As of August 2017, the US Department of Health & Human Services reported that there were 116,000+ adults and children on the national transplant waiting list. The number of transplants performed in 2016 was 33,611. Of the adults in the United States 95% say they believe and support organ donation, however, only a little more than half of that number actually sign up to be a donor. The organ shortage is real.
The need for organ donors is tremendous as each year the number of individuals on the waiting list out- number the individuals on the donor list. Organ transplant is a gift of life to someone. Overcoming the issue of supply and demand depends on education to dispel myths, fears, and attitudes that people have about organ donation. Nurses can provide the education needed to help potential donors understand the process and they can be advocates for patients and their families. Nurses play a significant role in the organ donation process.
This module will explore organ and tissue donation and recovery. The nurse’s role in organ donation, the organ donation process, and the barriers to organ-tissue donation will be presented.
NURSE’S ROLE IN ORGAN DONATION
Nursing is an art and science. The art of nursing is the caring and respect that the nurse gives to each patient. When the nurse performs patient-centered care s/he is putting the patient’s personal needs first. Nursing focuses on the promotion, maintenance, and restoration of health or a dignified and peaceful death. The relationship between nurse and patient and patient’s family and/or significant other is valuable. Nurses provide safe care, practice within a legal and ethical scope, maintain life-long learning, and are advocates for quality health care. Today advances in medical science has provided the nurse with the opportunity to become involved in organ and tissue donation and recovery.
Acute and critical care nurses play a central role in the organ and tissue procurement process. Nurses are often the coordinator for the procurement process with four primary roles: identification of potential organ donors, obtaining consent and supporting of the family, successful retrieval of the organ, and maintaining current knowledge and skills. The first role “identification of potential organ donor” requires the nurse to assess the patient for suitability for organ donation. When the patient has been identified as “Do Not Resuscitate” and determined to be brain dead the nurse will move from the role of patient care to assessing suitability for organ donation. The health care agency’s protocols/procedures for organ donation need to be clearly identified and available.
Once brain death has been determined and support for the family has been provided, the nurse can begin to discuss the idea of organ donation with the family. Family many not have considered donating a loved one’s organs prior to brain death occurring. There are instances where an individual many have requested that his or her organs be donated upon death. Throughout the entire process the nurse must always respect the family’s wishes, particularly if they choose not to donate. The nurse will help the family understand what options they have and support obtaining the family’s consent. During the entire process one of the most important roles of the nurse is providing emotional support to the family.
The third major role the nurse has is to maintain the individual in astate that allows for retrieval of viable organs as well as safe storage and transfer of organ(s) to the transplant center. The nurse does this in collaboration with the health care team, each individual having a specific responsibility in the procurement, storage, and transfer process. An Organ Procurement Organization representative is also contacted and becomes an important individual on the team.
How well nurses carry out their role in the organ and tissue procurement process is tied to their level of knowledge and understanding of organ procurement and transplantation. Professional competence in the areas of nursing practice, clinical ability, communication, ethical and legal issues specific to institution and or state guidelines are areas that the nurse needs to maintain at the highest level.
ORGAN DONATION PROCESS
There are two types of organ donors, either deceased or living donors. A deceased organ donor is an individual that has been determined to have either experienced brain death or circulatory death. Living donors are living individuals who donate their tissue or an organ or part of an organ to another living individual. In the early years of organ donation cardiac death was the only form of donation available.Today, brain death, including brain stem death, is allowed if the individual is certified as brain dead even if cardiopulmonary function is still being maintained.
Brain death is the permanent neurological ceasing of brain function. This can occur due to several causes such as a head injury or brain tumor. The brain swells within the skull and pressure continues to build up. As the swelling increases it interferes with blood flow to the brain and brain cells die. Once brain death has been determined and brain function will never return the person is considered “brain dead”. The medical team, made up of two physicians, perform extensive clinical tests to determine if the brain has stopped functioning to certify that the individual is indeed brain dead.
Circulatory death is when the heart stops beating and blood flow and oxygen is no longer reaching the body’s organs. Once circulatory death occurs it is very difficult to keep organs from failing. Maintaining organs following circulatory death is best accomplished when the person is in an intensive care unit and death is near. The patient is put on artificial or mechanical support, which keeps blood with oxygen flowing to the organs until the family has reached a decision about organ donation.Discussion with the family must occur to support the decision for organ procurement.
The steps of the procurement process begin with a decision by the patient or the family to donate the decease’s organs. Several steps occur in both the deceased organ donation and the living organ donation process.
Deceased Organ Donation
Maintaining Life Support
When an individual has been determined to be a possible organ donor life support must be maintained to allow time for all the necessary arrangements to be made. It is during this time that the medical team prepares the family, uses established criteria to determine death, and begins to move the process forward.
Evaluation of Suitability for Organ Donation
The evaluation of suitable organ donation includes the patient’s medical history and physical examination. The Organ Procurement Organization (OPO) is notified and a representative comes to the hospital and is involved in the evaluation process. It is usually the OPO representative that coordinates the donation process along with the nurse. This coordination includes all aspects of the process, from meeting with family, contacting the computer system for match recipients, to transporting donated organs to the operating room or transplant center.
