Organ Donation Organization Unethical

[dangerous1]

I've been a critical care nurse for 6 years, I'm employed at a Southern California hospital that mandates all nurses taking care of poor prognosis patients to report them to one organ donation company. If a nurse fails to comply or report it to that "none profit" organization, even if the family does not want to donate organs, we are written up. Essentially, we are forced to call them regardless and this organization sends a nurse to persuade the next of kin in their vulnerable state. I mean within hours of being declared brain dead.

If the deceased did not make their wishes known about organ donation, nurses should not force another third party to come in and try to sales pitch them. I asked one of the family's what they said, and they said all the good things that come from it, i.e. a tragedy. I think the organ donation organization plays on their vulnerability.

I've done research on this particular organ donation company and the CEO makes well above $500,000. I've seen invoices from other hospitals the amount of money that goes into harvesting an organ and clearly have been disenchanted by the thought of donation. Additionally, this organization threw a thank you party for our unit because we had 6 organ "harvesting" in a month.

I feel there are HIPAA violations of reporting something to a third party without the family's knowledge and mandating it by the hospital. Note, we do not get permission from the family to divulging information about the decease.

[traumaRUs, MSN, APRN]

Have you taken your concerns to management?

I work peripherally in transplant and the thought process is by having a third party come in to ask about organ donation, it takes the onus off the treatment team.

Ethics and Organ Donation

"The first thing is to decouple roles in the emergency department. "The person who tells the family that their loved one is dead should not be the person who approaches them to discuss organ donation," she explained. The same individual cannot ethically conduct these 2 conversations. "Furthermore, decoupling has been shown to increase the rate of successful organ donation," she added.When it comes to slowing things down, Dr. Marcolini explained that there are 2 schools of thought: utilitarianism, which the greatest amount of good for the greatest number of people; and categorical imperative, which is the duty to act with full disclosure. "In other words, we need to tell families what we know and when we know it.""

In IL, if you have indicated on your drivers license you wish to be a donor, the family can NOT rescind it so there is not ethical decision involved:

"When you register, the organ donor registry will carry out your wish to donate your organs and tissues upon your death. "

[Rose_Queen, BSN, MSN, RN]

It may not be the facility's policy requiring the reporting to the organ donation organization. My state, by law, requires all to be reported. And $500,000 for a CEO? That's actually pretty darn low compared to other CEO pay (did you put in the same amount of effort in seeing how much the CEO of your facility makes?), especially if it's CA. Bringing in the third party means talking organ donation is not the responsibility of the nurse caring for the patient and provides the separation needed between those caring for the patient before declaration of brain death and those looking for permission for organ harvest. Otherwise, there could be questions of conflict of interest and "did they really do everything they could or did they want the organs".

[dangerous1]

It may not be the facility's policy requiring the reporting to the organ donation organization. My state, by law, requires all to be reported. And $500,000 for a CEO? That's actually pretty darn low compared to other CEO pay (did you put in the same amount of effort in seeing how much the CEO of your facility makes?), especially if it's CA. Bringing in the third party means talking organ donation is not the responsibility of the nurse caring for the patient and provides the separation needed between those caring for the patient before declaration of brain death and those looking for permission for organ harvest. Otherwise, there could be questions of conflict of interest and "did they really do everything they could or did they want the organs".

I have actually, 1-2 million, quick google is very taxing. But, let's not digress.

Bringing in a third party after the family already made their wishes known regarding organ donation and during the grieving process seems predatory and unethical.

[dangerous1]

@ traumaRUs, MSN, APRN, CNS

In California, the same license practice of being an organ donor is done. I was wondering about the people that didn't respond yes or no on their license.

I understand the role of the third party to show no impropriety. But, is it really ethical to persuade someone during the vulnerable state of grieving?

And, thank you for the good read. It was an intelligent and thoughtful reply.

[dangerous1]

Have you taken your concerns to management?

