Organ Procurement and transplantation
What did the Consolidated Omnibus Reconciliation Act of 1986 require?
Requires hospitals to establish a relationship with a federally mandated Organ Procurement Organization, which must work with hospitals to coordinate transplants at the local level This act forced all hospitals receiving Medicare or Medicaid funding to enact a "required request" policy, which ensures that all families of potential donors are told about organ donation and their right to decline donation TLDR: COBRA includes organ donation and established procurement organization (OPO)
What is the process of organ procurement?
*patient not on the table until we know the organ is viable*
What is the issue with organ donation?
124,000 people in the US are in need of an organ While 98% are in favor of donation, only 60% are registered The number of cadaveric donations continues to decrease as the number of fatalities from motor vehicle collisions continues to decrease 15,700 Virginians have been recipients of tissue or organ donations
What tissues can be donated
Cornea Skin Bone Marrow Blood Islets of Langerhans Heart Valve Ovary
What are the benefits to living donors?
Donation can be pre-arranged, allowing patient to begin taking antirejection drugs in advance, increasing the chances of success Better matches between donors and recipients with living donation, because many donors are genetically related to the recipient Psychological benefits for both the donors and recipients Non financial incentives such as medical leave or special insurance for living donors In 2004, Wisconsin became the first state to offer a living donation incentive to its citizens, allowing living donors in Wisconsin to receive an income tax deduction to recoup donation expenses like travel costs and lost wages
What are the 2 main objectives for organ donation laws?
Ensure a safe and fair organ donation collection and distribution practice Widen the pool of potential donors in an effort to increase the number of organs available for transplant
What organs can be transplanted?
Heart Lung Heart-lung Kidney (most common) Liver Pancreas Intestine Face Hands Leg Penis Bone Uterus Thymus
What are arguments against living donations?
Inappropriate under any circumstances and should not only be discouraged but abandoned all together because risk and dangers associated with donating organs Extending life through costly and physically taxing medical procedures is not the purpose of health and healthcare in America
When can you have a living donor?
Kidney, liver, intestines
What are the factors for OPO organ procurement organziation
Organ type, blood type and organ size Distance from the donor organ to the patient Level of medical urgency (inconsistent for liver donations) Time on the waiting list
other definitions?
Orthotopic: means the patient has their organ removed and it is replaced with the donated one Heterotopic: patient organ is left in w/ transplant
What are the risks to living donors?
Pain, discomfort, infection, bleeding, and potential future health complications Psychological consequences: Family pressure, guilt or resentment Coercion— Family members may feel pressure to donate when they have a sick family member or loved one No donor advocate, like the transplant surgeon or medical team (who are there to advise the patient and work in favor of his or her best interests
What is the hierarchy for giving post-humous consent?
Spouse Adult child Parent Adult sibling Legal guardian
How is brain death defined in Va?
To be a legal determination, Virginia Code requires two physicians to make this declaration based on clinical exams and nationally accepted brain death testing methods
Who runs the waiting pool?
UNOS
What happens if there is no readily available organ or pt is high risk?
Waiting pool for a cadaver organ
cadaveric
dead donor
What happens if someone dies without a clear organ donation preference?
hospital, physician, or organ procurement organization will approach a family member to obtain consent to remove the organs
living
whole or partial
