CASE 01: Organ Donation

OVERVIEW

Organ and tissue donation is a relatively new intervention in the scope of medical treatment. Up until the late 1950s, there was no cure for end-stage renal disease or similar ailments such as chronic heart disease, liver failure, chronic obstructive pulmonary disease (COPD), cystic fibrosis, or any other disease that causes irreversible organ failure. Deceased and living donation, although lifesaving and in critical need across the United States, has been the subject of ethical debate over the years and is still ongoing. These discussions range from the ethics of brain death, the dead donor rule, allocation of organs, consent/autonomy, and the means of registering people to be donors on the consent registry. The goal of this chapter is to review the key ethical components of transplantation from deceased donors, specifically for the kidney and pancreas.

ETHICAL PRINCIPLES TO CONSIDER

• Autonomy – A patient or surrogate’s right to choose what happens to them or their loved one in terms of organ donation

• Informed consent – The principle that a patient or surrogate must have all the pertinent information before making a decision regarding end-of-life care, including organ donation

• Beneficence (nonmaleficence) – Making medical decisions that are in direct benefit of the patient or conversely not directly harming the patient

• Justice – The duty of the health care team and organ procurement organization (OPO); in the case of organ donation, to uphold the wishes of the patient or surrogate and do what is best for that patient, family, and potential recipients

DECEASED ORGAN DONATION

• Types of donation

  • Donation after brain death (DBD)

    • Procurement of a patient’s organs following declaration of brain death (permanent cessation of all brain function, including brainstem) and either informed consent from a legally authorized party (NYS Public Health Law, Article 43, Section 4302) or first-person authorization via a valid state or national registry

  • Donation after circulatory death (DCD)

    • Procurement of a patient’s organs following death based on permanent cessation of circulatory and respiratory function, given informed consent by legally authorized party or first-person authorization

• Organs that can be donated

  • Heart

  • Lungs (double or single)

  • Liver (whole or lobes)

  • Kidneys

  • Pancreas

  • Intestine

• One deceased organ donor can save up to 9 lives (1 heart, 2 lungs, 1 adult liver recipient and 1 pediatric liver recipient for split livers, 2 kidneys, 1 pancreas, 1 small intestine) through the donation of solid organs

ORGAN PROCUREMENT ORGANIZATIONS

• An OPO is a third-party, federally designated organization that collaborates with hospitals to facilitate solid organ and tissue donation

  • Established in 1984 by the passing of the National Organ Transplant Act (NOTA)¹

  • NOTA also established the national Organ Procurement and Transplant Network (OPTN), which is operated by the United Network of Organ Sharing (UNOS)

  • OPTN is responsible for managing the national wait list, among other regulatory oversights

  • Fifty-eight federally designated OPOs ...