Running Head: Organ Donation

Title: Name: Melvin Pegus Course: Health Care Ethics and Medical Law Date: April 30, 2012 Instructor: Joyce Williams

Organ Donation Organ Donation legal and ethical issues

In the movies organ donation has been portrayed as a cynical ways of producing organs to people who deserve them but in a speed up way, horror movies show doctors in third world countries that pick the weak and clueless to produce the vital organs that are needed. In this research I will break down the past, present and future outlook of organ donation as well as tackling the legal and ethical ramification that have been associated with organ donation. About 20 million Americans tuned in for an October 2005 episode of ABC's medical drama "Grey's Anatomy" in which a woman is prematurely declared brain dead. When an intern discovers she is still responsive to stimuli, a literal tug-of-war over the patient breaks out, and the transplant team chides the hospital staff for its resistance. Such inaccurate and negative portrayals of organ donation and transplantation are surprisingly common on TV and feed the public's fears about the process, according to new research. Now, a coalition of more than three dozen organ procurement and transplant organizations, called Donate Life Hollywood, is urging TV producers and writers to think twice before taking creative license in telling stories that could indirectly hurt the more than 96,000 patients waiting for organ transplants. (Clinical Transplantation, October 2005). Susan Morgan, associate professor of health communication, has found that inaccurate storylines about organ and tissue donation stop people from registering as organ donors. As a result, Donate Life Hollywood was created to discourage the "stolen-kidney" storyline from television and film, said Tenaya Wallace, director of the national campaign. During 2004 and 2005, organ donation appeared as a primary storyline on entertainment television in more than 80 episodes in medical dramas, police shows, comedy and daytime soap operas," Morgan said. "It is difficult to believe that none of these appearances presented organ donation in an accurate or positive light, but that is what we found." Morgan's follow-up study shows that viewers, especially

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those who had not decided if they would register as donors, were influenced by what they saw on TV. (Purdue University 2007Aug 4). Before we continue this paper it may be a little mixed in its format lets look at what organ donation is defined as the donation of biological tissue and organ of the human body from a living or dead person to a living recipient in need of a transplantation. The tissues are removed in a surgical procedure following a determination, based on the donor medical and social records, such procedures are termed allotransplantations, to distinguish them from xenotransplantation, the transfer of animal organs into human bodies. 40 years ago irreversible cardiopulmonary failure was the only standard for determining death for purposes of donation after cardiac death or heart failure, by the early 1980s the cessation of all brain activity brain death had become the new standard for organ donation determination, this was attractive to doctors as bodies of such donors could remain on respirators to keep their organs healthy, even during much of the organ-removal surgery which was extremely important to keep the organ viable so it work in the new body. Today the medical establishments are facing a huge shortage of organs and need new sources for transplantation. One solution has been a return to procuring organs from patients who die of heart failure. Before dying, these patients are likely to have been in a coma, sustained by a ventilator, with very minimal brain function a hopeless distance from what we mean by consciousness. Still, many people, including some physicians, consider this type of organ donation, known as donation after cardiac death or DCD, as akin to murder. DCD is a donor who has suffered devastating and irreversible brain injury and may be near death, but does not meet formal brain death criteria. In these cases, the family has decided to withdraw care. When the patients heart stops beating, the organs are then recovered in the operating room. The surgeons involved in

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transplantation cannot be part of the end-of-life care or in the declaration of death. This type of donation does not cause or hasten death. Organs recovered from a donor after cardiac deaths have some degree of oxygen deprivation during the time after the heart stops beating. This may make kidneys from this type of donor slow to start. Critics of DCD contend that some patients may still be alive five or even 10 minutes after cardiac arrest because, theoretically, their hearts could be restarted, and some of their brain function might still remain. In such cases, critics assert, the patients were clearly not dead because their condition was reversible. Advocates of DCD counter that do-not-resuscitate orders from a patient or family render the argument about irreversibility moot. In any case, there would be little debate about DCD if organs in a body remained viable for transplantation 20 or 30 minutes after heart and lung failure. But they become damaged quickly, so surgeons have to act fast ideally, within about 10 minutes of cardiac arrest. According to the Uniform Determination of Death Act, which was drafted about 30 years ago and has since been adopted, in some form, by all of the states, you can be declared dead in one of two ways: Your brain can irreversibly cease functioning, or your heart and lungs can irreversibly stop working. Irreversibly, in this context, has fueled the controversy. Does it mean the heart is unable to spontaneously start by itself? Or does it mean that even resuscitation efforts fail to restart the heart? To be certain that a heart does not have the capacity to start beating again on its own, most organ procurement organizations, including the California Donor Transplant Network, require that doctors observe patients for five minutes after cardiac arrest before declaring death and admitting the transplant team into the operating room. (Five minutes is the amount of time recommended by the Institute of Medicine, even though under typical end-of-life conditions no adult heart is known to have started beating again by itself two minutes after stopping?)

