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.
Second , the organ procurement organization ONLY approach family when the decision is made to withdrawal care, declared brain death, DNR status, or if the patient has an extremely poor prognosis. Nobody else is allowed to approach the topic (it is the law) .
I have been an ICU nurse for 16 years and I had never witness what you are referring to as a "sale pitch" or pushy behavior by the organ procurement coordinators. When the family is approached, it is usually done in a private setting (never at the bedside); once a family decline, that is the end of it...I am not sure what you are referring by "several meetings" (The only situation I can think of is when there is disagreement within the family).
Lastly, what do you mean by "3rd party companies" running organ donation?
In So. California, One Legacy, Golden State, Donor Network, and Lifesharing are the onlystaterun organ procurement agencies...there is no such a thing as "3rd party or private companies".
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I want to make it clear, I said 3rd party. Meaning, it's someone outside of the hospital. And, these places are not state run, they are non profit organizations. I researched organ procurement and there's no place does it say it a state run organization. Please let me know when you find a link that says so.
Again, you may not have seen it. But, I have and other's too. You don't have to believe me, I came here because I wanted to know how other's feels about the process and if they experienced what I have. Clearly, a few people have, too. But, I'm glad you haven't.
I wanted to have discussion with a lot of nurses, glad that I did, because allnurses is a perfect place to have a discussion.
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.
When else would you like it done? Time is life. And they'll be grieving for months. So, please explain when you think an appropriate time would be? If we waited until grieving was done, we'd never have any viable organs for donation!
When else would you like it done? Time is life. And they'll be grieving for months. So, please explain when you think an appropriate time would be? If we waited until grieving was done, we'd never have any viable organs for donation!
Did I say it shouldn't be done? no. I asked, is it ethical to persuade someone during they grieving state? those are 2 different questions.
I wish these decision were made in medical offices automatically. It should be part of your annual medical assessment, information should be given when the patient is fully alert. That's when I feel is the appropriate time. It would completely resolve the grey areas of seeming predatory.
The thing about organ donation in my state is talking to the family is actually just a courtesy. In my state, if you have a heart on your license - i.e. if you agreed to be an organ donor - that is informed consent and family cannot legally override it. If you want your organs donated, and you are brain dead, your organs are going to get donated whether your family wants them donated or not. The fact that the OPO representative even asks at all is a courtesy and a very compassionate thing to do, in my opinion.
It is also the law in my state that all deaths and patients about to die meeting certain criteria have to be called in to an OPO.
I'm reminded of a college age patient I had with irrecoverable anoxic brain injury. The patients mother, understandably in shock initially, said she didn't want his organs donated, which based on the arguments given here should have stopped any continuing assessment of donation, which would have been a huge failure on our part to advocate for and protect the patient's wishes, which is our primary ethical responsibility. A friend of the approached us to make sure we were aware he wanted to be a donor, and even supplied us with a paper the patient wrote how important that would be to him to have that chance to help others after having a relative who received a donor heart. Had we just gone with what the mother wanted we would have completely failed our ethical obligations to the patient, which comes first.
I'm reminded of a college age patient I had with irrecoverable anoxic brain injury. The patients mother, understandably in shock initially, said she didn't want his organs donated, which based on the arguments given here should have stopped any continuing assessment of donation, which would have been a huge failure on our part to advocate for and protect the patient's wishes, which is our primary ethical responsibility. A friend of the approached us to make sure we were aware he wanted to be a donor, and even supplied us with a paper the patient wrote how important that would be to him to have that chance to help others after having a relative who received a donor heart. Had we just gone with what the mother wanted we would have completely failed our ethical obligations to the patient, which comes first.
Agreed. The point is how to handle this without such information.
I'm not sure that a pt's loved ones can truly make their decision an informed one without the ability to talk to organizations such as this third party.
I feel like many people would probably just say no based on their own preconceived notions.
I understand how you're looking at it though, it can seem so intrusive and cruel on the surface.
On one hand it's upsetting to think about people being asked about organ donation so soon after losing a loved one, but on the other hand, knowing their loved one helped to save the lives of others could help the healing process.
