ORGAN DONATION

What is organ donation?

Organ donation takes healthy organs and tissues from one person for transplantation into
another. Experts say that the organs from one donor can save or help as many as 50 people.
Organs you can donate include:

● Internal organs: Kidneys, heart, liver, pancreas, intestines, lungs

● Skin
● Bone and bone marrow
● Cornea

Types of Donation
1. Living Donor - is a surgical procedure to remove an organ or portion of an organ from a
living person and place it in another person whose organ is no longer functioning
properly.
Kidney and liver transplants are the most common types of living-donor organ
procedures, but living people may also donate tissues for transplantation, such as skin,
bone marrow and blood-forming cells (stem cells) that have been damaged or destroyed
by disease, drugs or radiation.

There are two types of living donation:

● Directed donation – the living donor chooses the specific person they want to
give their organs to. This type of donation usually happens when the donor and
patient are family members or friends.
● Non-directed donation – the living donor does not name a specific person who
should receive their organ. The organ can be given to anyone in need and to
whom is a match. A non-directed donation is less common than a directed
donation.
2. Deceased Donor - is the process of giving an organ or a part of an organ, at the time of
the donor’s death, for the purpose of transplantation to another person. At the end of
your life, you can give life to others.
​Only after all efforts to save the patient’s life have been exhausted, tests have been
performed to confirm the absence of brain or brainstem activity, and brain death has
been declared, is donation a possibility.

Facts About Organ Donation

 ● Anybody can be an organ donor irrespective of their age, gender, caste, religion, and
community. However, anyone younger than 18 needs to have an agreement of parents
or guardians to be a donor.
● The decision to donate the organ is based on the strict medical criteria and law.
● Tissues such as cornea, heart valves skin and bones can be donated in case of natural
death but vital organs such as heart, liver, kidney, intestines, lungs and pancreas can be
donated only in case of “brain death”
● Organs such as heart, pancreas, liver, kidney, and lungs can be transplanted to those
recipients whose organ are failing, because it allows many recipients to return to normal
life style.

Guiding Principles on Organ Transplantation according to WHO

● Guiding Principle 1: Cells, tissues, and organs may be removed from the bodies of
deceased persons for the purpose of transplantation if:
○ Any consent required by law is obtained, and
○ There is no reason to believe that the deceased person objected to such
removal.

Consent is the ethical cornerstone of all medical interventions. The person who had
expressly consented to such removal during his or her lifetime depending upon the
domestic law, such consent may be made orally or recorded on a donor’s card, driver’s
license or identity card or in the medical record.

● Guiding Principle 2: Physicians determining that a potential donor has died

should not be directly involved in cell, tissue, or organ removal from the donor or
subsequent transplantation procedures; nor should they be responsible for the
care of any intended recipient of such cells, tissues, and organs.

This principle is designed to avoid conflict of interest that would arise were the physician
or the physicians determining the death of a potential donor to be responsible in addition
for the care of other patients whose welfare depended on cells, tissues, or organs
transplanted from the donor.

● Guiding Principle 3: Donation from deceased persons should be developed to its

maximum therapeutic potential, but adult living persons may also donate organs
as permitted by regulations. In general, living donors should be genetically,
legally, or emotionally related to their recipients.

This principle stresses the importance of protecting the health of both living and dead
donors during the process of selection, donation, and necessary aftercare to ensure that
the potential untoward consequences of donation are unlikely to occur in the donor’s life.
● Guiding Principle 4: No cells, tissues, or organs should be removed from the body
of a living minor for the purpose of transplantation other than narrow exceptions
allowed under national law.

This principle states a general prohibition on the removal of cells, tissues or organs from
legal minors for transplantation.

● Guiding Principle 5: Cells, tissues and organs should only be donated freely,
without any monetary payment or other reward of monetary value.

Payment for cells, tissues and organs is likely to take unfair advantage of the poorest
and most vulnerable groups, undermines altruistic donation, and leads to profiteering
and human trafficking. Such payment conveys the idea that some persons lack dignity,
that they are mere objects to be used by others.

● Guiding Principle 6: Promotion of altruistic donation of human cells, tissues or

organs by means of advertisement or public appeal may be undertaken in
accordance with domestic regulation.

This principle aims to prohibit commercial solicitations, which include offering to pay
individuals, the next of kin of deceased persons, or other parties in possession (such as
undertakers), for cells, tissues or organs; it targets brokers and other intermediaries as
well as direct purchasers.

