[robsta]

Originally Posted by NurseGuy_in_06

What if you are in an accident and need blood. Should only blood doners receive blood? If you want me to be a donor then convince me, don't bribe, coerce, or threaten me. (Not you personally but society in general) Organ donation is a personal decision. Let's leave it that way and not make receiving one conditional. Only when the same rules apply to everyone, that is, the sickest gets the organ, will the system remain fair.

Well said.

[robsta]

Originally Posted by 3rdShiftGuy

I've seen some donor cases happening in my sister unit when I worked neuro. It's quite a process. It's not like a person dies and their organs are immediately removed at the scene or when they arrive to the hospital.

Say a person has massive head injuries and is brain dead, it's determined are a donor, or the family wants to donate, and then they have to find a match for the organs, test those organs for disease (do an echo, do a bronchoscopy, blood work, etc.), then take the person to the OR to remove them. This can take hours. During this time they do whatever is necessary to keep those organs perfused and viable, using ventilators, medication, etc. So the heart is beating, the patient is on a ventilator, etc. being kept by alive by artificial means. Brain death is confirmed with EEGs.

It's hard for the lay person to understand that during this time, the person might be technically alive while being brain dead. Am I making sense. Perhaps an ICU nurse with more experience can explain it better.

Yes, you're making sense if I understand you correctly: the patient is still alive even though EEGs indicate possible brain death. Autonomically, the body is still functioning. So the patient is not clinically *dead* when the organs/parts are surgically removed... is this correct?

robsta

[VizslaMom]

Originally Posted by boulergirl

I'm an organ donor, but have some concerns about it now. A couple of months ago, my mom posted an article about this on her online journal (blog): "Are You Licensed to be Killed? Understanding Brain Death". Apparently the person has to be living for the organs to be donated. Umm, anyone know if this is true?

Yes, the BODY must be kept alive until the organs are harvested. If the body dies, the organs die with it and there can be no donation. The body is kept alive by a multitude of drugs, on ventilator support. Testing is done, such as echocardiogram and bronchoscopy, to verify if the heart and/or lungs are suitable for donation. For example, we had a young female MVA that they were not able to harvest the heart from because her heart had apparantly suffered trauma as well. Her ejection fraction was between 5-10%.
There IS testing done that shows if the patient is brain dead or not before organ donation is brought up to the family. One of these is an apnea test. The ventilator will be stopped and the patient observed for any signs of spontaneous respirations for a matter of minutes...NOT exactly the favorite of conclusive brain death tests for a critical body you're trying to keep alive. There is also EEG for wave activity and blood-flow scan done in radiology to determine if the brain is getting any blood flow at all. When a patient has a severe head injury, there can be so much pressure built up in the brain that prevents further blood flow and oxygenation. This is often how brain injured patients become brain-dead patients. The built up pressure can also cause brain-stem herniation which also results in brain death.

It is unfortunate that so many in the public, even other nurses, don't have a complete understanding of the process. That is why some assume that we are "killing people for their organs". That is not the case. These patients are already technically DEAD. If you are brain dead, you are dead. If these patients were not organ donors and simply taken off the ventilator, their bodies would die naturally in a matter of minutes due to lack of oxygen. There is no command from the brain to tell the body to breathe.

[Marie_LPN, RN]

My values have nothing to do with me donating my organs. They can have them when i'm gone, i mean after i'm dead, what the heck do i need them for?

[Spidey's mom]

Originally Posted by fergus51

No. I'm saying people who refuse to go on the donor list in the event that they die, should not be allowed on the recipient list. No free ride. Either people are willing to contribute to the system or they should not expect to take from the system.

What if you are still on the fence?

steph

[Spidey's mom]

Originally Posted by 3rdShiftGuy

I've seen some donor cases happening in my sister unit when I worked neuro. It's quite a process. It's not like a person dies and their organs are immediately removed at the scene or when they arrive to the hospital.

