Ethics Exam #3 - Organ Donation and Transplantation and Health Policy

Dead donor rule

1. Apart of the 1968 Uniform Anatomical Gift Act
2. "Donors must be declared dead before their organs are taken"
3. Vital organs should only be transplanted from dead patients

Barriers to success of transplantation

1. A person's ability to carry out a specific function that is essential to prevent social disintegration or a great number of deaths during a time of crisis
2. Do providers deserve special treatment?

Brain based criteria for death

1. a person who is determined to be brain dead is clinically and legally dead
2. standards must be met
3. Then, neurologic testing, brain stem reflex testing, and apnea testing should be followed

Standards that must be met to determine brain death

1. Etiology of the injury to the brain must be known
2. Any reversible condition should be ruled out (shock, chemical imbalance, drug intoxication, hypothermia)
3. Hemodynamically normal and stable

Neurologic exam for determining brain death

Full exam - a patient does not react to painful stimuli nor exhibits any purposeful or spontaneous movement

Brain stem reflex tests for determining death

1. Nonreactive pupils
2. Cranial nerve testing
3. apnea test

Medical record documentation must include what when determining brain death?

1. Etiology and irreversibility of unresponsiveness
2. Absence of motor response to pain
3. Absence of brainstem reflexes during two separate examinations separated by at least 6 hours (absence of respiration with PaCO2 ≥60
4. Justification for, and result of, other confirmatory tests if used (e.g. EEG)
5. Notification of procurement agency

Death law in PA

1. Death defined as an individual who has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem
2. A determination of death must be made in accordance with accepted medical standards

Organ donation by cardiac death

Patient is expected to die but not determined to be dead by brain-based criteria can have his/her organs retrieved if certain conditions are met

What conditions must be met for organ donation by cardiac death?

1. Decision to terminate life support is made separately from the decision to donate organs
2. Within UPMC, having ethics consultation is mandatory
3. If the family agrees with life support withdrawal and then with organ donation

What is the procedure of organ donation by cardiac death?

1. ventilator is withdrawn
2. palliative care interventions
3. The patient's respiration and heart rate must stop within one hour to be eligible for organ donation
4. After cessation of cardiopulmonary activity for at least 5 minutes, death is announced
5. Treatments for temporary organ preservation begins
6. Then patient's body is then supported and quickly brought to the operating room for organ retrieval

Types of donors

1. deceased donors - cardiopulmonary death and brain death
2. living donors - cardiac death imminent (non-heart beating)

What informs public policy?

1. government
2. normative policy analysis
3. political philosophy

What are the four impulses of political philosophy?

1. welfare
2. liberty - the power or scope to act as one pleases
3. virtue
4. revolution

Justice

The condition under which persons receives those benefits and burdens to which they are entitled or due based on his or her particular characteristics and circumstances

What are the moral limits of utilitarianism in producing justice?

1. No account of individual rights
2. No account for different types of pleasures and tastes
3. Outside force will likely have to decide when utility is maximized