● Guiding Principle 7: Physicians and other health professionals should not engage
in transplantation procedures if they have reason to believe that the organs
concerned were obtained through exploitation or payment.

Health care professionals should only proceed with the removal, intermediate
management or implantation of cells, tissues or organs when donations are unpaid and
truly voluntary.

● Guiding Principle 8: All healthcare facilities and professionals involved in cell,

tissue or organ procurement and transplantation procedures should be prohibited
from receiving any payment that exceeds the justifiable fee for the services
rendered.

Health authorities should monitor the fees charged for transplantation services to ensure
that they are not disguised charges for the cells, tissues or organs themselves.

● Guiding Principle 9: The allocation of organs, cells and tissues should be guided
by clinical criteria and ethical norms, not financial or other considerations.
Allocation rules, defined by appropriately constituted committees, should be
equitable, externally justified, and transparent.
 This principle emphasizes that multidisciplinarity is important to ensure that allocation
takes into account. It is not only medical factors but also community values and general
ethical rules

A. Ethics of Organ Donation

Dead donor’s rule

An ethical norm that has been formulated in at least 2 ways:

1. Organ donor must be dead before procurement of organs begin
2. Organ procurement itself must not cause the death of the donor

BRAIN DEATH

- Legitimating the withdrawal of life support and the extraction of vital organs
- Vital organs are retrieved for transplantation from brain dead patient who’s hearts
continue to beat via mechanical ventilation from patients declared dead immediately
after life support is withdrawn
- These brain dead patients are actually corpses breathing mechanically. By telling
themselves, patients, patient’s families that brain death is a form of death, clinicians and
ethicist have become comfortable with “cadaveric” organ donation

Withdrawing Life support

- You cannot withdraw life support for the sole purpose of obtaining an organ

Nursing’s chief moral concerns: three questions to ask

1. Is the donor patient’s death being hastened?

The decision to withdraw life-sustaining treatment could be affected by the desire to make
organs available and could interfere in various ways with responsible end of life decision
making.

2. How well informed is the informed consent?

● A patient seeking a “good death” may, as a donor, receive a more technologically

invasive death than the patient and family understand.
● It is obligatory to inform the patient how their care will change as a donor.

OBTAINING CONSENT
 - The OPO or the Organ procurement Organization representative will search the state’s
donor registry to see if the deceased is enrolled as a donor. If so it will serve as legal
consent
- If the deceased had not registered and there was no other legal consent such as Driver’s
license the OPO will seek consent for the next of Kin
- Once they have the consent the , medical evaluation will continue including obtaining the
deceased’s complete medical and social history from the family

3. Is the family able to be with the patient donor at the moment of death?

● Arrangements should be made to have treatment withdrawn in the ICU, with the family
present, or in the operating room until the patient dies.
● The staff should try to create the most family-supportive environment possible during the
final hours of a loved one’s life.

Guidelines for nurses who work in areas where organ donations occur

1. The nurse’s first obligation is the well-being of the patient entrusted to our care.

● Provision 1 of the Code of Ethics for Nurses states, “The nurse, in all professional
relationships, practices with compassion and respect for the inherent dignity, worth, and
uniqueness of every individual, unrestricted by considerations of social or economic
status, personal attributes, or the nature of health problems.”
● In the case of the organ donor, the nurses have a duty to protect the patient’s dignity and
make the patient’s comfort and well being their first priority.

2. The act of procuring organs should never be the explicit cause of a person’s
death.

● Provision 1.3 of the Code of Ethics states, “The nurse should provide interventions to
relieve pain and other symptoms in the dying patient, even when those interventions
entail risks of hastening death. However, nurses may not act with the sole intent of
ending a patient’s life even though such action may be motivated by compassion,
respect for patient autonomy and quality of life considerations.”
● Bound by this moral rule, in organ donation defining death is morally essential. It is vitally
important that nurses who serve the patient population who are potential donors are
educated in the acceptable definitions of death.*

3. Nurses understand the good of organ donation itself.

● Provision 1.4 of the Code of Ethics addresses the patient’s Right to Self Determination
(Autonomy). “Patients have the moral and legal right to determine what will be done with
their person; to be given accurate, complete and understandable information in a
manner that facilitates an informed judgment.”
 ● A patient’s wish to be a donor gives people a novel way to die well by making their death
a benefit to the living.