When the patient has given consent his/her name will appear on the state donor registry. If the patient has not given consent then the family or next of kin is approached by the physician or nurse to discuss providing permission for organ or tissue donation. The OPO representative is often present for this discussion.
Matching Organ Recipient(s)
Once a donor has been identified as suitable the OPO representative will contact the United Network for Organ Sharing (UNOS) to find a match. The UNOS administers the national transplant waiting list and matching of recipients. It also maintains the database that includes all organ transplant information in the United States.
Once consent has been given and organ matching has occurred organ recovery can begin. The patient is taken to the operating room where surgery is carried out in a sterile environment just as any other surgery would be conducted. Care, dignity and respect are upheld. Organs and tissues that can be transplanted are: heart, lungs, liver, kidney, intestine, pancreas, cornea, skin, bone, middle ear, bone marrow, heart values, and connective tissue.
The family can move forward with funeral arrangements after the recovery process is final. If the family wishes an open casket there is usually no problem as organ donation does not usually disfigure the body.
After a respectful period of time the OPO representative will communicate with the family telling them what organs were transplanted. The OPO representative remains available to the family for as long as the family needs the support.
There are two types of living organ donations: directed and non-directed donation. When a donor indicates a specific person to receive the organ it is called a directed donation. If a specific recipient has not been named by the donor then that is called a non-directed donation. There are several steps involved in being a living organ donor.
Living Organ Donation
Contacting the Transplant Center
Individuals who are considering becoming a living organ donor will need to start by contacting the transplant center in their area. The Organ Procurement and Transplantation Network (OPTN) has a complete directory of transplant centers. UNOS may be of helpful as the individual makes the decision to become a live donor.
The initial screening is done to determine if there is any medical history that would not allow the individual to donate. The medical screening includes a complete medical history and blood tests. This screening is done to see if the individual is compatible.
During the evaluation period the individual will be asked many questions both psychological as well as medical. The individual will be asked why s/he wants to be a donor. It is also a time for the potential donor to ask questions.
Medical and psychological risks and financial and insurance factors are discussed with the donor. The typical risks associated with surgery and anesthesia are also discussed. Understanding the possible short and long term psychological issues are discussed. Usually the recipient’s insurance will cover the donor’s medical expenses. However, things such as transportation, lodging, child care, lost wages will not be covered and may be the responsibility of the donor.
Recovery from Surgery
Depending on the organ donated the stay in the hospital could be from three to seven days or possibly longer. Usually the donor is able to resume normal activity within six to eight weeks.
Stephen Austin, 51, is client diagnosed with an inoperable brain tumor approximately six months ago and has been admitted to the hospital. Mr. Austin symptoms related to increased intracranial pressure, alternations in consciousness, slow respirations, low blood pressure and paralysis. Mr. Austin’s was transferred hospice unit where the nurse was informed by family that his living documents his desire to be an organ donor. The nurse notified the transplant team and his physicians and began the donation process.
- Why would Mr. Austin’s organs be considered a deceased donation?
- What conditions must be met before Mr. Austin can be considered brain dead?
- Which organization would the nurse call to assist in the coordination of the donation process?
BARRIERS TO ORGAN-TISSUE DONATION
All individuals need to consider registering to be an organ and tissue donor. However, people may not have all the correct information about what it means to be a donor. When a person does not have the correct information, barriers can be created leading to the individual not registering to donate. Understanding the myths around organ donation can help potential donors make the decision to give life to others. The following is a list of misconceptions regarding organ and tissue donation:
|If I have a medical condition I am not eligible to donate||Anyone can register to be a donor regardless of medical history. At the time of the individual's death the transplant team will determine if an organ donation is possible.|
|There is an age limit to being a donor||There is no age limit. Individuals in their 70s and 80s, even in their 90s are organ and tissue donors|
|Doctors and nurses will not do everything they can to save y life if they know I am an organ donor||Positively not true. the healthcare team's first priority is to provide the best possible care they can to save your life. Organ donation does not occur until it has been determined that the individual has died|
|I believe my religion will not allow me to donate my organs and/or tissues||Very few religions do not support organ and tissue donation. Christianity, Judaism, and Islam are examples, in addition to other world religions that support organ and tissue donation|
|The donors family or donor's estate will be charged a fee for the donation made by their loved one||There are no costs to the family for an organ and/or tissue donation|
|Organ donation disfigures the body||The healthcare team treats the individual's body with complete respect and dignity. Any surgical incision that is necessary is cared for like any operation incision.|
|Enough people donate so there is no need for me to donate||There are over a hundred thousand names on the transplant waiting list for an organ or tissue donation. Althrough people philosophically support organ donations, much less actually sign up to be donors.|
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Organ Procurement & Transplantations Network. The Basic Path of Donation. Retrieved April 2, 2018.
UNOS. (2018). Living Donation. Retrieved April 2, 2018.
US Department of Health & Human Services. Organ Donation Process: How Does It Work. Retrieved April 2, 2018.
US Department of Health & Human Services. (2017). Organ Donation Statistics. Retrieved March 28, 2018.