Organ works towards facilitating adequate levels of organ

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Last updated: September 18, 2019

Organtransplants are a modern-day success story, defined as the transfer of a livingtissue or organ to an injured or ill person to restore their health and aid theirquality of life. Organ transplantation first started in the 1930’s, this conceptgave a new insight into medical research and provided hope for ailing patients.Several kidney transplantations were successfully preformed in the 1950’s andfollowing that doctors successfully transplanted many other organs, hence improvingquality of life and reducing morbidity and mortality. Organ transplantationswithin medicine are considered safe procedures and a viable treatment optionfor patients experiencing heart disease, liver cirrhosis, respiratory diseaseetc. Organ transplants and are no longer a medical experiment, but a tried andtested procedure (Robson, 2012). There arethree types of donation; Brain stem death, where the person no longer hasactivity in the brain stem and has lost all potential consciousness, thuspronounced dead. Circulatory death, irreversible loss of function of the heartand lungs after a cardiac arrest and patient cannot or will not beresuscitated.

Living donor, whilst still alive an individual can choose todonate a kidney or a small portion of their liver etc. Like all medical procedures, organ donationsand organ transplantations have many stigmas in society. Approximately 6,500patients are currently waiting for an organ transplantation, and whilst half amillion people die in the UK per year, fewer than 6,000 people die willing todonate their organs. The gap between the abundance of individuals needingorgans and the number of people on the donor register is widening. Many legal,social and ethical dilemmas and controversies are associated with theseprocedures, and it is important we are vocal and discuss such concerns; A clear, facilitative legal framework isessential for governing organ transplantation. The Human Tissue Act 2004 workstowards facilitating adequate levels of organ donations and ensuringappropriate levels of public trust in clinicians (Price,2012). Inevitably there are tensions between the donor, the potentialtransplant recipient and healthcare professionals. The UK works under an ‘opt-in’system whereby you must express your preference if you wish to be an organdonor and only then will your organs be used after death.

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Medically allprocedures must be consented, even in the event of the patient holding a donorcard, lack of family consent results in approximately four out of ten organsconsidered for transplantation not being used (Ralph etal., 2014). Regulations relating organ donors end of lifecare can facilitate organ transplantation as long as it’s in the best interestof the donor and will not cause them harm or distress, or place them atsignificant risk. Patients eligible for Non-heart beating organ donor (NHBD)will always lack the capacity to make treatment decisions due to their conditiontherefore The Mental Capacity Act 2005 (MCA) authorises healthcareprofessionals to treat someone who lacks the capacity, provided they reasonablybelieve their actions to be in the person’s best interests (Welsh assembly Government, 2018). If a patient isknowingly an organ donor the treatment plan for the patient may be altered, assome treatment plans will damage the patient’s chances of being a viable organdonor. The legislation also allows healthcare professionals to decide where thepatient will be stationed for the best results of successful organtransplantation (Bell, 2005). Due to ever increasing demand of organ donors,transplanting suboptimum organs has become a necessity in urgent cases.

Theseorgans include; those with poor predicted outcomes or increased risk ofdisease. Organs which otherwise would be considered unsuitable are now suitableincluding; organs from elderly donors and from donors with previous history ofcancer, infections, smoking and drug use. Ultimately immediate organs offer abetter outcome for recipient population than waiting for an organ of betterquality.  The clinician’s decision is thereforeextremely difficult, balancing the best interests of the patient and all on thewaiting list. Equally the patient’s decision is truly difficult waiting couldprove to be difficult (Dyson et al.

, 2015). In2013 two organ recipients died from a rare nematode infection, demonstratingthe effects of organ transplantations from less than ideal donors. Cliniciansare ever changing their approaches to avoid the possibility of negligence andproduct liability. Procedures and possible risks are explained thoroughly toall parties involved reducing the risks of litigation. Pre-conceptions of organ transplants dramaticallyimpact the number of people on the donor list. Although legislation protectsboth the donor and transplant recipient, media plays a huge role in socially deterringfuture donations. Patient-doctor trust is essential with a fully informedprocess highlighting the respect held for human dignity. Organs are not harvestedunless the patient is declared dead, a patient is not killed for their organs,however, the correct interval between death and organ harvesting is a continuousissue.

Two or three cases of declared dead donor patients waking up during an unintentionallydelayed interval is enough to discourage patients. The fear of the unknown. Will a doctor let medie because I’m an organ donor is one of the most searched questions relatingorgan transplantation, and this simply isn’t the case. All lifesaving effortscome before organ donation is even addressed. Healthcare professionals work inthe best interests of the patient and there’s no incentives in letting one dieto save another.