C. Principles involved in Organ Donation

1. Principle of Utility
- This principle states that actions or behaviors are right in so far as they promote
happiness or pleasure, wrong as they tend to produce unhappiness or pain.
- The principle of utility takes into account all possible goods and harms that can be
envisioned, considering the quantity and probability of the various outcomes.
- The principle of utility holds an action or practice to be right if it promotes as much or
more aggregate net good than any alternative action or practice.
- The entire enterprise of organ procurement and transplantation is undertaken in order to
benefit a group of critically ill patients. The overall good that is done to benefit that group
is the primary reason for the program. The principle of utility holds an action or practice
to be right if it promotes as much or more aggregate net good than any alternative action
or practice. The principle of utility, applied to the allocation of organs, thus specifies that
allocation should maximize the expected net amount of overall good (that is, good
adjusted for accompanying harms), thereby incorporating the principle of beneficence
(do good) and the principle of non-maleficence (do no harm).
- Factors to be considered in the application of the principle of utility are: 1) patient
survival; 2) graft survival; 3) quality of life; 4) availability of alternative treatments; and 5)
age.
- Good consequences of transplantation include, but are not limited to: saving life,
relieving suffering and debility, removing psychological impairment, and promoting
well-being.
- Possible harmful consequences of transplantation include, but are not limited to:
mortality, short term morbidities (post operative surgical complications and acute organ
dysfunction and/or rejection), and long term morbidities (side effects and complications
from immunosuppressive medications, psychological impairment, and potential rejection
of the organ).

2. Principle of Justice
- states that “the idea that the burdens and benefits of new or experimental treatments
must be distributed equally among all groups in society. Requires that procedures uphold
the spirit of existing laws and are fair to all players involved”
- Refers to the fairness in the pattern of distribution of the benefits and burdens of organ
procurement and allocation programs.
- ​The National Organ Transplant Act (NOTA), in its mandate for the establishment of the
Task Force on Organ Procurement and Transplantation, specifically expressed concern
for "equitable access by patients to organ transplantation and for assuring the
equitable allocation of donated organs among transplant centers and among
 patients medically qualified for an organ transplant.". The Task Force specifically
recommended that selection of patients for waiting lists and allocation of organs be fair.
- Thus, we are concerned not exclusively with the aggregate amount of medical good that
is produced, but also with the way in which that good is distributed among potential
beneficiaries. This does not mean treating all patients the same, but it does require
giving equal respect and concern to each patient. In general, allocation of organs based
on social characteristics (such as race, socioeconomic class, gender) will conflict with
the principle of justice, although there may be special cases such as the matching of
skin-tone in face and hand transplant that call for exceptions in the allocation of
vascularized composite allografts (VCAs), which is beyond the scope of this paper.
- Factors to be considered in the application of the principle of justice are: 1) medical
urgency; 2) likelihood of finding a suitable organ in the future; 3) waiting list time; 4) first
versus repeat transplants; 5) age; and 6) geographical fairness.

3. Principle of Respect
- States that it is “the requirement to acknowledge autonomy and the requirement to
protect those with diminished autonomy”
- This principle holds that we owe to humans a respect that they should be treated as
“ends in themselves,” not merely as means. This principle embraces the moral
requirements of honesty and fidelity to commitments made. Most importantly, respect for
persons embraces the concept of respect for autonomy.
- The concept of respect for autonomy holds that actions or practices tend to be right
insofar as they respect or reflect the exercise of self-determination.
- Persons and their actions are never "fully" autonomous, but nevertheless it is possible to
recognize certain individuals and their decisions as more or less substantially
autonomous, meaning they have the right to make decisions free from coercion and
interference as long as the decisions do not impose harm to others.
- (1) respect for the moral worth and dignity of each human being; (2) respect for each
individual’s right to govern the disposition of his or her body after death, including the
voluntary choice of whether or not to donate organs; (3) respect for the remains of
human beings, as represented in particular cultural and religious practices; and (4)
respect for the wishes and feelings of the families of deceased individuals.
- Factors to be considered in the application of the principle of respect for autonomy are:
1) the duty to respect decisions of donors or those who refuse to donate organs; 2) the
right to refuse an organ; 3) free exchanges among autonomous individuals; 4) allocation
by directed donation; and 5) transparency of processes and allocation rules to enable
stakeholders to make informed decisions.

Summary

Utility refers to the maximization of net benefit to the community (taking into account both the
amount of benefit and harm and the probability of such benefit and harm) and justice refers to
the fair pattern of distribution of benefits. The principle of respect for persons incorporates a
number of related concepts such as the duty to speak truthfully and keep commitments, but
primarily conveys the concept of respect for autonomy. Respect for autonomy holds that actions
or practices tend to be right insofar as they respect independent (without coercion or
interference) choices made by individuals, as long as the choices do not impose harm to others.

