10: Organ Donation ✅ Flashcards
(28 cards)
Organ transplantation types
Auto-grafts
Allo-grafts
Xeno-grafts
Auto-grafts
Come from the recipients
Allo-grafts
Transplants between genetically non-identical individuals
Xeno-grafts
Tissues or organs transplanted from one species to another
Living donations
Living related: donated to a family member
Living unrelated: donated to a non-family member
Deceased donation
Donation after brain death: death diagnosis on neurological criteria
Donation after circulatory death: non-heart beating donation
-often after withdrawal of mechanical ventilation
Brain death
Irreversible loss of BRAINSTEM function
Criteria for brain death
Unconscious
Fail to respond to outside stimuli
Heartbeat and breathing can only be maintained using a ventilator
Clear evidence that serious brain damage has occurred and it cannot be cured
Issues with brain death
Notions of personhood:
-where is it located in the human body
-UK approach: a person seizes to exist when they have lost the capacity to have consciousness
Cultural and Religious Orders
-different views regarding death
-death rituals and ways of attending to the dead body
->e.g. burial or cremation
Paired donation
A and B are in a relationship but not genetically compatible
C and D in same situation
A compatible with C, B compatible with D.
Pooled donation
More than 2 pairs involved in a swap
Aka paired donation but more pairs
Types of organ donation
Non-directed
Directed
Conditional
-UK: all conditional deceased donation should be prohibited
-US: LifeSharers- allows people to register as donors and request their organs offers to members of the organization first
Ethical issues of living organ donation
Many more people are willing to receive organs than are willing to donate them
Issues relating to Cadaveric organ donation
Issues relating to the:
-definition of death
-ownership of the body
Issues relating to Xenotransplantation
A concern with mixing of species
Risk of transfer of diseases from animal to human
Legal framework of organ donation
Opt-in and opt-out system
People must actively register and remove themselves from the system
Other systems of organ donation
Mandated choice
-people must record their choice at some point in their lives
Benefits in kind
-offering reimbursement, health insurance or priority
UK: Deemed Consent Bill
All adults are considered potential donors unless they have recorded a decision not to donate and if:
-under 18
-lack mental capacity to understand the new arrangements
-visitors to England
-people who have lived in England for less than 12 months before their death
Issues to consider with organ donation
Ethical considerations
- autonomy
- beneficence and non-maleficence
- decision-making
Legal Issues
- organ donation system
- donor registry
- opt-in or Opt-out system
Family Involvement
- soft or hard system
Organ Market
Priority and Reimbursement System
In Israel
People who sign up for organ donation are given:
-priority on transplant list
-financial reimbursement for any medical expenses and lost work
Organ markets
Organ trafficking and transplant tourism
Violate the principles of equity, justice and respect for human dignity
Allocation of organs for transplantation
Restrictive selection for transplantation
-conditions associated with positive outcome
-clinical criteria
-co-morbidities
Key factors for the allocation of organs
Urgency
Chance of success
Age of donor
Difference in age/size between donor and recipient
Proximity of medical centre
Ethical principles relating to the allocation of organs
Utility = an action is to be right if it promotes more benefit than any alternative action
-allocation should maximise the estimated overall good adjusted for potential accompanying harms
-consider:
->patient survival,
->graft survival,
->quality of life,
->availability of alternative treatments and
->age
-social acceptance that we dont include socioeconomic status, career, race or education in determining who ought to recieve an organ
Justice = equality and distributive justice
-all people should have an equal right to the benefits of transplantation
-not only the good of the outcome but the good with the distribution
