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Organ donation

Ethical Issues related to organ donation
by

C. Rodriguez

on 15 November 2012

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Transcript of Organ donation

Many hospitals in the United States are tacitly participating in the illegal organ transplant industry by not scrutinizing potential donors too closely, experts worry purchase or sale of organs is illegal in most countries, including the United States, but a chronic shortage of organs for transplant has led to a thriving international black market.
According to WHO nearly 11, 000 organs were bought on the black market in 2010.
Typically, poor donors (usually from Third World countries) are paid several thousand dollars for organs that are then resold for upwards of $100,000 to rich recipients, usually from the First World.
Data from the WHO shows that of the 106,879 solid organs known to have been transplanted in 95 member states in 2010 (legally and illegally), about 73,179 (68.5%) were kidneys. But those 106,879 operations satisfied just 10% of the global need, the WHO said.
The arrests of 44 U.S. residents on organ trafficking charges in July 2009 marks the first documented case of the practice in the United States, and has raised concerns that hospitals here might be encouraging it.
Hospitals have a large financial incentive to facilitate organ donation -- the procedures are costly, with large profit margins for doctors and institutions. The average kidney transplant cost $259,000 in the United States in 2008, netting between $80,000 and $100,000 in insurance reimbursements for hospitals and doctors. Because of this conflict of interest, many hospitals do not train their staff to screen for organ trading too vigorously.
How is this system managed? Criteria for waiting list priority…. Who manages all the information? Things to think about Do you think it exist in U.S? Black Market Patient’s autonomy

Family

Doctors Who has the final say? At the end of December 2011, 54 year old Avi Cohen, an Israeli soccer star who had played in England's top league, passed away after suffering substantial injuries when he crashed his motorcycle. Cohen, who was not observant, had signed an organ donation card that would have allowed doctors to remove his organs for transplant purposes. After the accident, Cohen slipped into a coma, and was connected to a ventiltor, which kept his body's physical functions going – although doctors could not detect any brain activity, including that of the brain stem which controls respiration.
Doctors planned to “pull the plug” and allow Cohen to die, and to remove his organs as planned. However, after some discussion, Cohen's family decided not to allow the removal of the organs, despite the accident victim's apparent wishes. Under Israeli law, the family has the last word on whether or not to allow organ donations.
Cohen was still considered to be alive, since his heart was still beating, and it could not be known in advance if his heart would be able to function without the respirator. If it could, then removing Cohen's vital organs would be nothing short of murdering him.

Case 2: The recent death of soccer star Avi Cohen
refocused attention on organ donation dispute:
When is a person actually "dead" ?
When does death occur? A sudden accident

Marion 45, administrative assistant with no known health problems, suddenly became unresponsive at work. In the ER it was determined that a ruptured intracranial aneurysm had casued an acute subarachnoid hemorrhage. She was intubated and placed on a mechanical ventilation and transferred to the ICU. She was classified as brain dead donor even though her heart continued to beat.

Her husband and family were shocked by this sudden events.

The staff was instructed NOT to mention organ donation to the family instead according to Pennsylvania Law the resident physician notified the Gift of Life (GOL) donor program.

When the GOL rep became involved the focus became preserving her organs and tissue for a possible recipient.

Marion had no living will or advanced directives, No one seemed to know her wishes.

Would Organ retrieval proceed?

Her husband became her surrogate decision maker and it was his duty to protect marion's life goals by acting as her advocate.

Surrogates should base thir decisions on the substituted judgment standard.

Their next step would be to use the best interest standard.

In the end, her husband donated Marion's organs and tissue to the GOL. Two men each received one of her kidneys, no longer needing dialysis. Marion's liver was given to a man in his 40's and her heart valves went to another patient. Case 1 Cost involved in organ transplantation Over the past two decades, the gap between the number of patients waiting for a transplant and the number receiving a transplant has continued to widen. The substantial difference between the number of donors and the number of patients waiting for a transplant is one factor that contributes to waiting time from listing to transplant. The Gap Continues to Widen 116,465 people are waiting for an organ

18 people will die each day waiting for an organ

1 organ donor can save up to 8 lives General statistics Organs
Heart, kidneys, lungs, liver and intestines

Tissue
Cornea, skin, heart valves, bone, blood vessels, and connective tissue

Bone Marrow/ Stem cells

Umbilical cord blood

Peripheral blood stem cells What can you donate? Almost everyone can be a donor

Under 18 requires parental permission

Exceptions
Transplant team review
Pathological conditions Who can donate? By Cindy Rodriguez and Samita Malla Organ Donations and Ethical Issues Indeed, fetal tissue such as pancreas, brain, liver, thymus, bone marrow and adrenal gland have all been used sporadically in clinical transplantation despite widespread concern over the legality and ethical appropriateness of the procedure. Also the collection and sale of fetal tissue by corporations is known to occur.


