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organ transplantation

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Jordan Vogel

on 24 November 2013

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Transcript of organ transplantation

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In 1962 the first successful kidney transplant from a deceased donor was led by the same doctor.
in 1954 at the Peter Bent Brigham Hospital in Boston, the first kidney transplant case succeded. Richard and Ronald Herrick were identical twins, but Richard was dying of kidney disease. Ronald donated one of his kidneys,It was successfully transplanted into Richard. Because they were identical twins Richard's body did not reject it.
In 1984 the National Organ Transplant Act (NOTA) established a nationwide computer registry operated by the United Network for Organ Sharing (UNOS).
Organs include heart, kidneys, pancreas, lungs, liver and intestines. Tissue that can be donated include eye, skin, bone, heart valves and tendons.
Nearly 50,000 Americans are waiting for organ transplants while hundreds of thousands more need tissue transplants.
History
UNOS was first awarded the national OPTN contract in 1986 by the U.S. Department of Health and Human Services. UNOS continues to be the only organization ever to operate the OPTN
UNOS
Fun Facts
Walter Graham is the Executive Director
Requires a complex computer system
average price of a kidney:$150,000
In 2006, UNOS launched DonorNetSM, an integrated part of UNet, to increase the efficiency and accuracy of the organ placement process
Types of Transplants
Autograft: Transplant tissue from the same species
Allograft and Allotransplantation: a transplant of an organ or tissue between two genetically non-identical members of the same species.
Isograft: A subset of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient
Xenograft and Xenotransplantation: A transplant of organs or tissue from one species to another.
Split Transplant: Sometimes a deceased-donor organ, usually a liver, may be divided between two recipients, especially an adult and a child.
Domino transplants: This operation is performed on patients with cystic fibrosis because both lungs need to be replaced. It is easier if a heart and lung transplant are put together.
All Hospitals have to be part of UNOS if they want do organ transplants.
What is an Organ Transplant?
the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ.
Organ donors may be living, or brain dead
Tissue may be recovered from donors who are cardiac dead – up to 24 hours past the cessation of heartbeat
Heart 4–6 hours
Liver 12–18 hours
Kidney 24–48 hours
Heart-Lung 2–4 hours
Lung 2–4 hours
Pancreas 12–18 hours
The Five Steps Of Organ Matching
1. Organ is donnated
The OPO manages the donors medical information and enters it into the UNOS comuputer system

2.A list of potential recipients is generated.
UNOS computer system creates a list of candidates who have medical and biological profiles that are compatable with the donor's. The computer tracks candidates based on their similarity of medical characteristics with the donor's, medical urgency, time spent on waiting list, and proximity of candidate to the donor.

3. The transplant center is alerted of an available organ.
Organ placement specialists at OPO or UNOS contact transplant centers whose patients appear on the ranked list.
selling a kidney — sometimes for as little as $2,000 — can be a quick way out of a debt or to keep from sinking deeper into poverty.
Iran is the only country where organ sales are legal
in the U.S. selling organs is punishable by 5 years in prison and a $50,000 fine
to date no victims of forced organ harvesting have ever come forward.
Organ Transplantation
Jordan Vogel, Stacey Thurston,
Kelsey Lee
The Black Market
Organ preservation time
Open casket funerals are possible after organ donation
There is no cost to the donor or the family
An average of 18 people die each day from the lack of available organs for transplant.
Every 12 minutes another name is added to the national organ transplant waiting list.
Approximately 1,000,000 tissue transplants are performed annually.
Medical Costs In the U.S.
Insurance deductables and co-pays
Pre-Transplant evaluation and testing
Surgery
Fees for recovery of the organ from the donor
Follow-up care and testing
Additional hospital stays for complications
Fees for surgeons, physicians, radiologist, anesthesiologist and recurrent lab testing
Anti-rejection and other drugs, which can easily exceed $2,500 per month
Rehabilitation
Food, lodging and long distance phone calls for you and your family
Transportation, to and from your transplant center, before and after your transplant
Plane travel to get to your transplant hospital quickly
Child care
Lost wages if your employer does not pay for the time you or a family member spends away from work
If your transplant center is not close to your home, lodging close to the center before and after your surgery. Some centers offer free or low-cost hospitality houses for you and your family.
Living Donation Procedures
for Organ Donation
They vary for each organ.
Living Donation of the liver:
The size of the portion and specific part of the liver that is donated depends on the recepient:
If you are donating to a child, a portion or all of the left lobe is taken.
If you are donating to an adult of similar or lesser size, the entire left lobe is taken.
If you are donating to a larger adult, the right lobe is removed.
Procedure:
An incision on the side of the chest.
Ethical Dilema
More than 100,000 men, women and children currently need life-saving organ transplants.
Every 10 minutes another name is added to the national organ transplant waiting list.
An average of 18 people die each day from the lack of available organs for transplant.
90% of Americans say they support donation, but only 30% know the essential steps to take to be a donor.
14,510 Organ Donors in 2010
Some say no because they will not be able to pay back the full amount, or not pay it back in a timely matter. Some say yes because even though the hospital will be out the money it cost for the transplanation procedure to occur human worth is more important.
There is a huge organ shortage

The factor of who is more in need of the organ is considered and which situtation of the two is more dire.

Some say the younger candidate should receive the transplant reguardless of who is more in need because they have a better chance or recovering after a transplant, they are young and still have a full life to live. Some say the elderly candidate should because they are in a more "critical" condition. And some say they the organ should go to whoever is more in need of it.
Questions to be considered...
Medical Costs

Should people who are
younger be
given an organ transplant over
an elderly person?