Other misconceptions include; donor mutilation and organmutilation. Socially concepts have arisen assuming the donors body will betreated badly and severely mutilated, however this is not the case. Organswould be surgically removed in a routine procedure, without disfiguring thebody of the donor. Recent media coverage of clinicians branding organs andpatients, cause a huge uproar and often deter the masses.  Social misconceptions need to be addressed individuallyfor perceptions to change across past and future generations. Other socially considered issues includereligious beliefs and Quality of life (QOL). In multicultural societies such asthe UK, beliefs often play a huge role in whether organ transplantation is atreatment option or even if a patient can offer an organ.

Most cultures seeorgan donation to be a positive contribution to aid others, however, variouscultures e.g. Islam and Jehovah Witness believe the body is under Godsownership and thus works under gods will. The body is not our piece to share,life will take Gods chosen course (Bruzzone, 2008).

On the other hand, organ recipients after successful transplantation canexperience psychological turmoil with expediential stress and pressure. QOLmeasures the patient’s ability to function physically and psychologicallypost-op. Research has shown factors affecting this include; constant medicationmonitoring, post-op complications and medication side effects.  On the other hand, social dilemmas for livingorgan donors is also an ever-growing concern.  Psychological side effects have been reportedincluding; depression and family conflict.

Negative psychological consequenceshave been reported due to risk factors including; high age, lack of social supportand organ rejection in the recipient. Living-related organ (LROD) donors refersto family members (direct matches) who offer organs e.g. kidney to a familymember. Research has shown that in the event of organ rejection in therecipient, LROD’s are likely to feel responsible and blame themselves.Psychologically this is extremely difficult for family members with increasedstress and the impending what next.

Lack of awareness during consultations coheresrelatives to make moral decisions without considering side effects, motivatedby the prospect of saving the life of a loved one. Mentioning a possible quickmatch as a direct relative can often eliminate voluntary control behind thematter and this should always be considered.  Angel donors/ Living organ donors tend to feelsuccessful and oblivious however this feeling can be stripped away fromrelatives as they know the outcome.

Other socially driven issues relating ODTinclude; social desirable factors in donor motives. Organ donors are motivatedfrom a variety of intrinsic factors; acting in accordance to what is expectedof you religiously and extrinsic factors; social pressures to inspire thedonor.  Motives range from normative toempathy. Commonly donors experience a ‘feel good’ psychic gains with higher postdonation self-worth (Westphal, 2001). Organ transplantation, like most medicalprocedures faces huge ethical dilemmas and thus legislation and strictmonitoring by the National Organ Donation Committee (ODT) is paramount.  Many questions can be asked about organtransplantation including; who gets priority? Will priority be influenced bypeople with a higher social status, money or government connections? Will age,severity of the illness affects patient’s chances? One of the most importantquestions people are starting to ask is are they more eligible for a new kidneythan a recurring alcoholic? Within the UK there are little restrictions onwho is eligible for a new liver, urgent cases are often given priority. Specifically,with the liver children and young adults are given priority if a matched donorbecomes available. Older adults are scored based on how long they’ve been onthe waiting list and how well they match to the donor e.

g. tissue type, bloodgroup and age. The priority does not alter whether the liver damage was causedby self-inflicted damage or natural cirrhosis. Ethically many can state thatdiscrimination is limited within the UK, chances are provided to all patientsto have a higher Quality of life however, equally is it fair to give a healthyliver to someone who will just abuse it. Medically, alcoholism is a physicaland psychological addiction, with rehabilitation breaking abstinence is to beexpected. In the USA a six-month abstinence from alcohol is required beforepatients with acute alcoholic hepatitis are considered for a transplant.

However,30% of those who do not respond to treatment die within 6 months and most diewithin 2 months, delayed treatment playing a huge factor. Equally debates havefollowed a similar suit for obesity and heart transplants. Obesity is alsoconsidered a psychological and physical addiction posing similar ethicalconcerns. Restrictions could delay urgent treatment and cause patients to havea higher death toll.

 Another factor contributing to ethicalconcerns is cost. Organ transplants are extremely expensive considering;medical tests, medical appointments, surgical consultations, surgery andcontinuing rehabilitation. Immuno-suppressive drugs are administered to the patientfor the reminder of their lifetime, which is costly for the NHS.

Is thereenough money to go around? Luckily for patients in the UK personal income haslittle to do with their overall care. Many charities and organisations aid theNHS in research based donations for continual growth.              Consent and incentives are at the forefront oftoday’s ethical analysis of organ transplantation. organ donation is anentirely altruistic act irrespective of whether the donor is alive or dead. A successfuldonation in the UK depends on the unequivocal confirmation that the patientwished to become an organ donor, both through the organ donor register (ODR)and by discussing with relatives. Less than one third of UK donors are on theODR and 50% of consents are based on knowledge of the individuals wishes.Currently the UK-wide Donations Ethics committee (UKDEC) is looking tointroduce a soft opt-out policy.

