Organ donation is the

donation of biological
tissue of an organ of the
human body, from a living
or dead person to a living
recipient in need of a
transplantation.

Transplantable organs and

tissues are removed in a
surgical procedure
following a determination,
based on the donor's
medical and social history,
of which are suitable for
transplantation

Organs and/or tissues that are

transplanted within the same
person's body are called
autografts.

Transplants that are recently

performed between two
subjects of the same species
are called allografts. Allografts
can either be from a living or
cadaveric source.

Organs that can be

transplanted are the
heart, kidneys, liver,
lungs, pancreas,
intestine, and thymus.
Tissues include bones,
tendons (both referred
to as musculoskeletal
grafts), cornea, skin,
heart valves, nerves
and veins

The Need:

Whats Being Transplanted?

Organs:
in adults & children with end-stage
organ failure
Heart
Heart-Lung
Lung

single or double

Liver
Kidney
Kidney-Pancreas
Pancreas only
Intestine

Organ Donor
Demographics

AGE

January 2000 through December 2000

0-5
4%

6 - 10
4%

11 - 15
4%

16 - 20
18%

82 recovered donors

66 - 70
4%
21 - 30
9%

61 - 65
6%

56 - 60
6%
31 - 40
13%
51 - 55
11%

41 - 50
21%
NOTE: Data subject to change due to future data submission or correction.

Transplant waiting list as of

TheFebruary
Problem:
(as of 4/22/15) 24, 2003
1

The median wait time for an individuals first

kidney
transplant
is 3.6 years
can vary
80,432 patients
are currently
waitingand
nationwide
for a livedepending
on health, compatibility and
saving organ transplant.
availability of organs.2
In 2014, 17,105 kidney transplants took place
in the
Of are
these,
came from
Over
2,000US.
patients
waiting11,570
here in Virginia.
deceased donors and 5,535 came from living
1
donors.
Three Virginians
die each week waiting.

History of Human
Organ Transplant

The first human organ transplant was a

kidney transplant performed in 1954.
The donor of the kidney was the
identical twin of the recipient and
therefore there was no immune
rejection of the organ.
The recipient lived for eight years
following the transplant and the
surgeon who performed the transplant,
Dr. Joseph Murray, went on to win the
Nobel Prize for this work.

The recipient of the first heart

transplant, performed in 1967 by
Dr. Christian Barnard, lived only
18 days. The patient did not die
because the new heart failed,
but because of pneumonia that
the patient acquired due to the
patients immune system being
compromised by the antirejection drugs that the patient
had to take.

These two cases illustrate both

the promise and the challenges
of organ transplantation: donor
organs can greatly extend life,
but there is a critical shortage of
donors and, unless the donor is
the identical twin of the recipient,
the recipients body will always
reject the donor organ.

In the 1960s, anti-rejection

drugs were very poor and hence
very few organ transplants took
place.

In the 1970s, better antirejection drugs, particularly

cyclosporine, were developed
and by the late 1970s many
heart transplant patients were
living up to five years with their
donor hearts.

In 1983, the FDA

approved cyclosporine
for use in organ
transplantation, and the
first lung transplant
patient survived more
than six years.

Although the improved antirejection drugs increased

the life expectancy for
patients receiving organ
transplants, they came with
harmful side effects that
shortened the recipients
natural life span.

In addition to the side

effects, the anti-rejection
drugs are also very
expensive and can cost
$20,000 to $30,000 per
year and must be taken for
as long as the patient lives.

Amendment to RA
7170 - Organ
Donation Act of 1991
AN ACT TO ADVANCE
CORNEAL TRANSPLANTATION
IN THE PHILIPPINES,
AMENDING FOR THE
PURPOSE REPUBLIC ACT
NUMBERED SEVEN
THOUSAND ONE HUNDRED
AND SEVENTY (R.A. NO. 7170),
OTHERWISE KNOWN AS THE
ORGAN DONATION ACT OF
1991

On average:
Over 3,000 new patients are
added to the kidney waiting list
each month.1
12 people die each day while
waiting for a life-saving kidney
transplant.1
Every 14 minutes someone is
added to the kidney transplant
list. 1
In 2014, 4,270 patients died
while waiting for a kidney
transplant.
Another, 3,617 people became
too sick to receive a kidney
transplant.1

Organ Donor Criteria

Age is generally less than

80, but is based on patients
current medical history
Dead by Neurologic Criteria
Brain Dead

Medical history is examined

at the time of death
Free of HIV
all serologies are examined at
time of death

Death by
Neurological Criteria

JAMA 246:2184-2186, 1981

An individual with
irreversible cessation
of all functions of the
entire brain, including
the brainstem, is dead.

