation. Even if only one organ can be donated, it will improve or save one person’s life.

I am a non-resident alien so I am unable to be an organ donor.

Non-U.S. citizens who don’t permanently live in the U.S. can both donate and receive organs in the U.S. Organs are given based on medical need and not on citizenship. Approximately 1 in 100 non- U.S. residents receive transplants each year.

Organ donation will disfigure my body, and an open casket funeral will be impossible.

Any donated organs will be carefully removed and all incisions will be closed. Organ donation will not affect how a person looks for a funeral service.

I have to complete a lot of paperwork to designate myself as an organ donor.

Signing up to be an organ donor is a quick and easy online process. Persons wishing to become organ donors can also sign up at their respective state’s department of motor vehicles (DMV). Many states can proceed with organ donation without consent from the next of kin if potential donors are registered with their state's organ donor registry or have a driver's license with an organ donor designation.

I am afraid my religion will not allow organ donation.

Most major religions in the United States, including Protestantism, Catholicism, Islam, and most forms of Judaism approve of organ donation and view it as a final act of love to one's fellow man.

I am afraid to agree to the organ donation of my relative's organs because he or she may wake up and come back to us.

Countless stories of patients miraculously awakening from brain death have been told over the years. Patients can awaken from coma, but not from brain death. Brain death is final and should not be confused with coma.

If I agree to become an organ donor or a living organ donor, the decision is final.

At any time once the donation process has begun, persons have the right to stop the process if they change their mind. Potential donors should consider how organ donation will affect their lives and the lives of those around them. Ultimately, the decision is that of the donor (or donor's parents if the deceased child is a minor under age 18), and the donor must be confident that he or she has made the right decision.

I have heard stories of patients waking up during transplant surgery, and this really scares me!

These types of stories are found in the scenes of Hollywood movies and are written to appeal to human emotions and to sell tickets. In reality, no organ will ever be removed from a patient without complete testing to determine brain death.

Discussing Donation with Potential Organ Donors

The way in which donation is discussed with a patient and family members can be the most important factor in determining whether or not a patient or his family will choose to donate organs. Healthcare professionals must take into account the distress, grief, and complex feelings of a family who are coping with the loss of a loved one. Under federal regulations, anyone approaching a family about organ donation must be trained in this process. Such persons are known as designated requestors, and are often staff members of an OPO. Designated requestors are often aided in this process by a member of the patient's healthcare team, since these are the people who are familiar to and trusted by the family. It is important to note that OPO members are exempt from the Health Insurance Portability and Accountability Act (HIPAA) because they need a basic understanding of the patient's health conditions to determine if the patient is a candidate for organ donation.

Before any conversation about organ donation is begun, one of the most important conditions that must be met is that the patient's family be able to express what is happening to their loved one. When a patient is facing imminent death, a member of the hospital should notify the OPO. The healthcare worker directly caring for the patient is the most likely one to identify that person as a potential donor and begin the notification process. An OPO representative is then informed about the patient's medical condition and prognosis, and will come to discuss donation with the family.

Timing the conversation regarding donation is critical. Family and loved ones must not still believe that the patient will recover. The setting in which conversations are carried out is also important and must be private and quiet. Participants in the conversation may include the patient's family, healthcare staff, a member of the clergy, and the OPO representative. Families who are well treated and respected and are allowed to express feelings and grief are the most likely to respond in a positive manner. When families feel that they are doing what is best and are carrying out the wishes of their loved one, their grief can be turned into something positive in knowing that their loved one has saved or enhanced the lives of others.

Ethical Considerations in Transplantation

Organ and tissue donation can bring up ethical considerations for patients as well as healthcare workers. The dead donor rule is an ethical norm that states that a person must be declared legally dead before any vital organs are removed, and therefore implies that an organ that is harvested must not cause the death of the donor. Ethical and legal issues revolve around the question, "When is a person actually dead?" A person is said to be dead when the complete electrical activity of the brain ceases and this becomes truly irreversible (brain death), or when the heart quits beating and this becomes truly irreversible (cardiac death). Over the years, great debate has occurred among the medical, scientific, religious, and lay communities concerning the criteria for determining who can be considered legally dead and when one can be considered legally dead. This multifaceted ethical, moral, and religious dilemma has long existed and will likely continue to be debated.

Persons deciding to become organ donors or families making the decision for their loved one to become an organ donor must ultimately do what is right for them. They should not feel swayed or pressured into doing anything they do not feel right about doing. In this manner, regardless of the debates that are ever present, donors and donor families can rest assured that they have made the correct decision.

Designating Yourself as a Donor

A single person can save eight lives with vital organs and also enhance the lives of many others with donated tissues. In all, one person can affect up to 50 lives. Organs can be placed with a needy candidate locally, regionally, or nationally.

Persons wishing to become an organ donor should first ensure that their relatives know their wishes. In most states, the law mandates that persons have the right to donate their organs upon death, and this designation overrides the decisions of any relatives.

Donate Life America is a non-profit organization dedicated to increasing the number of donated organs and tissues by managing the National Donate Life Registry and by educating and promoting awareness with its Donate Lifesm brand. Potential donors should register with their state's organ donor registry and can access their state’s registry through the Donate Life America website at donatelife.net or by searching for their state’s registry directly. A state driver's license also can designate a person as an organ donor, and persons wishing to donate their organs can sign up at their local state’s department of motor vehicles (DMV).

A potential donor may also carry a “uniform donor card” or organ donor card. This card is a legal document for those who are 18 and older that gives permission for organ donation in the event of death of the individual. It should be noted that family and next of kin still will be consulted in the event of death, which is why it is so important that family knows the wishes of the potential organ donor.

Donor Card Family Card
donor card family card

This card and a family notification card can both be found at http://www.organtransplants.org/donor/donorcard_en.pdf.

For more information about how to become an organ donor, consult the U.S. Department of Health and Human Services Web site: https://www.organdonor.gov/index.html.

Conclusions

The donation of organs after death can be a final and lasting way to show caring and love for others. The donation of an organ or tissue by a living donor is another example of this selfless act of caring. Healthcare professionals have many important roles to play in this life-giving process. By educating persons about organ donation, a healthcare professional has the potential of saving many lives and greatly improving the lives of many others.

References

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Organ Procurement and Transplant Network. News: *Organ transplants in United States set sixth consecutive record in 2018*; Jan 2019. Avail at: https://optn.transplant.hrsa.gov/news/organ-transplants-in-united-states-set-sixth-consecutive-record-in-2018 . Last accessed Feb 10, 2019.

United Network for Organ Sharing. Types of Living Donation. Available at: https://transplantliving.org/living-donation/types/. Last accessed Feb 10, 2019.

U.S. Department of Health and Human Services. OrganDonor.gov. What can be Donated. Available at: https://www.organdonor.gov/about/what.html. Last accessed Feb 10, 2019.

Seem DL, Lee I, Umscheid CA, Kuehnert MJ. PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation. *Public Health Reports* 2013 Jul-Aug;128(4):247-343. Avail at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675207/. Last accessed Feb 10, 2019.

UCLA Health. Incompatible Blood Type Kidney Transplant. Available at: https://www.uclahealth.org/transplants/kidney/incompatible-blood-type. Last accessed Feb 10, 2019.

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