D. Pivotal Role of Nurses in Organ Donation and Transplant

● Registered professional nurses are often primary caregivers for patients approaching the
final stage of life.
● It is the nurse who facilitates the coping of patients and their families. In general, the
work of transplant nurse is anchored on counseling and facilitating the process of organ
or tissue donation by educating and guiding to the donor families without doubt, a
difficult, heart wrenching process.
● The nurses stay with the patients and help the family to understand the organ donation
process, which includes keeping the brain dead patient’s body functioning until the organ
been collected.

1. As a Transplant Coordinator - A transplant coordinator handles many aspects of

the organ transplant process. They support surgeons, recipients and donors or
their families to create a seamless transplant experience for everyone involved.
Transplant coordinators are vital to safe, effective transplants as they ease donor
and patient stress and let surgeons focus on the delicate medical procedures.

Nurses must have in depth knowledge regarding the following aspects:

● What is organ donation and why is it needed?

● How does organ donation help patient with organ failure?
● Counseling of the family members of brain dead for organ donation?
● What body parts can be donated?
● Who can be potential donors?
● Document required for the donor and for the recipients
● What are the ethical aspects?
● Standard operating guidelines of HOTA.
● Network of organ donation, transportation and transplantation functioning.
● Why to become organ donor and how to get registered
● How does the family of deceased donor cope up with their loss
● Creating the awareness in the community about organ donation

What do Transplant coordinators do?

Evaluating potential donors

Before a patient can donate an organ, transplant coordinators must screen potential donors to
make sure their organs are healthy and viable for a new recipient. They evaluate donors using a
set of interview questions and qualifications to determine the health of the donor, including any
medical and social history that can affect the health of a donated organ. These evaluations may
involve a donor or a donor's family members and are the first step in the organ transplant
procedure.

Matching donors to recipients

Another important aspect of a transplant coordinator's job is matching the donors with
recipients. Once a donor has cleared the evaluations, coordinators can add them to lists for
patients hoping to receive new organs. They match donors and recipients based on factors like:

● Blood type

● Proximity

● How long the patient has been waiting

This part of the transplant process is very important as well matched donors and recipients can
have higher chances of transplant success.

Transporting organs

Transplant coordinators do much of their work in hospitals, but they also spend a lot of time
traveling to transport organs from one site to another. Sometimes, donors and patients might be
in different hospitals, or a donor's organs might need to be taken to a temperature-regulated
storage facility for a short period. This requires knowledge of proper transportation techniques to
keep the organs viable for transplant and a valid driver's license.

Providing resources for donor families

Sometimes, a donor's family may have to make decisions about the donor's organs. When this
happens, transplant coordinators can provide resources and support to the families to help them
understand the procedures. These resources are usually educational and summarize how the
organs will be used and the ways the transplant will benefit the recipient.

So there are the other few vital roles can be played by the nurses.

2. Nurse as Educators -. She also need to educate her patients about the transplant
process and provide emotional support. If a patient or the family of a patient asks a
nurse about the possibility of an organ donation or transplant, the nurse has to notify this
to the transplant team in the hospital.
3. ICU Nurses - ICU Nurses take care of the live donors and recipients after organ
donation, the deceased person till the time of organ donation after the brain death. If the
patients and their relatives if they have any doubts it is to be clarified by the ICU nurse or
the transplant team.

4. Procurement Nurses - Procurement nurses initiate contact with the family of the patient
whose organs might be suitable for transplant — then coordinate the timing of the organ
harvest from the donor with the transplant into the recipient. The procurement nurse also
might assist with the surgical removal of organs from the donor and ensure that the
organs are properly transported to maintain viability when they reach the recipients.

5. Surgical Nurses - The transplant team consists of doctors and nurses specially trained
in transplant, which involves two patients: the donor and the recipient. Separate surgical
teams might handle the removal of the organs from the donor and the placement into the
recipient, or the same team might perform both surgeries.

6. Nurse Researchers - The researchers can do research in the field of organ donation
such as the quality of life of the live donors, recipients and their families, recipients, case
studies on organ recipients and organ donors
7. Nurse Administrators - Nurse administrators must take the initiative to develop
guidelines clarifying the role of nurses in the organ donation and transplantation process
to promote organ donation and improve rates.