The first such case of using an organ from an anencephalic infant was that of Baby Gabrielle born in 1987 with prenatal anencephalopathy, who was brought to Children’s Hospital in London, Ontario. She was placed on a respirator and declared brain-dead. The baby was then flown to Loma Linda University Medical Center in California, her heart was taken and transplanted into baby Paul Holc, who had been delivered by cesarian section to receive the transplant.
Case 3: Use of Organs from Fetuses In 1988, there were 5,901 Donors, 12,618 Transplants, and 15,029 Waiting list
In 1989, there were 5,927 Donors, 13,140 Transplants, and 17,917 Waiting list
In 1990, there were 6,630 Donors, 15,001 Transplants, and 20,443 Waiting list
In 1991, there were 6,952 Donors, 15,756 Transplants, and 23,149 Waiting list
In 1992, there were 7,090 Donors, 16,133 Transplants, and 27,510 Waiting list
In 1993, there were 7,766 Donors, 17,630 Transplants, and 31,273 Waiting list
In 1994, there were 8,200 Donors, 18,297 Transplants, and 35,192 Waiting list
In 1995, there were 8,854 Donors, 19,393 Transplants, and 41,096 Waiting list
In 1996, there were 9,205 Donors, 19,747 Transplants, and 47,397 Waiting list
In 1997, there were 9,537 Donors, 20,304 Transplants, and 53,381 Waiting list
In 1998, there were 10,361 Donors, 21,517 Transplants, and 59,862 Waiting list
In 1999, there were 10,861 Donors, 22,016 Transplants, and 65,260 Waiting list
In 2000, there were 11,917 Donors, 23,248 Transplants, and 71,628 Waiting list
In 2001, there were 12,687 Donors, 24,218 Transplants, and 76,893 Waiting list
In 2002, there were 12,819 Donors, 24,907 Transplants, and 78,498 Waiting list
In 2003, there were 13,284 Donors, 25,467 Transplants, and 81,979 Waiting list
In 2004, there were 14,154 Donors, 27,035 Transplants, and 85,610 Waiting list
In 2005, there were 14,488 Donors, 28,108 Transplants, and 89,884 Waiting list
In 2006, there were 14,755 Donors, 28,930 Transplants, and 94,472 Waiting list
In 2007, there were 14,403 Donors, 28,358 Transplants, and 97,782 Waiting list
In 2008, there were 14,209 Donors, 27,966 Transplants, and 100,775 Waiting list
In 2009, there were 14,630 Donors, 28,463 Transplants, and 105,567 Waiting list The Gap Continues to Widen These are local organizations in the United States designated by Centers for Medicare and Medicaid Services (CMS). They are responsible for increasing the number of registered donors in their service area. There are 58 OPO’s in the United States
Most states only have 1 OPO, but the state of Texas has 3
The 3 Texas OPO’s are divided into regions, Central, Northern and Southern by counties OPO- Organ Procurement Organization By increasing availability and access to donor organs for patients with end-stage organ failure. The organization must be non profit, in the private sector and a member of the US transplant center, organ Procurement and histocompatibility laboratories.

The OPTN is under federal contract though Health Resources and Services Administration of the U.S. Department of Health and Human Services and goverened by a Board of Directors. 1987 Congress passed the National Organ Transplant Act establishing the OPTN
This was done to improve the nations organ procurement, Donations and transplant system. OPTN – Organ Procurement Transplant Network Accoding to the Nationl Oragan Transplant Act (Public Law 98-507) you cannot sell your organs.
The establishment of this act makes it illegal to sell human organs and tissue in the U.S.
-This was done to ensure the wealthy did not have a financial advantage. What you cannot do… You must first register at organdonor.gov select your state
You can be choose to be an organ, tissue or eye donor
Designate to be a donor on your when you renew your drivers license
Tell family and friends of your wishes
Inform your physician and/or faith leader
Have advance directives, wills, and living wills stating your wishes

**Your blood type and tissue do not have to be an exact match. How do I become a donor? This is a private, non profit organization that manages the nations organ transplant system and under contract with the Federal Govertment. Manage waiting list 24 hours a day 365 days a year, matching donor and recipient
Maintains database of all organ transplant data events
Helps develop/promote policies for fairness with limited supply
Education: process, professional and public UNOS – United Network of Organ Sharing Blood type
Time on the waiting list
Severity of illness and other medial criteria Organ donation can truly be "the gift of life", and such innovations holds much promise to increasingly meet the needs of people with failing organs.

When it comes to organ donation YOU and you alone have to decide what you want.

People are urged to sign an organ donor card with little or no awareness of what that action can mean

The most important thing is to let your family and doctor know your wishes.

Be sure to have a living will and/or advance directives.

If you don't do any of these things make sure you have a surrogate decision maker selected that would know what you would want. References http://www.organdonor.gov/about/transplantationprocess.html#process3

http://publications.milliman.com/research/health-rr/pdfs/2011-us-organ-tissue.pdf

http://www.faculty.umb.edu/gary_zabel/Courses/Moral%20Issues%20in%20Medicine/000068158.pdf

http://www.foxnews.com/health/2012/05/28/growing-demand-fuels-black-market-organ-trade/

http://www.naturalnews.com/028994_organ_transplants_black_market.html

http://www.wf-f.org/02-3-OrganDonation.html
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