Ethical Issues about Extension of Life Flashcards by Franchez Cassandra Escander

is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.

organ transplantation

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involves surgically replacing a failing organ with a healthy donor organ.

organ transplantation

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The donor and recipient may be at the same location, or organs may be transported from a donor site to another location.

organ transplantation

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organs and /or tissues that are transplanted within the same person’s body.

autografts

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Transplants that are recently performed between two subjects of the same species. It can either be from a living or cadaveric source.

allografts

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allografts can come from what source (2)

living
cadaveric

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Organs that have been successfully transplanted

heart, kidneys, liver, lungs, pancreas, intestines, thymus and uterus.

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tissues that are referred as musculoskeletal grafts

bones, tendons

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tissues including bones and tendons are referred to as

musculoskeletal grafts

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are the most commonly transplanted organs worldwide

kidneys

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kidneys are the most commonly transplanted organs worldwide, followed by the

liver
heart

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are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.

cornea and musculoskeletal grafts

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Organ donors may be (3)

living
brain dead
dead via circulatory death

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issue may be recovered from donors who die of (2)

circulatory death
brain death

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Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to
___ hours past the cessation of heartbeat.

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Unlike organs, most tissues (with the exception of ___) can be preserved and stored for up to five years

corneas

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Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to

five years

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Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be

banked

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offer a great solution for many patients with organ failure and can improve their lifespan and quality of life

transplants

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Undergoing an ___transplant can lengthen a person’s life and allow those with a chronic illness to live a normal lifespan.

organ

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donor organs are often rejected by the host’s (recipient’s) immune system

transplanted organs rejection

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recognizes that the new tissue is foreign, causing an inflammatory attack on the new tissue which if not stopped results in failure of the transplanted organ.

immunesystem

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stimulate cytotoxic T cells to attack the transplanted organ while simultaneously inhibiting the action of protective T regulatory cells.

inflammatory cytokines

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Multiple inflammatory cytokines stimulate ____ _ cells to attack the transplanted organ

cytotoxic T cells

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Multiple inflammatory cytokines stimulate cytotoxic T cells to attack the transplanted organ while simultaneously inhibiting the action of

protective T regulatory cells

help suppress the immune system and protect the transplanted organ

conventional treatmentts

help suppress the immune system and protect the transplanted organ however, they often have severe side effects.

conventional treatments

also reduce the amount of T regulatory cells in circulation, preventing the immune system from developing tolerance to the new organ.

immunosuppressive drugs

Natural interventions such as ___ and ___ may help lessen the inflammatory immune response and promote more successful transplant tolerance

circumin omega-3 fatty acids

Help Prevent Organ Transplant Rejection

conventional medical treatment

Immunosuppressive drugs are under what kind of treatments

conventional medical treatment

example of immunosuppresive drugs

calcineurin inhibitors (e.g. cyclosporine)

May Be Beneficial for Organ Transplantation

natural interventions

a component of the spice turmeric, is a potent anti-inflammatory agent.

curcumin

Numerous studies demonstrate ____ability to inhibit inflammatory cytokines involved in transplant rejection. An animal study showed mice that had heart transplants survived significantly longer when treated with an immunosuppressive drug in combination with ___than the drug alone.

curcumin

found in fish oil, known for their anti-inflammatory properties, also suppress cytokines involved in transplant rejection.

omega-3 fatty acids

Many studies demonstrate their beneficial effects, including a study where kidney transplant patients supplemented with ___oil experienced better recovery of renal function after a rejection episode than control patients.

fish

has been shown to inhibit the activity of multiple inflammatory cytokines.

resveratrol

Animals who received a genetically incompatible liver transplant had reduced levels of cytotoxic T cells and survived significantly longer when supplemented with

resveratrol

is known to modulate the action of several inflammatory cytokines. In combination with vitamin E

Quercetin

has been shown in vitroto combat the hepatotoxic effects of cyclosporine, a common immunosuppressive drug.

quercetin

also inhibited T-cell proliferation, suggesting it may be effective in reducing transplant rejection.

quercetin

found heart transplant patients with the lowest blood levels of the active form of vitamin _ (1,25-dihydroxy vitamin _)were over 8 times as likely to die one year post transplant than those with the highest levels.

vitamin D

active form of vitamin D

1,25-dihydroxy vitamin D

seed extract has been shown to alter the ratio favorably and modulate immune response.

