Non-Heart-Beating Organ Transplantation Practice and Protocols (2000) / Chapter Skim
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4 Non-Heart-Beating Donation Protocols: Content
4 Non-Heart-Beating Donation Protocols: Content
Pages 38-55
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From page 38... ...
There was strong consensus at the workshop about the need for locally developed, publicly accessible protocols and for a strong national climate supporting these local efforts. There was strong consensus also on the underlying ethical standards for non-heart-beating donation: avoiding harm, avoiding conflicts of interest, and respecting patient and family decisions.
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From page 39... ...
When a patient has died following failed resuscitation efforts, Washington Hospital Center places cannulae and begins in situ organ preservation to keep the option of donation open until the family can be contacted. This intervention for uncontrolled nonheart-beating donation was developed through a program of community outreach and oversight and is permitted by local legislation.
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From page 41... ...
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From page 42... ...
OPO protocols may specify the patients to whom these protocols apply, this supplements but does not alter prior decisions to stop support. Consensus and Variations Provider, family, and public confidence in non-heart-beating organ and tissue donation depends on confidence that the decision to stop aggressive treatment has been made appropriately, on its own grounds, independently of organ procurement interests.
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From page 49... ...
The Decision to Donate Decisions Referring patients to the local OPO and approaching the family with the option of donation fall within Health Care Financing Administration (HCFA) guidelines for routine referral and trained request.
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From page 50... ...
Workshop participants reported that OPO, hospital, and physician experience in this area varies, and identified this as an area for further in-hospital education and development. The University of Pittsburgh non-heart-beating donor program attaches its protocol for withdrawing support to its protocol for non-heart-beating organ and tissue donation.
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From page 51... ...
Variations in the administration of medications are based on differences in clinical judgment among patient care physicians, transplant surgeons, and OPO staff. These judgments are based on clinical experience and on a limited number of empirical studies.
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From page 52... ...
This variation requires considerable forethought and public scrutiny, as Washington Hospital's program illustrates. Declaring Death Decisions The physician who declares death cannot be associated with organ donation or transplantation.
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From page 53... ...
More research is needed to establish the efficacy of organ preservation measures. Ohio Valley Life Center allows three hours of warm ischemia time and does not find that this interval affects kidney transplants adversely (Appendix F)
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From page 54... ...
This is an area in which local variation can be expected among hospitals and practitioners. Cooperation between the patient care and organ procurement teams can provide maximum flexibility for accommodating family wishes.
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From page 55... ...
Workshop participants identified the central role of the OPO in facilitating the development of non-heart-beating organ donation activity. However, participants recognized that OPOs may find that they have few financial incentives and limited local support for developing this option.
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