Non-Heart-Beating Organ Transplantation Practice and Protocols (2000) / Chapter Skim
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3 Patient- and Family-Centered Donation
3 Patient- and Family-Centered Donation
Pages 27-37
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From page 27... ...
Recent Health Care Financing Administration (HCFA) regulations require that hospitals report all deaths and impending deaths to the local organ procurement organization, and that a trained professional discuss organ and tissue donation options with the patient's family.
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From page 28... ...
The current practice of non-heart-beating organ procurement has been influenced by family requests for organ donation to take place after the withdrawal of lifesustaining treatment. Organ procurement organizations that engage in non-heartbeating organ procurement report that their efforts have been stimulated by family requests.
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From page 29... ...
Second, organ donation could not take place because neither the hospital nor the organ procurement organization had experience with, or a protocol for, non-heart-beating organ donation. As the father stated: It is difficult for us to understand how we could allow our son to die with one set of criteria, but could not let someone else live because of another set of criteria.
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From page 30... ...
These broad but fundamental questions indicate the kind of information and reassurance that families seek when organ donation is being considered. They suggest a broad outline of the information and support that patient care and donation staff can offer to assist families in coming to a decision about donation.
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From page 31... ...
The division or decoupling of organ donation from patient care creates an additional level of complexity. In order to avoid conflicts of interest, discussions about withdrawing life sustaining treatment must be kept separate from discussions about non-heart-beating donation.
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From page 32... ...
Participants emphasized the need for close communication between hospital and OPO staff to provide a clear understanding of what donation options can be offered, and how donation will proceed. While conflict of interest concerns prevent the OPO staff from being involved in the decision to withdraw artificial support, early communication between the patient care team and the donation team (1)
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From page 33... ...
The committee reviewed brochures on rapid organ recovery, organ donation, bereavement, and brain death (Hartford Hospital, Northeast Organ Procurement Organization, National Kidney Foundation,
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From page 34... ...
Although almost all mainstream religious denominations in the United States support organ and tissue donation, support for donation is not universal among all cultural and religious backgrounds. An example of this was provided at the workshop (Cook et al., 1999~: Persons with a Native American cultural heritage comprise the dominant ethnic minority tin rural Montana]
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From page 35... ...
While the evidence of an association between lack of financial resources and the decision to forgo treatment is limited, socioeconomic differences create severe inequities between those who have resources to pay for treatment and those who do not. Those who donate may be providing a benefit for others while they or their families lack adequate health care (Eggers, 1995, Schutte and Kappel, 1997, Alexander and Sehgal, 1998~.
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From page 36... ...
When donation follows death by neurological criteria, the OPO covers the costs of patient care after death has been declared. However, one study of donation costs found that in a third of the cases reviewed, consent was given for donation but donation did not take place because neurological criteria for death were not met (Grossman et al., 1996~.
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From page 37... ...
Required referral can be expected to increase the number of patient referrals and necessitate increased OPO resources for evaluating potential donors. Expanded donor criteria also contribute to the supply of organs as well as to the cost of organ recovery (Jacobbi et al., 1997~.
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