Topic 13: organ transplant/donation Flashcards
(21 cards)
Define organ transplantation
- Surgical replacement of malfunctioning organ by another organ
- Transfer human cell/tissue/organ from donor to recipient = restore function in body
Give types of transplants
1) Autologous = self is both donor + recipient e.g. skin
2) Syngeneic = identical twins
3) Allogeneic = genetically non-identical people
4) Xenogeneic = animal to human
Describe living donation
- Living pateint consents to donate
- Living related = family member
- Living unrelated = non-family = paired/polled donation
Describe deceased donation
- Donation after death
1) After brain death = neurological criteria
2) After circulatory death = heart not beating = circulatory criteria = after withdrawl of ventilation
Define brain death
- Irreversible loss of brainstem function
Give the NHS criteria for brain death
- Must be unconscious + fail to respond to outside stimulation
- Heartbeat + breathing only maintained via ventilator
- Clear evidence = serious brain damage = cannot be cured
Define when a person seizes to exist
- Lost capacity to have consciousness
- Dead = ceases to function in intergrated way
Give issues with deceased donation
1) Notion of personhood = when does person cease to exist
2) Cultural/religious = different views regarding death + afterlife + soul leaving body
- Death rituals = burial as soon as possible + allowing time for family to view body
Give types of organ donation
1) Non-directed: person offers to donate to anyone it might benefit
2) Directed: person agrees to donate organ only if to specific recipient
3) Paired: donor A + recipient B in relationship but not compatible → donor C + recipient D in same position = A+D/C+B
4) Pooled: paired but more than 2 pairs involved
5) Conditional: agrees to donate on condition that allocated/withheld from specific recipient
Describe UK law on conditional donations
- Should be prohibited
- Directed donation to qualifying relationships = considered = if agreed donation isn’t conditional + will not deprive super urgent recipient
Give main issues relating to organ donation
1) Living = more people willing to receive than donate
2) Deceased = definition of death + ownership of body/decision making
Give the organ donation systems
1) Opt-in: actively join register
2) Opt-out: presumed consent = actively remove from register
3) Mandated choice: must record wishes on organ donation after death during lives
4) Benefits in kind: offered reimbursement/health insurance/priority
Describe organ donation system in UK
- Pre-2020 = opt-in system = on NHS organ donation register + clear expression of wish
- Post-2020 = all adults considered willing after death unless recorded decision against OR:
> Under 18
> Lack mental capacity to understand new rule
> Visitors to UK
> Lived in UK for less than 12 months
Describe family involvement when considering
- Soft = family consulted
- Hard opt-in = only if registered
- Hard opt-out = donation will go ahead irrespective of family views
Arguments for opt-out system
- Autonomy = majority agree with donation but haven’t opted in
- Presumption made = proportion wronged either way
> In opt-out = some people might not want to donate but never opted out = donors against their will.
> In opt-in = some people want to donate, but never registered — so they’re denied the chance to donate - Alleviates some burden from family
- Countries with opt-out systems = higher donation rates
Arguments against opt-out system
- Applying presumed consent = organ no longer donation = taken from dead
- Patients may wish not to donate but not get chance to opt out
- Family burden = if soft they are asked BUT if hard = additional distress to cope with + death
- Opt-out doesn’t automatically guarantee high rates of donation on it’s own
What is the opt system in Spain?
- Opt-out
What is the opt system of Israel
- Encouraged organ donation
- Reimbursement + priority system
Describe allocation of organs in UK
- NHS blood + transplant:
- Guideline for patient selection onto waiting list = restrictive selection
- Allocation from waiting list based on key factors
Give key factors of allocating organs
- Urgency
- Chance of success
- Age
- Differences between donor/recipient = age/size
- Proximity of medical centres
Give the ethical principles in living donor kidney transplant UK guidelines
1) Altruism = basis of organ donation = selfless gift without expectation of remuneration
2) Autonomy = consent required before organ can be removed
3) Beneficence = best interest of patients
4) Dignity
5) Non-maleficence
6) Reciprocity = mutual exchange