I work peripherally in transplant and the thought process is by having a third party come in to ask about organ donation, it takes the onus off the treatment team.

Ethics and Organ Donation

"The first thing is to decouple roles in the emergency department. "The person who tells the family that their loved one is dead should not be the person who approaches them to discuss organ donation," she explained. The same individual cannot ethically conduct these 2 conversations. "Furthermore, decoupling has been shown to increase the rate of successful organ donation," she added.When it comes to slowing things down, Dr. Marcolini explained that there are 2 schools of thought: utilitarianism, which the greatest amount of good for the greatest number of people; and categorical imperative, which is the duty to act with full disclosure. "In other words, we need to tell families what we know and when we know it.""

In IL, if you have indicated on your drivers license you wish to be a donor, the family can NOT rescind it so there is not ethical decision involved:

"When you register, the organ donor registry will carry out your wish to donate your organs and tissues upon your death. "

The same drivers license donor practice is done in California, as well. But, I was referring to the people that did not have the sticker.

Thank you for posting a very intelligent thought provoking post.

[dirtyhippiegirl, BSN, RN]

Well, you have to harvest fast because the body starts to decompose fairly quickly -- that's why there is pressure to talk to undecided families very quickly after the brain death diagnosis. But surely you know that if you've been an ICU nurse for six years?

I'm not sure what you think is unethical. Nobody is getting rich off of organ donation and organ transplantation is complex, poor outcomes in recipients can skew morbidity/mortality rates for a hospital which can hamper funding and ratings. Some people may be over-eager at the thought of potentially saving lives but that's not unethical in itself.

[dangerous1]

@ dirtyhippiegirl, BSN, RN

Well, you have to harvest fast because the body starts to decompose fairly quickly -- that's why there is pressure to talk to undecided families very quickly after the brain death diagnosis. But surely you know that if you've been an ICU nurse for six years?

I'm not sure what you think is unethical. Nobody is getting rich off of organ donation and organ transplantation is complex, poor outcomes in recipients can skew morbidity/mortality rates for a hospital which can hamper funding and ratings. Some people may be over-eager at the thought of potentially saving lives but that's not unethical in itself.

Bringing in a third party after the family already made their wishes known regarding organ donation and during the grieving process seems predatory and unethical. That's what I find unethical. Please let me know if there's more confusion.

I do know the different time frames when harvesting from someone that is declared brain dead and actively dying, do you? So, please don't passively question my knowledge and digress. You've been a nurse for 4 years, right, I can tell.

[dishes, BSN, RN]

I feel there are HIPAA violations of reporting something to a third party without the family's knowledge and mandating it by the hospital. Note, we do not get permission from the family to divulging information about the decease.

Ask the US dept of Health and Human Services if this is a violation of HIPAA, if it is a violation, ask what can be done to prevent further violations.

[dangerous1]

Thank you, I didn't mean to offend anybody by my post.

And, sadly, I'm receiving unintelligible replies questioning my intelligence. You and the first poster are the two that don't passively insult. I read up on HIPAA policy further, I guess, organ donation organization or an exception, similar to ambulance companies.

But, I am glad you were able to see my point and not insult me.

[Rose_Queen, BSN, MSN, RN]

I have actually, 1-2 million, quick google is very taxing. But, let's not digress.

Bringing in a third party after the family already made their wishes known regarding organ donation and during the grieving process seems predatory and unethical.

That is your opinion. The "third party" has had special training and education to handle the act of speaking with families about organ donation.

I highly doubt your facility has chosen to proceed in this manner on its own. What do laws and regulations state? If you disagree with any laws and regulations, feel free to take that up with your local legislators.

[traumaRUs, MSN, APRN]

My point being to that in order to facilitate organ donation, a third party is needed so that the ER staff doesn't become enmeshed in both the treatment and the organ harvest.

That is why there is a third party - to ensure ethics and legalities are completely covered.