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Ethical Issues in Organ Procurement and Organ Donation

Ethical Issues in Organ Procurement and Organ Donation. Mitchell Forman, DO, FACR, FACP Dean Touro University Nevada College of Osteopathic Medicine Weldon (Don) Havins, MD, JD, FACS Professor of Medical Jurisprudence Touro University Nevada. Current Status.

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Ethical Issues in Organ Procurement and Organ Donation

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  1. Ethical Issues in Organ Procurement and Organ Donation Mitchell Forman, DO, FACR, FACP Dean Touro University Nevada College of Osteopathic Medicine Weldon (Don) Havins, MD, JD, FACS Professor of Medical Jurisprudence Touro University Nevada

  2. Current Status • A new name is added to the national waiting list every 12 minutes • Every day, 18 people die waiting for an organ that never comes • The current waiting list exceeds 108,000 people • 136 Patients waiting in NV (UMC); another 200 waiting at other centers

  3. “List Jumper” You Get What You Pay For

  4. Organ Transplantation Laws • National Organ Transplant Act (NOTA) • Organ Procurement and Transplantation Network • United Network for Organ Sharing (UNOS) • NOTA prohibits the purchase or sale of organs • Uniform Anatomical Gift Act (UAGA) • Prohibits purchase or sale of organs • gift or donation to a specified individual is okay

  5. Cremation Story “It Doesn’t Pay to Be Generous”

  6. Living Will & DPA • Living Will • Consent for the Withdrawal of Life Support • Designating another to make the decision • Durable Power of Attorney for Health Care • Witnesses • Notarized • Much wider powers

  7. “That’s Not What I Want”

  8. Religious Consideration “Is it God’s Will?”

  9. Ethical Issues – Recipient Selection Who should receive a transplant? • Alcoholics • Smokers • Drug abusers • Convicted felons • Non-compliant patients • Patients who need multiple organs

  10. UAGA – 2007Consent Hierarchy • An agent of the deceased • Spouse • Adult children • Parents • Adult siblings • Adult grandchildren • Grandparents • An adult who exhibited special care or concern for the deceased • Persons acting as guardians at the time of death • Any other person authorized to dispose of the body

  11. Majority Rule rules • Old UAGA • All family members of the same “class” must agree. • New UAGA • Decision rests with a simple majority of family members of the same “class” reasonably available

  12. NRS 451.548 • Reasonably Available • “… able to be contacted by a procurement organization without undue effort and willing and able to act in a timely manner consistent with existing medical criteria necessary for the making of an anatomical gift.”

  13. Organ Procurement Voluntary organ donor?

  14. Organ Transplantation • Outside U.S. • Cost • Availability • Quality of care • Within U.S. involving foreign donor • Physician’s ethical responsibility to inform patients?

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