Say a person has massive head injuries and is brain dead, it's determined are a donor, or the family wants to donate, and then they have to find a match for the organs, test those organs for disease (do an echo, do a bronchoscopy, blood work, etc.), then take the person to the OR to remove them. This can take hours. During this time they do whatever is necessary to keep those organs perfused and viable, using ventilators, medication, etc. So the heart is beating, the patient is on a ventilator, etc. being kept by alive by artificial means. Brain death is confirmed with EEGs.

It's hard for the lay person to understand that during this time, the person might be technically alive while being brain dead. Am I making sense. Perhaps an ICU nurse with more experience can explain it better.

Hey, I saw that on ER!

steph

[Marie_LPN, RN]

I'm saying people who refuse to go on the donor list in the event that they die, should not be allowed on the recipient list. No free ride. Either people are willing to contribute to the system or they should not expect to take from the system.

I agree.

[fergus51]

Originally Posted by NurseGuy_in_06

What if you are in an accident and need blood. Should only blood doners receive blood? If you want me to be a donor then convince me, don't bribe, coerce, or threaten me. (Not you personally but society in general) Organ donation is a personal decision. Let's leave it that way and not make receiving one conditional. Only when the same rules apply to everyone, that is, the sickest gets the organ, will the system remain fair.

Blood is very different from organs. How many people died last year waiting for blood? Apples and oranges.

Organ donation is a personal choice and I don't think it should ever be mandatory. I just don't think people should be able to have it both ways either. If you would never consent to donation, I think it's selfish and hypocritical to accept an organ from someone else. Obviously people who can't donate shouldn't be penalized for that, but if you just don't want to then that's another matter. It's completely your right to do and I am not going to try to convince you to do otherwise, but no one ever said that choices don't have consequences. I think an opt out system where those who opt out of organ donation are also opting out of the option to receive organs is completely sensible. Don't worry though, I am sure it will never happen and you'll always be able to get on the organ recipient wait list should you need it regardless on your stance on donation.

[fergus51]

Originally Posted by stevielynn

What if you are still on the fence?

steph

Not to sound harsh, but I was always raised to believe that almost doesn't count. If you're on the fence and you're not going to donate the strength of your belief doesn't matter. You aren't going to donate period. In my ideal world you would just have to answer this question at a certain age, maybe when you get your license or register to vote or something. Something tells me if you did have to be on the donor list in order to receive organs, people wouldn't be "on the fence" anymore. They'd make up their mind one way or the other and I can respect either decision.

[susanna]

WOW! This thread got a lot of responses really fast. It looks like a good topic that everyone has a lot of input on.

Originally Posted by fergus51

No. I'm saying people who refuse to go on the donor list in the event that they die, should not be allowed on the recipient list. No free ride. Either people are willing to contribute to the system or they should not expect to take from the system.

Yeah, in a perfectly just and fair world, a system could be enforced that, if you are eligible(healthy, no transmittable diseases, old enough to make the decision yourself and take responsibility for it) to donate and choose not to for any reason, then you would give up your right from being higher up on the list of accepting donations than other people who do choose to donate. That will never happen and can never happen.

Its like charity and fundraising for diseases. When I did fundraising in college, we had people that were taking the money for themselves and whose lives were being very much saved by our funds come in and admit that they NEVER, EVER did anything to raise funds or contribute to charity for anyone else in their same kind of situation in the past. Is it fair that they should receive so much help from us when they never would have thought about lifting a finger to help another person in their situation? When they never contributed and other people have? No. But can you turn them away? No. Can you make a clause that says that, now that they have been helped, they have to make an effort in the future to help others in the same situation? No, that doesn't feel quite right either.

I see how you feel though. Its like, so many people suffered in the past from lack of this resource and here you are, giving the resource to someone who wouldn't help someone else with that same resource. You feel irked for the people who still aren't getting the help but who would help someone else in their situation. It makes you angry, its depressing, and its not fair but thats the way it has to be and there is not much more to do about it because, as everyone else has said, its such a personal issue and, even though it makes me feel angry, it just doesn't feel morally right to force people to become donors in order to receive donations.