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  1. 1. Issue Paper 1RUNNING HEAD: Issue Paper Issue Paper: The Multiple Layers of Organ Donation Group 5 Liana Bruneau, Allison Drinnon, Erin Hartley, Jessie Klauder, Carly McMacken, Leo Rivas and Emily Viehmann Pacific Lutheran University Nursing 260 Profession Foundations I April 15, 2009
  2. 2. Issue Paper 2 This story reveals the selfless decision of an organ donor who impacted the livesof many. Jason Ray was a senior at the University of North Carolina and he was also themascot for the men’s basketball team. The Tar heels had earned a number one spot in theNCAA basketball tournament and there was no doubt in Jason’s mind that his teamwould make it to the Final Four. On March 23, 2007, just hours before the University ofNorth Carolina basketball team faced USC in the sweet sixteen, Jason decided to go outfor a walk and grab something to eat. On his way back, a vehicle struck Jason and hesuffered severe head trauma. The physicians told Jason’s parents that there was no sign ofbrain of activity. The news was heartbreaking not only to his parents, but to all the peopleJason had known throughout his life. Stephanie Falbo, a transplant nurse from the NewJersey Sharing Network, approached Jason’s dad and reminded him that Jason was anorgan donor. At first Jason’s dad did not want to hear anything about organ donation. Hejust wanted to take his son home. After some thinking, Jason’s parents realized that it wasabout doing the right thing and granting their son’s wish. Jason’s wish helped recipientsfrom twenty-four states, from a thirteen year old Oklahoma girl to an eighty year oldwoman from Minnesota. Furthermore, his tissue is still being preserved for another fiftyto seventy recipients. Jason’s parents still hurt from the loss of their son, but it broughtthem comfort knowing that their son was able to affect the lives of so many people notonly in life, but also in death. (Drehs, 2007) What is Organ donation? Organ donation is the process of giving a part of anorgan or a whole organ for the purpose of transplantation to another person. Thefollowing are facts that will help dismiss the taboo or misguided information about organdonation in society. Anyone can be a potential donor regardless of age, race or medical
  3. 3. Issue Paper 3history. If a person is an organ donor and is injured or sick and admitted to the hospital,the number one priority is to save the donor’s life. Organ donation can only be consideredafter a person dies, and contrary to popular belief, the body is treated with respect anddignity. Contrary to popular belief an open casket funeral is possible for organ, eye, andtissue donors. Need source Though there are many organ donors like Jason, there are currently over 97,000Americans waiting for a transplant. Every twelve minutes a name goes on the transplantlist and every day eighteen people die waiting (Donate Life America, 2009). In order tobe eligible to legally get an organ transplant one has to follow a few specific steps. TheUnited Network of Organ Sharing, which was established by congress in 1984 aids in theorgan matching process and organizes the transplant wait list. To get on this waiting list,one must be referred by a doctor. Then a transplant hospital must evaluate the patient anddecide if they want to put the patient on the wait list, and perform the surgery when theorgan becomes available. If the hospital evaluation goes well, then the hospital can putthe patient on the UNOS waiting list. The UNOS has several wait lists. There are lists foreach organ that is in need, in addition to lists that combine organs, such as heart andlungs or one kidney verses two. Need Source Patients on the waiting list are rated on the severity of their illnesses, time spentwaiting, blood type, and other important medical information. It is a misconception thathaving good financial status or celebrity status will move a patient to the top of the list.Other factors that affect the order of the list include tissue matches, blood type, immunestatus, distance between organ and recipient, heart, lungs and intestines, and the degree of
  4. 4. Issue Paper 4medical emergency. Once a recipient has been chosen for transplant, they must be readyimmediately and healthy enough to undergo surgery. Need Source Thoracic organs are first given to people highest on the wait list that live theclosest to where the organ is. This is due to the short time frame of four to six hours thatthe organs can survive outside the body. The average wait time to get a heart transplant is230 days. For lungs, two groups, one consisting of one lung and the other consisting oftwo lungs, are formed. This list is determined by lab values, test results, diseasediagnosis, and likelihood of prognosis. Blood group, age and distance are first used todetermine who gets the lungs. The average wait time for a lung transplant is 1,068 days.Need Source Unlike the heart and lungs, livers, kidneys and pancreases can remain outside thebody between ten to seventy-two hours. Define MELD/PELD A MELD/PELD score isgiven to patients, it indicates greatest need. Determining factors for receiving a liverinclude MELD score and matching tissue. A liver can survive from ten to twelve hoursoutside the body; however, the average wait time for a liver transplant is 796 days. For akidney, tissue match, blood type, blood antibody levels, length of time on waitlist, child,size and geographic factors determine who receives the organ. A kidney can last 48-72hours outside the body, but the average wait time for a kidney transplant is 1,121 days.One can be on a pancreas wait-list or a kidney-pancreas list or pancreas-kidney-islet list.A pancreas lasts from 12-24 hours outside the body. The average wait time for a pancreastransplant is 501 days. Need source The Scientific Registry of Transplant Recipients says74 percent of liver and heart recipients, 81 percent of kidney recipients, and 86 percent ofcombined kidney and pancreas recipients live more than five years. Need source