Grape

Higher ___ levels have been shown to be associated with increased mortality after transplantation.

homocysteine

. Several natural interventions can lower homocysteine levels, including

B complex vitamins N-acetylcysteine

B complex vitamins

B6 B12 folate

such as those found in green andblack tea, cocoa, and pomegranate, have cardioprotective effects that may be beneficial after organ transplantation.

polyphenolsp

polyphenols is found in

green andblack tea, cocoa, and pomegranate

Steps in the process are as follows 1st step

Identification of the Potential Donor by the Hospital

Medical professionals at a hospital identify a potential candidate for donation. The nature of the injury leads a physician to determine the patient is brain dead or a potential donation after circulatory death (DCD) candidate. what step

identification of potential donor by the hospital

2nd step in determining organ transplantation

evaluation of donor eligibility

Information is provided on the patient's medical status and the recovery coordinator evaluates the patient. The evaluation includes a medical and social history and physical examination of the patient. This determines whether or not the patient is a suitable candidate for donation. what step

evaluation of donor eligibioity

3rd step in organ transplantation

Authorization for Organ Recovery

If the patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached with the opportunity of donation. If a donor designation or individual authorization by the decedent cannot be identified, the family must give their consent in order for the donation process to proceed. If the family consents, the legal next-of-kin signs a donor consent form. what step

authorization for organization recovery

4th step in donor transplantation

medical maintenance of the patient

Once family consent or donor designation has been provided, the clinical coordinator, in concert with the hospital staff, maintains the patient medically. In some cases physician support is requested on a consultation basis. what step

medical maintenance of the patient

5th step in organ transplantation

5. Matching Organs to Potential Recipients

Information on the organs available for donation, the donor's blood type and body size is provided to clinical coordinator. The computer then matches the donated organs to potential recipients. Recipient selection is based on blood type, body size, medical urgency and length of time on the waiting list. The heart, liver and lungs are matched by blood type and body size. In matching the pancreas and kidneys, genetic tissue type is also considered what step

matching organs to potential recipients

6th step in organ transplantation

6. Offering Organs Regionally, Then Nationally

A computerized list of waiting patients in the matching blood group is provided to the coordinator who seeks to match organs with recipients in the donation service area. If a match cannot be made for a specific organ within this area, the organ is offered on a regional basis, then nationally, if necessary. what step

offering organs regionally; then nationally

7th step of organ transplantation

7. Placing Organs and Coordinating Recovery

When a recipient match has been found, the coordinator calls the transplant center for the patient who matches the donated organ(s). The patient's transplant surgeon is responsible for making the decision whether to accept the organ. If the surgeon declines the organ for that patient, the coordinator contacts the transplant surgeon of the next patient on the list. This process continues for each organ until all of the organs have been appropriately matched with recipients. The coordinator then arranges for the operating room (for the recovery of the organs) and the arrival and departure times of the transplant surgery teams. what step

placing organs and coordinating recovery

8th step of organ transplantation

Surgical Recovery of Organs

When the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure. In accordance with law, physicians recovering the organs do not participate in the donor's care prior to the determination of brain death. what step in organ transplantation

8. Surgical Recovery of Organs

9th step in organ transplantation

9. Preparing Recipients for Surgery

Once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital. Upon the organs' arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed what step

preparing recipients for surgery

10th step of organ transplantation

. Distribution of Organs

The coordinator takes a sample of the lymph node tissue to a laboratory for tissue typing and subsequent matching with recipients. Other organs are taken directly to the recipients by the surgical recovery teams. what step

distribution of organs

raises a number of bioethical Issues including the definition of death, when and how consent should be given for an organ to be transplanted, payment for organs for transplantation.

transplantation

a term sometimes used when you go to another country and pay for an organ transplant

transplantation tourism

the trading of human organs, tissues, or other body products, usually for transplantation.

organ trafficking

guiding principle for organ transplantation by WHO (4)

Autonomy Beneficence 3. Non-maleficence Justice

Cells, tissues and organs may be removed from the bodies of deceased person for the for the purpose of transplantation if: (a) any consent required by law is obtained, and (b) there is no reason to beleive that the deceased person objected to such removal. what principle

autonomy

Cells, tissues and organs may be removed from the bodies of deceased person for the for the purpose of transplantation if:

any consent required by law is obtained, and there is no reason to beleive that the deceased person objected to such removal.