Organ Donor Case Overview

Arrival at
Hospital

Transplant

Donor Management with LifeNet

Authorization

Recognition as
Potential Donor

Brain
Death

EMS
Referral to LifeNet
for Initial Evaluation

Organ Recovery
in OR
Organ Placement
Organ
Resuscitation
(Enhance organ
oxygenation
& perfusion)

Serology
Lab results
OR time
Coordinate
teams

Tissue Donor Criteria

Donation occurs after

cardiac death
Criteria:
Age < 70
Recovered within 24 hours
after death if body is cooled in
the first 12 hours
No active, transmissible
disease
No autoimmune disorder

The Need: Whats

Being Transplanted

Heart valves
Pericardium
Skin
Bone -Whole or processed
grafts
Veins
Fascia
Ligaments/Tendons

Eye Donor Criteria

Donation occurs after cardiac

death
Criteria:
No upper age limit
1 year to 68 years

cornea transplant

Less than 1 year or greater than 68

years

research

History of cancer is acceptable

Other research for patients with
history of glaucoma, diabetes, etc.

The Need:

Whats Being Transplanted?

Eyes:
Cornea, Sclera
Whole Eyes for Research

The Donor Card

A donor card is now recognized as a legally binding document and

cannot be overturned by the family.
Amendment is possible

Donation by Donor Designation

Common Concerns
About Donation

Disfigurement
Funeral Arrangements
Financial Responsibility
Religious Beliefs
I cannot be a donor
because of my medical
history.
If I want to be a donor, they
wont try and save me!

Some Donation
Controversies

Who should be
transplanted?

Smokers? Alcoholics?
The very young or old?
The rich or the poor?
Those in prison?
Only those who have agreed
to be donors themselves?

Some Donation
Controversies

How should organ

donation be increased?
Financial Incentives
More Public Education?
Presumed Consent?

AS NURSES, WE FACE
TOUGH ethical
dilemmas as we provide
end-of-life care,
especially when our
patients are candidates
for organ donation.

Nurses must consider respect

for life and bodily integrity in
light of the procedure for
recovering organs. Nursing is
primarily grounded in
beneficence (doing good) and
nonmaleficence (not doing
harm)

Some, believing that

removing vital organs is
what kills the patient

1Others suggest that

organ donation is a
"moral duty, an
obligation," considering
society's lack of
alternative healthcare
resources

Brain death. The Uniform

Determination of Death
Act provided the legal
articulation of the wholebrain criterion of death:
"irreversible cessation of
all functions of the brain,
including the brainstem."6

Issues surrounding
brain death

But defining death as brain death also

presents ethical quandaries. Robert D.
Truog, MD, director of clinical ethics at
Harvard Medical School in Boston,
Mass., writes that using brain death as
the standard legitimatizes organ removal
from bodies that continue to have
circulation and respiration (usually
sustained by mechanical ventilation),
and this "fails to correspond to any
coherent biological or philosophical
understanding of death."13

The Uniform Anatomical Gift

Act (UAGA) has been
revised in 2006 to permit the
use of life support systems
at or near death for the
purpose of maximizing
procurement opportunities
of organs medically suitable
for transplantation.

The Uniform Anatomical Gift

Act (UAGA) has been
revised in 2006 to permit the
use of life support systems
at or near death for the
purpose of maximizing
procurement opportunities
of organs medically suitable
for transplantation.

The best interests standard for

incompetent
ordecisions
incapacitated
When making
for
persons
all
ages.
adults of
who
lack
decision-making
capacity and have no
discernable preferences,
widespread support exists for
using the Best Interests
Standard. This policy appeals to
adults and is compatible with
many important
recommendations for persons
facing end-of-life choices.