Chapter 43: Deceased Donor Management

THE CREATION OF THE ORGAN DONATION SYSTEM

Historical timeline of organ donation:

• 1954: First successful living donor organ transplant – Joseph Murray, MD¹

• 1962: First successful deceased donor organ transplant – Joseph Murray, MD¹

• 1968: Uniform Anatomical Gift Act (UAGA)

• 1969: Formation of the Southeast Organ Procurement Foundation (SEOPF)

• 1977: Implementation of the first computer-based organ matching system

• 1980: Uniform Determination of Death Act²

• 1982: SEOPF establishes the Kidney Center

• 1984: Enactment of the National Organ Transplant Act (NOTA)³

• 1984: Creation of the United Network for Organ Sharing (UNOS)

• 1984: Formation of a nonprofit organ procurement organization (OPO)

DONATION AND THE LAW

• NOTA is the legal framework system for organ donation and transplantation.

• NOTA facilitated organ donation by establishing a national registry and also prohibited the sale of organs.⁴

THE RIGHTS OF DONORS

• The UAGA legally protects the rights of the individual to become an organ donor.

• The UAGA system also protects the individual’s right to become an organ donor if death is formally declared.

• UAGA defines the authorized party most responsible for acting on behalf of the deceased.³

• Regardless of family demographics or other characteristics, caregivers and OPO representatives should provide all patients with equal opportunities for organ donation.

• Clinicians and OPO representatives should be aware that a patient’s own authorization for organ donation through a donor registry is increasingly common and that this can assist in conveying the potential donor’s wishes to the family.

• The OPO must approach the authorized party or next of kin to give authorization on behalf of the deceased individual to become an organ donor, usually in the knowledge that the first person authorization (FPA) had been expressed.

• The FPA provides helpful information for the OPO.

• Some countries in Europe have a presumed consent system, which means that organ donation is automatically considered in patients declared brain dead, unless they have specifically registered their wish to not donate.

UNDERSTANDING AND DEFINING BRAIN DEATH

• The concept of brain death was first described in 1967 by the Harvard Medical School Ad Hoc Committee.⁵

• The first legislative definition of death in the history of the United States was enacted by the state of Kansas in 1967.⁶

• Finland became the first country to adopt brain death as a legal definition in 1971.⁷

• In 1981, brain death was legally defined as the cessation of neurologic functions by the Uniform Determination of Death Act.²

• A determination of death must ...