Physician determining that a potential donor has died should not directly involved in cell, tissue or organ removal from the donor or subsequent transplantation procedure; nor should they be responsible for the care of any intended recipient of such cells, tissues and organs. what principle

beneficence

Cells, tissues and organs should only be donated freely without monetary payment or reward of monetary value. The prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income, or paying the cost of recovering, processing, preserving and supplying human cells, tissues and organs for transplantation. what principle

beneficence

Minors and legally incompetent people no cells, tissues or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law. Specific measures should be in place to protect the minor and, wherever possible the minor assent should be obtained before donation. what principle

non-maleficence

Physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures, if the cells, tissues and organs concerned have been obtained through exploitation or coercion of, or payment to, the donor or the next of kin of a deceased donor. what principle

non-maleficence

The allocation of organs, cells and tissues should be guided by clinical criteria and ethical norms, and financial or other considerations. Allocation rules, defined by appropriately constituted committees, should be equitable, externally justified and transparent. what principle

justice

ethical issues for debate on organ transplantation

Is human body a commodity? How should decisions be made about who receive scarce organs? Who should pay for transplants? Should one person receive several organs or several persons receive one? Should one person have second transplant when the first one fails or should a different person be given a first chance at a new organ? Should organs be donated to those persons who have abused their bodies by drinking and smoking or only those whose organs are damaged by disease? Should state law maker be involved in transplantation?

medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ

organ transplantation

 Occurs because the recipient’s organ has failed or has been damaged through illness or injury

organ transplantation

 Transfer of a whole or partial organ from one body to another

organ transplantation

– a transplant of tissue from one to oneself (e.g. skin grafts, vein extraction, storing blood in advance surgery)

autograft

example of autograft (3)

skin grafts vein extraction storing blood in advance for surgery

transplanted organ or tissue from a genetically non-identical member of the same species

allograft

 Most human tissue and organ transplant fall under this

allograft

a subset of allograft in which organs or tissues are transplanted from a donor to a genetically identical recipient (identical twin)

isograft

 Anatomically identical to allografts, closer to autografts in terms of recipient’s immune response

isograft

isograft is anatomically identical to what

allografts

isograft is closer to ___ in terms of recipient's immune response

autografts

 Transplantation in which organs or tissues are transplanted from a donor to genetically identical recipient such as an identical twin

isografts

isografts are also known as

isotransplans

transplants that are always accepted

isografts

replacement of an individual’s defective organ with an organ harvested from another organ from another species

xenograft

source of organ for human use (2)

primates pigs

genetic similarities to humans

primates

large availability

pigs

transplantation of living tissues, cells, and organs from one species to another

xenotransplantation

 Genetically alter an animal organ with human genes to trick patient’s immune system into accepting it

xenotransplantation

– is an organ transplanted from one species to another

xenograft

refer to same species transplant

allotransplantation

disease transmission

xenozoonosis

sources for organ transplantation (4)

mandated choice presumed consent incentives prisoners

voluntary donation which source of organs?

mandated choice

a person is presumed to have consnted to organ donation in case of their accidental death what kind of source

presumed content

1st step for organ transplantation

identification of potential donor by hospital

medical professional at a hospital identify a potential candidate for donation what step for organ transplantation

identification of potential donor by the hospital

the nature of injury leads a physician to determine the patient (2)

brain dead circulatory death candidate (DCD)

DCD means

donation after circulatory death

information is provided on the patient's medical status what step for organ transplantation

evaluation of donor eligibility

2nd step for organ transplantation

evaluation of donor eligibility

the recovery coordinator evaluates the patient. This determines whether or not the patient is suitable candidate for donation what step for organ transplantation

evaluation of donor eligibility

recovery coordinator evaluates the following on whether the patient is suitable for donation (3)

medical history social history physical examination of patient

if a patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached with the opportunity of donation what step for organ transplantation

authorization for organ recovery

if a donor designation or individual authorization by the decedent cannot be identified, the family must give their consent in order for the donation process to proceed what step for organ transplantation

authorization for organ recovery

if the family consents, the legal next-of-kin signs a donor consent form what step for organ transplantation

authorization for organ recovery

once family consent or donor designation has been provided, the clinical coordinator in concert with the hospital staff, maintains the patient medically what step for organ transplantation

medical maintenance of the patient

in some cases, physician support is requested on a consultation basis what step for organ transplantation

medical maintenance of the patient

what information on the organs available for donation are known to be provided to the clinical coordinator

donor's blood type body size

after information on the organs available for donation are provided to the clinical coordinator, the computer then matches the donated organs to potential recipients what step for organ transplantation

matching organs to potential recipients

recipient selection is based on ($)

blood type body size medical urgency length of time on waiting list

used for matching heart, liver, and lungs

body type and body size

body type and body size were used to match

heart, liver, and lungs

in matching pancreas and kidneys, what is typed

genetic tissue type

genetic tissue type is used to match what organs (2)

pancreas kidneys

a computerized list of waiting patients in the matching blood group is provided to the coordinator who seeks to match organs with recipients in the donation service area what step for organ transplantation

offering organs regionally, then nationally

if match cannot be made for a specific organ in the area, the organ is offered on a regional basis, then nationally, if necessary what step for organ transplantation