  5. 5. Issue Paper 5 Contrary to societal beliefs, the donor has the right to refuse the procedure atanytime during the process; the decision and reasons are confidential. As with anysurgery there are risks for a living donor. But there are also unique psychological riskswith donating an organ. Pressure from family and guilt may occur when donating to aloved one. If a donor is hesitant to undergo the procedure the family may ostracize orconsider him or her selfish. Negative feelings and resentment may be present if the organis rejected by the recipient. Some donors may internalize this as being rejectedthemselves. But there are also positive psychological aspects to donating. Donors mayfeel optimistic feelings by helping to improve someone’s quality of life, even if they are astranger. Living donation can make the medical aspect of donating smoother also. Sincethe operation is scheduled the patient has time to take immunosuppressant drugs beforethe transplant, lowering the risk of organ rejection. This, coupled with the bettercompatibility of the organ and recipient, further reduces the risk of organ rejection(UNOS, 2005). To increase the number of donor-recipient matches from live donors, donorcascades have been arranged. Donor cascades are systems that require a high level oforganization to coordinate but have been able to supply more organs to those in need.Family members and friends of a person in need of a kidney often volunteer to donatetheirs but sometimes do not adequately match to be eligible. These families and friendsare asked to still donate their organs to a stranger they better match with, when theirloved one receives a kidney. The stranger receiving their kidney must have relativeswilling to donate to another stranger to make them eligible for this chain. These chainswould provide “up to 3,000 donors to the system” (Emery, 2009). But they would also
  6. 6. Issue Paper 6not follow the priority of the waiting list. Even though more people are matched sooner,which would eventually decrease the length of the waiting list, the sickest are notprovided organs first, which may be seriously life threatening. And if a family memberretracts their offer to donate a kidney, which all living donors are able to do at any timeduring the process, the chain will stop. This is unfortunate if a family member has alreadydonated but the organ recipient has not received a compatible organ yet. Need source In 2007, legislature was proposed in South Carolina to use prison inmates toincrease the availability of living donors. The legislation has not been passed butthoroughly discussed since then. It is thought to violate Federal Laws of organ donationand, in some groups, ethical standards. The proposal was to decrease inmates’ jail timewhen they agreed to donate bone marrow or a kidney. The time reduction would be 90days for bone marrow and 180 days for a kidney donation, but many are concerned aboutthe quality of organs and the organ recipients’ attitude toward the organ donor. Thelegislation would provide many more people with organs and possibility bettercompatibility without significantly shortening jail sentences (Associated Press, 2007). Even though the government is trying to create systems to increase eligibledonors, the cost of an organ transplant also effects who can receive a life savingprocedure. In 2005 it cost around $210,000 for a single kidney transplant. It cost over$800,000 for a heart transplant. Many times this can be covered partially or fully byinsurance companies; however the cost is a large determining factor of whether or notone can afford to do this. Need source While many sick and needy patients wait eagerly on a list to receive a life savingorgan, many scientists and researchers look on in frustration at the needless death of so
  7. 7. Issue Paper 7many. Scientists know that with the proper funding and time, they can use stem cellresearch to reproduce new organs and save many of the lives of those waiting fortransplants. According to the website Genetic Engineering, they believe “a world wheretransplants could be done without the sacrifice of another person losing an organ. Thisworld exists only within the boundaries of stem cell research,” (Ganesh, 2009). Stem cells are cells that have not differentiated or have not become a specializedcell. Totipotent, or completely undifferentiated, cells can turn into “210 different kinds oftissues in the human body” (Irving, 1999). In addition to growing new organs, thismedical procedure could be used to treat many diseases such as Parkinson’s,Alzheimer’s, Heart disease, Diabetes, and spinal cord injuries (Experiment-Resources,2008). There are three ways that stem cells can be acquired. You can extract adult stemcells which are taken from the bone marrow, umbilical cord stem cells or embryonic stemcells. The most controversy is around stem cells that are extracted from embryonic cellsvia early human embryos and aborted fetuses (Irving, 1999). Debate is raised becausemany religious people believe that life begins at conception and argue that a life is beingkilled in order to get the stem cells. In addition, opponents argue that stem cell researchcould be used to learn how to clone humans and eventually lives could be created just forthe purpose of experimentation (All About Popular Issues, 2009). Even though stem cellresearch and cloning might be done with good intentions, people do not want to givescientists the opportunity to do embryonic stem cell research, because they “have seendevastating consequences of other research, even with good intentions, such as nuclearresearch” (Experiment-Resources, 2008).
