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Organ Donation & Distribution
Transcript of Organ Donation & Distribution
Organ Donation & Distribution
1966- First successful liver transplant. The liver worked for over one year.
1967- First successful heart transplant.
The heart worked for about two and a half weeks.
Medical and Legal Advances
It is a life-saving and life-changing medical process where organs and tissues are removed from a donor and transplanted into someone who is ill or dying from organ failure.
The term "organ transplant" typically refers to transplants of the solid organs: heart, lungs, kidneys, liver, pancreas, and intestines.
“Policies need to be aimed at both increasing organ donations as
well as creating a system that allocates them in the fairest ways
1954- The first successful kidney transplant. A kidney was taken from one identical brother and was transplanted in the other where it worked for 8 years.
1972- The Uniform Organ Donor Card was established as a legal document in all 50 states due to the passage of the Anatomical Gift Act. This act allowed anyone over 18 to legally donate their organs.
1972- End Stage Renal Disease Act led to insurance coverage for kidney transplants under Medicare.
1981- First successful heart-lung transplant. The organs worked for 5 years.
1981- President's Commission drafted the Uniform Determination of Death Act (UDDA) which included irreversible brain death as a criteria for death.
1984- The National Organ Transplant Act (NOTA) passed. NOTA established the United Network for Organ Sharing (UNOS), allowed financing for organ procurement organizations, and prohibited the sale of organs,
1986- The Omnibus Reconciliation Act of 1986 passed and included "required request." This legally required all hospitals treating Medicare or Medicaid patients to ask the next of kin about donating their loved one's organs.
1996- The first "split liver" transplant was performed where one cadaveric liver was split into several pieces to transplant into more than one person.
1998- The Department of Health and Human Services required organ procurement organizations to be notified of every hospital death.
2000- First culture of human embryonic stem cells.
2001- The number of living organ donations passed cadaverous donations.
to the nation's organ transplant waiting list each day-- one every
transplants every day from either a living or deceased donor.
every day while awaiting an organ-- one person every
. In 2002,
on the U.S. organ transplant waiting list because the organ they needed was not donated in time.
Organ Donation Within the United States
Distribution of Available Organs
Distributive justice theory states that there is not one "right" way to distribute organs, but rather many ways a person could justify giving an organ to one particular individual over someone else. One distributive justice criteria is equal access. Organs allocated according to equal access criteria are distributed to patients based on objective factors aimed to limit bias and unfair distribution. Equal access criteria include:
Length of time waiting (i.e. first come, first serve)
Age (i.e. youngest to oldest)
Believe everyone should have equal access to organs because everyone could potentially benefit from the system.
Support an organ distribution process free of medical or social worthiness biases. Medical "worthiness" biases could exclude patients from reaching the top of the transplant waiting list if lifestyle choices like smoking and alcohol use damaged their organs. Social "worthiness" biases would factor in a patient's place in society or potential societal contribution before giving them an organ.
Encourage a distribution process for transplantable organs that is free of biases based on race, sex, income level, and geographic distance from the organ.
Believe individual worth is important to consider during organ distribution.
Argue that distribution is biased against worthy individuals when individual worthiness factors are not included.
E. Kluge argues that equal access distribution of organs is not fair and just if it includes people whose lifestyle choices, namely tobacco and alcohol use, ruined their organs. Kluge's argument states that people who engage in poor lifestyle choices are behaving irresponsibly and could have prevented their illness and are, in essence, increasing the need for organs and depriving people who, "have no control over their need," of necessary treatment.
Current Organ Distribution Policy
"Life is full of choices....
Some will only matter after we die...."
A second type of distributive justice criteria is maximum benefit. The goal for maximum benefit criteria is to maximize the number of successful transplants. Examples of maximum benefit criteria include:
Medical need (i.e. the sickest people are given the first opportunity for a transplantable organ)
Probable success of a transplant (i.e. giving organs to the person who will be most likely to live the longest)
Believe organs should be distributed so that the greatest benefit is derived from every available organ.
To avoid the wasting of organs, they support ranking transplant candidates by taking into account how sick the patient is and how likely it is that the patient will live after he or she receives a transplant.
Distributing organs in this way could leave the door open for bias, lying, favoritism, and other unfair practices more so than other forms of distribution due to the subjective nature of these criteria.
Argue against using age and maximizing life years as criteria for distributing organs because it devalues the remaining life of an older person awaiting a transplant.
The current organ distribution method in the United States relies on each transplant center to determine which criteria they will use to fairly allocate organs. UNOS encourages transplant centers to consider the following criteria for distributing organs:
Probability of Success
Time on the Waiting List
Distribution of Available Organs Continued
Should Organ Donation be Compulsory?
The Opt-Out versus Opt-In System
Can give many people a second chance at life.
Does not take away the pain of death but can be an opportunity for something positive to come out of a tragedy.
"It is our ethical obligation!"-- If you're dead you don't need your organs anymore, so why not give them away?
Some religions believe organ transplantation is a mutilation of the body and can actually damage a person's soul.
"We are given a freedom of choice!"--We are under no obligation to help one another.
People have such little control of what happens to them in their lives, they should be able to control what happens to their body after death.
The U.S. and many other countries all use what is commonly referred to as the "opt-in" organ donation system, in which individuals have to sign up to become a donor before their death, and then the final decision to use the organs from a given individual's body rests with the potential donor's family after their death.
Some European countries (including France, Belgium, and Sweden) have shed the restrictions of the opt-in system in favor of an opt-out system. The opt-out system presumes that all individuals would consent to have their organs used for transplant. Instead of having to go out of one's way to participate, a person would be presumed a donor (still with the permission of their families) unless they specifically object. In Belgium, only 3-4% opt-out, leaving 96-97% of the population still in the pool of potential donors, as compared with the roughly 30% of Americans who are organ donors in the opt-in system we have here.
In 2009, there were 14,630 Donors, 28,463 Transplants, and 105,567 people on the Waiting List
-Dr. Jeffrey Kahn