offering organs regionally, then nationally

when a recipient match has been found, the coordinator calls the transplant center for the patient whom atches the donated organ(s) what step for organ transplantation

placing organs and coordinating recovery

the patient's transplant surgeon is responsible for making the decision whether to accept the organ what step for organ transplantation

placing organs and coordinating recovery

if the surgeon declines the organ for that patient, the coordinator contacts the transplant surgeon of the next patient on the list what step for organ transplantation

placing organs and coordinating recovery

this process continues for each organ until all of the organs have been appropriately matched with recipients what step for organ transplantation

placing organs and coordinating recovery

the coordinator then arranges for the operating room (for the recovery of organs) and the arrival and departure times of transplant surgery teams what step for organ transplantation

placing organs and coordinating recovery

when the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure what step for organ transplantation

surgical recovery of organs

in accordance with law, physicians recovering the organs do not participate in the donor's care prior to the determination of brain death what step for organ transplantation

surgical recovery of organs

once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital what step for organ transplantation

preparing recipients for surgery

upon the organs' arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed what step for organ transplantation

preparing recipients for surgery

the coordinator takes a sample of the lymph node tissue to a laboratory for tissue typing and subsequent matching with recipients what step for organ transplantation

distribution of organs

other organs are taken directly to the recipients by the surgical recovery teams what step for organ transplantation

distribution of organs

puts unfair pressure on economically disadvantaged people, wealthy people have unfair access

buying and selling of organs

compromises the donor and recipient safety

buying and selling of organs

due to limited resource, distributive justice is observed

organ allocation

distributive justice includes

how to fairly divide resources equal access maximum benefits

everyone should have to able access it equally length of time age of recipient what part of distributive jsutice

equal access

reasons for equal access (3)

exclude individual worth from equation exclude medical worthiness (smoking) exclude social worthiness (prisoners)

maximize the number of successful transplants medical need probability of success

maximum benefit

reason for maximum benefit

limited resource should avoid waste second transplant factor in medical outcome

cells, tissues, organs may be removed from the bodies of deceased person for the purpose of transplantation what WHO guiding principle

autonomy

cells, tissues, organs may be removed from the bodies of deceased person for the purpose of transplantation (2)

any consent required by law is obtained there is no reason to believe that the deceased person objected to such removal

physician determining that a potential donor has died should not directly involved in cell, tissue, or organ removal from the donor or subsequent transplantation procedure what WHO guiding principle

beneficence

Physician should not be responsible for the care of any intended recipient of such cells, tissues, and organs what WHO guiding principle

beneficence

in general, living donors should be genetically, legally or emotionally related to their recipients what WHO guiding principle

Autonomy, non-maleficence, justice

has informed, voluntary consent and professional follow up is ensured and organized what WHO guiding principle

autonomy, non-maleficence, justice

no cells, tissues, or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law what WHO guiding principle

non-maleficence

specific measures should be in place to protect the minor, and wherever possible the minor assent should be obtained before donation what WHO guiding principle

non maleficence

cells, tissues, and organs should only be donated freely without monetary payment or reward of monetary value what WHO guiding principle

beneficence

the prohibition on sale or purchase of cells, tissues, and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income or paying the cost of recovering, processing, preserving, and supplying human cells, tissues, and organs for transplantation what WHO guiding principle

beneficence

capable persons must be allowed to accept or refuse recommended medical interventions what WHO guiding principle

autonomy

medical practitioners should act in the best interests of the patient what WHO guiding principle

beneficence

physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures, if the cells, tissues, and organs concerned has been obtained through exploitation or coercion of , or payment to, the donor or the next of kin of a deceased donor what WHO guiding principle

nonmaleficence

the allocation of organs, cells, tissues should be guided by clinical criteria and ethical norms, and financial or other considerations

justice

defined by appropriately constituted committees, should be equitable, externally justified, and transparent

allocation rules

What applications of principles of bioethics in choosing this, students are maximizing the life span for the most number of people. This related to the principle of Maximize benefits and minimize harm

Save the youngest

What applications of principles of bioethics option values fairness, relates to principle Justice

draw straws (or any randomization techniques)

What applications of principles of bioethics this option considers the special needs of vulnerable population. It relates to the principle Respect for persons

save the weakest

What applications of principles of bioethics saving someone who may be able to save others benefits a larger number of people. This relates to the principle Maximizing benefits and minimizing harms

Save the most useful

What applications of principles of bioethics honiring the dignity of human beings includes acknowledging their relationships. This relates the principle "respect for persons", this approach also relates to Care, an additional principle which can be used alongside the other principles mentioned

respect relationship

ethical issues for debate

Ethical Issues about Extension of Life Flashcards

(170 cards)