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Today organ donation has become two option opt in as someone who volunteer either on their drivers license other methods of showing that they are a donor, and there is opt out which means someone who does not refuse to become one at the time of medical attention. As I stated before the looming problem with organ donation is the availability over the accessibility. Before the 1950s, no statute in the United States authorized the removal of organs or tissues from living or deceased persons for transplant into another. Early attempts at organ donation were unsuccessful because delays caused by lengthy and complex legal proceedings deprived the transplantation process of urgency and timeliness. Today, all 50 states plus the District of Columbia have some form of legislation establishing procedures by which a person can donate organs for transplantation. Twenty-six states have enacted various forms of "routine request legislation, which requires hospital and medical personnel to present families with the opportunity for organ donation upon the death of a relative. The system of organ donation in the early years in the United States was a voluntary one based primarily on the expressed consent of the donors or their families During the 1960s when organs for the first kidney transplants were obtained from living donors, legal emphasis was on the rights of an individual to make a gift of an organ as long as the donor was fully informed about the risks of the procedure and free from any type of coercion - social, emotional, or monetary This informed consent approach is the foundation of the voluntary system by which most transplantable organs have been obtained to date in this country. The demand for organs significantly surpasses the number of donors everywhere in the world. There are more potential recipients on organ donation waiting lists than organ donors. In particular, due to significant advances in dialysis techniques, patients suffering from end-stage renal disease (ESRD) can survive longer than ever before. Because these patients don't die as quickly as they used to, and as kidney failure increases with the rising age and prevalence of high blood pressure and diabetes

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in a society, the need especially for kidneys rises every year. (United Network for Organ Sharing. Retrieved 2009). In the United States, about 108,000 people are on the waiting list although about a third of those patients are inactive and could not receive a donated organ Wait times and success rates for organs differ significantly between organs due to demand and procedure difficulty. Threequarters of patients in need of an organ transplant are waiting for a kidney, (California Transplant Donor Network 2011) Retrieved and as such kidneys have much longer waiting times. Another reason for low numbers of potential DCD donors is simply that fewer young people die because they are, well, young. And when a young person dies, family members may have trouble coming to grips with the loss and so neglect or scorn end-of-life considerations, such as organ donation. Thats unfortunate not only for potential recipients but for the family of the deceased, says Nikole Neidlinger, MD, the medical director of the California Donor Transplant Network. A lot of people think that its all about the organ recipient, but really, I think, the donors families get the biggest benefit, Neidlinger says. They have spent perhaps weeks dealing with the hardship of seeing loved ones on life support and coming to terms with their death. And the fact that the donor gets a chance to help another person live its a legacy that counts so much for families. The extended waiting list for organs also produces other real or potential problems that threaten to undermine some of the medical gains made by the advent of organ transplantation. Because the waiting list and waiting time for organs have increased, transplant centers (especially in large urban areas) have relaxed the criteria of donor eligibility, using organs from donors who are older or sicker, including drug users and those with infectious diseases. There are still inadequate data on the differential outcomes of using such extended criteria organs, and some observers fear an overall reduction in the quality of the organs actually transplanted. In addition, because patients suffering from organ failure are waiting longer for organ transplants, the

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medical condition of patients who actually receive organs is, in some cases, getting measurably worse. People who get organs today are in some cases sicker than people who got organs in the past, which also risks moderating or undermining the benefits of receiving an organ.

Over the past few decades, a series of public policies and medical protocols have been enacted that govern organ donation, procurement, allocation, and transplantation in the United States. Three acts of the U.S. Congress, in particular, establish the central legal, moral, and medical framework: (a) The Uniform Anatomical Gift Act (UAGA) of 1968, adopted in some form in all fifty states, which granted individuals the right to decide before death whether they wished to donate their organs. (b) The Uniform Determination of Death Act of 1981, which established the following criteria for declaring someone dead: "An individual, who has sustained either irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead." (c) The Organ Transplantation Act of 1984, which aimed to encourage organ donation by establishing an organized organ matching and procurement network, while outlawing the buying and selling of human organs or the direct compensation of organ donors and their families. Some other laws are Donor Consent, Respect for Families: a policies aim to ensure that organs are only procured with the explicit prior consent of donors and/or their surviving family members. In some cases, these two aims-respecting the wishes of potential donors and respecting the families of the deceased-can come into tension. The tension arise when the consent of the patient to donate once they die is refused by the grieving family members who feel a sense of being robbed through this law the doctor are not allowed to remove any organs as the family has the last say so although the patient themselves requested to donate the organs. The Dead Donor Rule: First, our

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policies aim to ensure that all deceased donors are truly dead; that there are clear criteria for discerning when death has occurred; that these criteria are grounded in the nature of death itself as a biological phenomenon and yet applicable in light of novel technological capacities to sustain various biological functions even after whole-brain death has occurred; and that the desire to procure organs does not invite us to redefine death in general or hasten the death of particular patients in order to expand the organ supply, or tempt us to procure vital organs from those who are severely debilitated or imminently dying but not yet dead.

"Family discussions about organ donation: how the media influences opinions about donation decisions," Clinical Transplantation, October 2005, in pdf (www.purdue.edu/dp/rche/donatelife/Family_Discussions_Organ_Donation.pdf) Purdue University. (2007, August 4). "Research Spotlights TV Portrayal Of Organ Donations, Spurs Advocates." Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/78676.php. Organ Donation and Transplantation". United Network for Organ Sharing. http://www.unos.org/. Retrieved 2009-03-24. John Sanford (Spring 2011). "When Are You Dead?". Stanford University School of Medicine. http://stanmed.stanford.edu/2011spring/article5.html. Retrieved 2011-03-31. Thomas May, Mark P. Aulisio, Michael A. DeVita Patients, Families, and Organ Donation: Who Should Decide? 5 JAN 2002 DOI: 10.1111/1468-0009.00172

Organ Donation http://bioethics.georgetown.edu/pcbe/background/staff_cohen.html

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