All UK individuals will have presumed consentto organ transplantation yielding high donor rates. In the event of there beingno recorded objection to the donation from the individual (donor), the donationwill only take place if relatives agree.             Presumedconsent has been presented to the UK as an attractive option, especially due tothe gap between UK donors and patients in need of a transplantation. 24European countries and Wales have seen dramatic results with an opt-out systemwith record donor rates. However, the UK run the risk of being accused ofdictating the ownership of one’s organs after death.

This bullying approachcould turn an altruistic feel-good decision to help people into a forcedmandatory regime. Replacement of the opt-in organ donor policy may not behelpful. Many argue communication is vital to increase donor numbers, creatinga willingness to donate as a normal part of end of life care, would be considerablymore effective, similarly to Spain (Rodríguez-Arias et al, 2010).             ODT is thoroughly discussed withmost patients for the treatment of acute or chronic illnesses; and is generallythe best option. Although the organs are considered financially free, emotionalattachment is not to be ignored. In many cases organs are ultimately not deemedviable for organ transplantation e.

g. due to prolonged warm ischemia or no viablerecipient matches found etc. Subsequently organs may be used for medicalresearch, this often does not hold as much value and is viewed as less of asuccess. On these occasions, relatives will be informed and asked if they stillwish to donate for research. Medical research is essential for the improvementof future procedures, educating new healthcare professionals and vital inenhancing physiological knowledge.

Willingness to donate for research should beseen as much of a success as organ transplantation.  The organ procurement process also poses therisk defining death. Everyone has their own definition of death, whereas the UKDECregulates and offers an abiding definition.

Many could argue that death is themoment your heart and lungs stop working for themselves, or when your higherfunctions stop? These are the most important questions asked by healthcareprofessionals regarding ethics and when its acceptable to take organs.  Vital organs are only extracted after ‘braindeath’ which is medically irreversible. Brain death is determined in thehospital by several physicians not associated with the transplantation team.Vital organs e.g. heart, kidneys and liver can still work momentarily if abreathing machine is used, however, many organs useful for transplantation atthis stage are damaged beyond repair and unusable.

A physician or transplantspecialist must respect patient autonomy. Most ODT’s are provided by Intensive carepatients thus providing dilemmas and conflicts of interest in Intensive care. Ethicalissues relate to caring for dying patients and pressures on ICU beds when apatient subsequently becomes a donor. The UKDEC remains imperative that anyadvice takes full account of factors including; emotional and work-relatedpressures. Sensible and regulated guidance on all matters regarding ICU donorsis essential. All resources are to be allocated equitably, however, one patientis a potential donor for several candidates. A conflict of interests is easilyfought daily with the ever growing gap in donations however, could we cope withan abundance of donations if it were that simple?  Regarding ICU patients the UKDEC has alsoevaluated the ethical considerations between withdrawing life-sustaining treatmentand successful Donation after cardiac or circulatory death (DCD) donation.

Standardoperating procedures hold an end-of-life care pathway for all possible patientailment scenarios. Standardising death is a hard topic, determining the exacttime each patient must have their life support removed. Although alien to us anoverall consensus in the order of death could maximise potential donors. A person’shealth could be monitored in such a way to minimise warm ischemia time(Simpson, 2012). However, is it ethically acceptable to modify anyone’s end oflife care plan with the aim of improving a potential transplant recipient aftertheir death? Ultimately there are many ethical, social andlegal considerations when debating medical practice. Although there are two orthree possible perceptions of all debates ultimately the aim is the bestpatient care with minimal harm. Some topics offer an insight into healthpractice professionals dilemmas while others the donors.

With every increasingdiabetes worldwide, the gap between donors and people on the waiting list is wideningand something needs to stick. Fundamentally the debates suggest that theopt-out system will offer an immediate positive impact on organ donor rates. However,communication between families and friends is essential, the discussion behind theopt-out system has indirectly encouraged families to discuss after death plans.More active encouragement should be implemented to make the public askquestions and speak about fears, open discussion will educate the masses. In 2013the UK was recorded to have one of the highest family refusal rates for organdonation, donations should be a positive enlightening aim after death, ratherthan a feared concept.

Often the debate leads to the ‘Holy Grail’ oftreatment for organ failure being, stem cell technology (Orlando et al, 2013). Regenerating individualorgans for an individual patient using embryotic cells, however, not as simpleas it sounds. Stem cell research holds a heap of ethical dilemmas.


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