  8. 8. Issue Paper 8 The opponents of embryonic stem cell research know there are tons of medicalbenefits of stem cells that can save millions of lives; but they do not think that thebenefits really outweigh the consequences. They argue that desperate people who needorgan transplants should not take away an innocent embryo’s potential at life to savetheirs. Opponents of embryonic stem cell research believe everyone deserves a chance atlife, from the patient at the top of the wait list for a new heart to an embryo. The NationalBioethics Advisory Committee said that “human embryos deserve respect as human life”(Irving, 1999). Opponents of embryonic stem cell research believe that scientists andresearchers should stick with adult and umbilical cord stem cells, as an option for organdonation, because they have just as many benefits as embryonic stem cells in addition tobeing more ethical. Many pro-life activists are against cloning, however, therapeutic cloning, eventhough it has not been accomplished in the laboratory or clinic, has many encouragingbenefits. The possible benefits are, if therapeutic cloning using embryos is successful,and perfectly matched, then replacement organs could become available to sick and dyingpeople. This would save lives, and increase the quality of life for many others. There arethree possible outcomes of therapeutic cloning; the use of insulin-secreting cells fordiabetes, nerve cells in stroke or Parkinson’s disease, or liver cells to repair a damagedorgan. There would also be other benefits in the success of cloning such as an increasedknowledge of how our organs regenerate; which would increase the range of possibletreatments. Need source There are a number of advantages in using cloning when compared with theadvantages of using a regular organ transplant donated by a second person. The risk and
  9. 9. Issue Paper 9danger of rejection of the transplant would be reduced because the organs DNA wouldmatch the patients DNA exactly. For transplants of organs that are duplicated in thebody, another individual would not have to experience pain, inconvenience, and apotentially shortened life span in order to donate the organ. The patient would not have tomake do with a replacement organ that is old and may have reduced functionality; abrand-new organ would be grown specifically for them. The procedure would save liveswhich would otherwise be lost waiting for a transplant that did not come in time. Thepotential exists to cure, or at least treat, certain diseases and disorders that cannot beeffectively handled today. For these reasons it is argued that stem cell research andcloning are a very positive aspect for organ donation. Need source The same could be said for using animal organs in transplants. Like cloning, ithas a lot of the same advantages. For instance the patients would not have to wait onorgans; they could have them as soon as they need them. This would allow transplants tooccur while the recipient is still strong and somewhat healthy and better able to toleratesurgery. According to statistics quoted by the Lincoln Journal Star, the current number of20,000 transplants per year in America could be increased to over 100,000, if animalorgans were used. The animals being using for this are pigs, which are being treatedwith great respect and are given pain killers for their comfort. In addition, they are keptin clean environments promoting a healthy outcome. Need source There are manybenefits from cloning and stem cell research, but these procedures are still on the drawingboard, therefore many people turn to alternative, maybe even illegal, ways of obtainingorgans.
  10. 10. Issue Paper 10 Organ trade in the black market has increasingly become more popular as peopledesperately seek organs that are not readily available in the United States. In the US,there are laws prohibiting the selling organs for any price. As the waiting list for organsincreases, people seek other methods, even though there could be health risks forthemselves and the exploitation of poorer people in developing countries. A commonterm called ‘transplant tourism’ has surfaced. Transplant tourism is when wealthy citizensfrom America, and other industrial nations without a black market organ trade, go tocountries where it is legal to operate and receive organs. This is all for a very steep price(National Geographic). There are many ethical considerations when it comes to organ trade in the blackmarket. Where do the organs come from? Are the medical conditions safe for both theperson giving and receiving the organ? Exploitation is an issue that cannot be ignored.People are willing to pay as much as $100,000 for a black market organ when the persondonating the organ receives only a small portion of that price. Most of the time, thepeople donating organs are poor villagers who receive about $800 for an organ. That is ayear’s worth of wages for them, but when the person has no more organs to sell, themoney eventually ceases to exist. They also have to live with the risk of medicalconditions because the medical practice can be very unsafe. The medical care is notregulated so there is risk of infection and disease after the organ is removed (NationalGeographic). There are many cases where uneducated workers are promised money for theirorgans and then die in the process. The corrupt individuals in charge of thetransplantation ring make off with 100% profit from the stolen organs. The people who
  11. 11. Issue Paper 11live through the process are left with a fraction of the price of what the doctors get paid.A specific example of organ exploitation happened in India. Poor farm workers andlaborers sold their kidneys for as little as $1,000. The black market doctors then soldthem for around $37,000 profit. Some of the East Indian workers had organs removedagainst their will without support from the local government. After the illicit doctorscompleted extraction of over 500 kidneys, they were shut down by authorities (Time). The ethics concerning the black market organ trade are major issues that need tobe handled, to stop the negative effects against legitimate organ donation. The primaryforce driving this underground business is rooted in the exploitation of third worldnations by opportunist doctors. Death rates are high do to the horrible conditions and lackof interest in the patient’s well being by the black marketers. At the end of the day, theonly people who made off with profits were the ring leaders, leaving the exploitedpatients with an uncertain medical future (National Geographic). This illegal trade hasdamaged the public’s view of what could be legitimate organ transplant organizations. While discussing ethical components of organ donation, religion cannot beoverlooked. As these two topics blend effortlessly, most populations have strongopinions regarding if, how, and why organs are donated. But exceptions occasionally areheld in certain scenarios. Regardless of the opinion, the majority of them stem fromreligion. This is due to the high value that religions have on the body. The reaction to thisview differs within different religions. When it comes to organ donation, Baptists,Lutherans, and Catholics hold beliefs different from Gypsies, Shintos, and Jehovah’sWitnesses.