Should people who don’t have insurance
and can’t pay for a transplant be
allowed to go on the national waiting list?
Medical costs
Non-Medical costs
Fun Facts
4. Transplant team considers the organ for the patient. The team bases it's acceptance or refusal of the organ on medical criteria, organ condition, candidate condition, staff and patient availability. The team only has one hour to make a decision.

5. The organ is accepted or declined, if the organ is rejected the OPO continues to offer patients at other centers untill it is placed. Organ sharing polices forbid favoritism based on ethnicity, gender, religion, political influence, or financial or social status. Sharing is based on medical and scientific criteria.
Kidney buyer in the U.S. :$120,000
Kidney buyer in Saudi Arabia: $16,000
Around seven days to recover
A Retractor is usually needed to spread the ribs to gain access to the donor's liver.
Because the vessel's surrounding the liver may not be large enough for transplantation,a portion of the vessel in your leg may also be removed and used to connect the donated liver to the recipient.
The procedure takes about 5-8 hours.
Ethical Principles of the Matching Process
When we look at the matching process
some of the principles do not apply, such as:

Autonomy - A person's free-will to choose

Paternalism - Someone being better suited to
make decisions from the person or patient

Fidelity - The duty to be faithful to the patient's expectations

Confidentiality - Keeping patient information private

Veracity - The duty to tell patients the truth and not decieve them

Nonmaleficence - Duty to do no harm to patients

Alturism - "others first"

Egoism - "me first"
Upheld Ethical Principals
Role of duty is upheld by the medical professionals because they try to do everything they can to work with the patients and make them more comfortable until their transplants become available.

Beneficence is upheld by the medical professionals because they are trying to "do good"

Upheld in the matching process:

Justice - in the matching process once a person is put on the waiting list and an organ becomes available, it goes through all of the possible candidates and selects a few that are in the most need for the surgery

Human Worth - in the matching process there are many things considered when the program makes it's selection but one of the most important is the urgency of which certain candidates are in need of the surgery

Lawfulness - The law doesn't necessarily apply but the guidelines of transplantation do. It is a very structured process that the computer system engages in. There is no favoritism.
1. Mandadtory donation after death

2. Educate people about the need vs. supply, in hopes that they will want to donate.

3. People being allowed to sell their oragans

Possible Solutions
1. Mandatory donation after death
2. Educate people about the need vs. supply, in hopes that they will want to donate
3. People being allowed to sell their organs
We can make education about organ trasplantation
mandadtory in schools. The hope is that once we
educate students about the extreme organ shortage
they will fully understand the situation and how to be
a part of the solution. The more people that are eduacated
about this cause, the more they will want to help. Most
don't even really understand what it means to be a living
donor.
Ethical Principals Upheld
Autonomy - people are not forced to become a donor. They have the ability to choose if they want to help to not.

Paternalism - it is the governments choice to make learning about organ transplantation mandatory, they believe it will encourage students to get involved.

Veracity - students are being educated about the serious organ shortage, they are not forced to become a donor.

Beneficence - this is in the hopes that more donors will be gained and help more people who are in need.

Human Worth - it will help more people on the waiting list get organs they need to survive.

Alturism - those that do decided to donate will be upholding this principle by putting other's needs before their own.

Egoism - those that do not decide to donate will be upholding this principle because they are not putting other's needs before their own.

Fidelity & Role of Duty - these will be upheld by professionals educating others and encouraging others to become donors because they are increasing the chances of their patients survival. When patients are put on the list it is because they are promised a chance of recieving a life-changing operation.
Ethical Principles Violated
Autonomy - people may not want to be eduacated about this particular topic, if mandatoy autonomy will be violated.
Utilitarianism can be adopted in this solution.
The basis of utilitarianism is to do whatever increases happiness and whatever decreases pain.
Some doctors say that this is a viable soluton for the major issue of organ shortage. It would allow us to get rid of our convoluted system of organ registery and therefore we could help many more people. Others argue that it takes away rights of the patient and their families.
Ethical Principles Upheld
Ethical Principles Violated
Autonomy- you have no choice it is just required of you

Human Worth- people are being used as only organs after death and not people

Egosim- you are not able to decide what is best for you.

Altrusim- people dont have the option to give becuase it is required of them
Paternalism- the government would be doing what is best

Beneficence- this would do good for many people

Utility- this maximizes the amount of happiness for the greatest number of people.
Ethical Principles Upheld
Autonomy: people have the choice or freedom to sell their organs for money.

Utility: maximizes the well-being for the greatest amount of people in need or organs

Beneficence: This is "doing good" for the patient who is recieving the organ to live

Human Worth: preserves the lives of others who need the transplant.

Egoism: this puts the organ donor first by selling the organs for money.
Ethical Principles Violated
Justice: the resources wont be distributed equally because people that have the money will get the organ sooner than someone else who is waiting on a list.

Lawfulness: this is currently against the law.

Non-Maleficence: they are doing harm to themselves and to the people who truely need the organs.

Paternalism: The autonomy is over-ruling paternalism because their freedom is going over what others think is best.
If people were to sell their organs legally they may be more willing to donate the ones they can live without or regain back. This is currently illegal in the U.S. but if a law like this was passed this could supply the shortage on organs that we have. The only country that has created a market to get rid of the shortage of organs is Iran.
Our chosen
solution

we chose solution number 2 which was to educate the public in hopes that they would chose to donate
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