I have mixed feelings about this process. On the one hand, I am an organ donor, and believe everyone should be. It saves lives. What a wonderful thing to do as you exit this world. BUT, on the other hand, if the patient has made his requests known that he does NOT want to be an organ donor, then I find this practice despicable, and should not be done. If the patient has not made his desire known to friends or family, especially in the case of a child, or a sudden departure like a car accident, then the family has to decide what is right for them. But in no way should they feel pressured. Being a critical care nurse, I wonder how many patients are near death at one time in her unit? I really don't know the size of the unit or if 6 patients in a month are a lot for them or not. If it's only 10% of the patients, then that's one thing, but if 6 organ donors are 80% of the patients who die, then that is another. I would be interested to know if any of the families do feel pressured. If so, that would anger me, because that is a time that they need with their loved one as they begin the grieving process. However, if they are merely presented with the option, and they can make an educated decision, then leave it up to them. I do understand that they are not in the best of state of mind at that time, and emotions can run all over the place, but truly, making a life saving decision for another human being to have their family member's organs will not in any way take away from the family or deceased. God bless them for making a decision to donate, but if not, then I respect that too. I think this needs to be done not as mandatory, but looked at on an individual basis from a religious, emotional, and educated point of view.
Well, I've seen it. I work in California. Let me give you one example, the organization was called and I introduced them. Family was given the information and declined. But, according to the rep, "wasn't an absolute a sure no, I'm going to meet with them later, I don't think they are there yet." They meet, still a no. Rep states, I'm going to get back to them tomorrow, I think they need to sleep on it. Mid afternoon arrives, I can hear the family, 3 to 1, for no. They at it until change of shift, finally, making a decision to donate.
I felt sorry for the family because instead of mourning their love one, they were fighting over organ donation. I saw them crying and arguing with each-other. Is that right? I don't think so.
Okay well lets turn the tables here for a second. It sounds to me like if that family had made decisions earlier about how end of life care would pan out, they would have avoided this entire situation in the first place. Were you in the patients room and heard them say, without any doubt in their minds, "no we do not wish to donate"? Are you sure there wasn't some of them saying yes, and the others no? If a donation person gets even one yes, its worth following up on if they can save the lives of up to 8 other people. Ever stop to think that it isn't the organ teams fault? Maybe the family is to blame? You know how many times I've seen siblings argue for DAYS about when to pull the plug? I know that grieving is important, and that everybody experiences grief differently, but you are refusing to see the facts that everybody is presenting.
You're assuming I never encountered organ donation close to home. I'm sorry for your disposition, but, I can see how it would be difficult for you understand how the other family is being treated for those organs.
Do the ends justify the means? Persistently persuade one family to save a lot more. At what point should the grieving family's wishes be respected?
You forgot to answer that post. Do you think questioning someone's intelligence during an argument isn't childish?
The grieving families wishes ARE being respected. No means no, end of story. Something tells me you're only privy to one side of the situation and have formed a strong opinion, and are now blind to the other side. The companies don't have the time of day to spend persuading families to say yes. Somewhere else, right then and there, someone else is dying who WILL donate. You're being unreasonably one sided in this.
Also your comments are incredibly inflammatory and condescending. You make a post about a personal opinion, asking a question to an online community where there are professionals that have experienced it much more and at a much greater depth than you, and then get offended when they don't share the same view. These people have presented you with FACTS, not just opinions. Also...
I know it's my opinion, that's why I stated "I think" many times throughout my post. But, clearly, you felt the need to one, concentrate on my mention of the CEO's salary and provide me the job description of the "third party."
I can appreciate you ignoring my opinion "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."
I wasn't asking how, I was really looking for an intelligent response like the first poster wrote.
You were the one that brought up the CEO pay in the first place... What are you trying to prove here? Take a couple of deep breaths and walk away from the keyboard before you get like this next time. Either that or get out of critical care, where people are going to die fairly consistently.
When else would you like it done? Time is life. And they'll be grieving for months. So, please explain when you think an appropriate time would be? If we waited until grieving was done, we'd never have any viable organs for donation!
I think that asking a parent who has already said no twice "don't you want a piece of your daughter to live on in others ?" Is just beyond. I have also heard "why are you doing so much for an organ donor?" in the ER. After seeing an organ harvest there is nothing respectful about it. Being gutted into 6 coolers and getting a row of very crooked staples along your chest hardly qualifies. I understand that organs are wanted but preying on people losing a loved one is low. Perhaps that contributes to the high failure rate.
Please, do yourself a favor and look up medical autopsy and body preparation at a mortuary. The body will end up the EXACT same way regardless of donation choice or not. It is critically important to gain knowledge of these sort of things. Also, harvests are carried out in a VERY ethical manner, but lets be realistic. The surgeon needs to work quickly to get the remaining things, such as corneas, skin, bone, ect harvested after the heart. Harvesting these things before cardiac death (aka removal of heart) is unethical.
What I'm failing to see is why individual nurses opinions on organ donation matter. The facts are solid, it saves lives. Does an opinion save lives? I can't say I've ever seen opinions save lives, if that were the case the ICU would have far greater outcomes. You are allowed to disagree, but you also have a duty, as a healthcare professional, to strive towards the general wellness of mankind.
dangerous1
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