  12. 12. Issue Paper 12 Most groups tend to encourage the gift of donating organs. Such include Baptists,Lutherans, and Catholics. While a key concept in religions like these is to give for thesake of others, organ donation is seen as a great way of relieving people from theirsuffering and pain. It is a worthy deed. This selfless giving is a key concept in suchreligions. Need source Minority U.S. religions mostly coincide with this thought as well. “Laws inJudaism and Islam, for instance, prohibit desecration of the human body. But bothreligions note that prohibition is trumped when it comes to saving a life” (Segal). Thesebelievers claim they possess eternal life through their spirit. When a physical body passesaway and the spirit leaves it, organs are not needed to pass on. However, some groups believe in a physical resurrection. Gypsies strongly statetheir opposition to donating. According to the US Department of Health and HumanServices gypsies “believe that for one year after a person dies, the soul retraces its steps.All parts in the body must remain intact because the soul maintains a physical shape” (USDepartment of Health and Human Services, 2009). Another viewpoint is that of theShinto religion. Followers of Shinto see dead bodies as impure, and “defiling a corpsebrings bad luck to the person who does it. Thus, many followers oppose the taking of organsfrom those who have just died, or say they would not want an organ transplanted from thedead” (Belief Net, 2009). However, there is speculation of this particular outlook will lose itsprevalence. But opinions on organ donation are not always black vs. white. There areexceptions at times. Jehovah’s Witnesses note the Old Testament passage that states oneshould never ‘eat’ the blood of another. This means even for the means of saving theirlives, they will not accept nor donate blood. However, if the organs needed to be
  13. 13. Issue Paper 13transplanted were ‘bloodless’ and washed, then Jehovah Witnesses will accept the organ(Religion Facts, 2007). Organ donation is a multilayered and complex situation that many current nursesfind themselves dealing with. It is important for a nurse to understand the physical,emotional, psychological and spiritual issues that patients and families go through whenthey are on the waitlist for an organ transplant. It is important for a nurse to be culturallycongruent and know how different cultures and religions view organ donation andtransplant. In addition, giving patients all the information is necessary in helping themmake informed decisions; therefore nurses should know the horrible facts about the blackmarket and relay this information with their patients. Nurses also need to keep informedabout black market procedures just in case they take care of a patient who received anillegal organ transplant. If nurses know the types of infections that are common incountries where patients receive the black market organs, then nurses can be betterprepared to treat the infection should they ever care for this type of patient. Nurses alsoneed to keep updated on stem cell research because new medical procedures coulddevelop that would be integrated into nursing. Finally, nurses need to know all the basic facts about transplants and organdonations. If nurses know the cost and wait time for organs they can better inform theirpatients to help them make a decision about donation and transplantation. Nurses need toview organ donation like they view a patient. Nurses look at the physical, emotional,mental, social, and all the other aspects of a person. Organ donation has just as manylayers that all need to be looked at together in order for the patient to receive the best careand treatment. The nurse, Stephanie Falbo, who approached Jason Ray’s family, gave
  14. 14. Issue Paper 14them the choice to honor Jason’s wish of being an organ donor. If Jason’s parents hadrefused to donate Jason’s organs then Stephanie Falbo would have respected their wishes.In order for every nurse to be as respectful as Stephanie Falbo, they need to have all theinformation about organ donation and understand all the different aspects of the situation.
  15. 15. Issue Paper 15SOURCES,8599,1709006,00.html donation programs, familys donate kidneys b/c their loved one got astrangers kidney. Carolina prison can cut time by donating kidney/bone marrow clinic, 10 myths about donating articles and links to articles on different topics about organ donation to donate dedections, life sharer network Life America (2009). Learn the Facts. Retrieved March 20, 2009, from, W. (2007). Ray of Hope. Retrieved March 20, 2009, from