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.

[NurseGirl525, ASN, RN]

I do not EVER talk to a family about donating organs unless they ask me about it. That is the job of the donor network, studies have shown that if a third party comes in and discusses this, rather than a caregiver, they are more likely to say yes.

It's not a sale's pitch...people need these organs!!

In my state, we are not allowed to mention it. At all. We do not talk about it even if they bring it up. They are promptly referred to our state's organ team.

[dangerous1]

These people have to be told the truth, hard as it is, and as many times as it takes for them to get it. Too much depends on their "yes" or "no".

Unfortunately, the families, are too shock about the death to even protest. There's no limit. How many times should it be?

First, the examples you provided earlier are life long changes, i.e. smoking and eating healthy. These people are actively making these choices daily. Not a quick. Grieving process is very distinct and a vulnerable time.

You said so yourself, "Donation" of organ/tissues is much more involving and multi-faceted process than most of health care professionals know of." Why is that? Because the families are grieving and they are being asked something to help other's.

Let's talk about being told the truth, families are not explained the whole truth of how the organs are harvested in details and process, it's rather gruesome. I witnessed it. I can see how people or non medical people were told the truth it'd be a deterrent.

[emmy27]

In my state, we are not allowed to mention it. At all. We do not talk about it even if they bring it up. They are promptly referred to our state's organ team.

I've worked in multiple states and this has always been the policy- for hospital staff not to discuss donation with the family at all, under any circumstances- if they initiate the conversation, we still can't, they're referred to the organ donation organization.

I don't think it's accurate to assume that families changing their minds after talking to someone trained in donation issues must necessarily have been coerced. In those cases I've seen where the family changed their minds, it was because they initially had misconceptions about donation (that it would change the care their loved one would receive, that it would prevent an open-casket funeral, etc) and decided in favor once those concerns were allayed, and having considered the positive aspects (so many people are looking for some glimmer of positivity in a terrible situation).

It's not wrong to consider the ethics of these things but I don't know how this could be done in a way that entirely allays the concern of coercion or potentially upsetting a family by raising the issue at all, other than simply never addressing the issue with anyone who didn't positively affirm their wish to donate in life. And that itself has major ethical issues- it denies the family the opportunity to make the donation (something many people value in retrospect) unless they happen to think of and raise the issue on their own under extreme stress within the narrow window (unlikely), and it would almost certainly massively reduce the number of donations (already inadequate to the demand) leaving many more people to die and suffer needlessly.

Those seem like harsh costs for the possible benefit of avoiding a possibly uncomfortable conversation, even for the grieving.

[NotYourMamasRN]

I know it seems in some ways like a horrible and pushy thing. I think of the joy that people experiencing a tragedy could bring to another family by saving a life or even to themselves by being a part of making the decision that could save someone's life. It is truly a gift, when someone donates their loved ones organs. I try to think of all the good the donations do for kids and all others who might have a second chance at life thanks to the kindness of others. If I was on an organ donor list, I would hope that someone would be so kind as to donate to me so that I could have a chance to see my daughter get married, have babies, grow old. I know someone had to die for that to happen, but I would be eternally grateful for the gift from one human to another. And if it were my daughter on the list, I would be forever indebted to the kindness of others. I could not imagine the joy a parent feels when some gives their child the gift of life.

[dangerous1]

I have not read this whole thread, but I honestly don't think you understand the process of organ donation.

My unit calls our organ network when any patient reaches a certain test threshold. They may fully recover from their injury. Regardless, the donor people follow.

Its not unethical. You as the nurse cannot approach the family about donation. That is up to the donor people. They are not giving a sales pitch. If the person dies a cardiac death, they have 60 minutes to get those organs. That's it. 60 minutes from time of death, until procurement. That's not very long. With a brain death, that can take days until they get that patient in correct homeostasis to get those organs.

OP, I just think you are misinformed. It's not a pitch. It's saving lives. If the family says no, it's no, unless the drivers license says differently. Those people are trained in how to approach families, which is why we as nurses, do not.

If all organs are a go, at the very least, 8 lives are saved. 8. That's a pretty awesome number. I 100% understand when a family says no to it. That's their decision. But watching what happens when they say yes? It's nothing less than incredible. Maybe you should witness the good side of it sometime. That experience will stick with me forever.

The very last thing it is, is a sales pitch.

I'm talking about when the family says no, these meetings are held. I'm only speaking of those family's that have already said no and the organization cannot take no for an answer.

I'm not misinformed. That remark is equivalent to me saying your misinformed. Does contribute anything, it's like a child's remark.

I live in a state where it's companies not state that run organ donations.

[emmy27]

Unfortunately, the families, are too shock about the death to even protest. There's no limit. How many times should it be?

First, the examples you provided earlier are life long changes, i.e. smoking and eating healthy. These people are actively making these choices daily. Not a quick. Grieving process is very distinct and a vulnerable time.

You said so yourself, "Donation" of organ/tissues is much more involving and multi-faceted process than most of health care professionals know of." Why is that? Because the families are grieving and they are being asked something to help other's.

Let's talk about being told the truth, families are not explained the whole truth of how the organs are harvested in details and process, it's rather gruesome. I witnessed it. I can see how people or non medical people were told the truth it'd be a deterrent.

What are these lengthy, multiple request situations you're describing? I have never seen the organ donation representative approach a family a second time after a refusal- in fact in our training on donation protocol they emphasize that part of the reason only they are to speak to the family, aside from decoupling the treatment team from the donation process and protect us, is that they have to strike the delicate balance between attempting to maximize donations (and save lives) while minimizing any potential harm to the family- both for their own sake, and to protect the reputation of organ donation as a process. The slight possibility of changing a single grieving family's rejection to a yes is not worth the risk to the organization or to the entire field of organ donation if an angry family were to take up a crusade against them after a negative experience, and they are acutely aware of that.

In all the training and real-life experience I've had with this, they've stuck firmly to this principle. I've never seen them badger a family who gave them a no, and really- how many times *could* they "meet" in the limited window for discussion?

[CelticGoddess, BSN, RN]

I too live in a state that uses a company for organ procurement. I have not witnessed what you are claiming. I work in palliative so daily deal with the company. Let me repeat that, daily. I have had nights where I have had to call in 3 or 4 times. I have NEVER witnessed the supposed harassment that you claim is occurring. One phone call and that is it.

And might I suggest you stop referring to our arguments as unintelligent or childish.

[dangerous1]

What are these lengthy, multiple request situations you're describing? I have never seen the organ donation representative approach a family a second time after a refusal- in fact in our training on donation protocol they emphasize that part of the reason only they are to speak to the family, aside from decoupling the treatment team from the donation process and protect us, is that they have to strike the delicate balance between attempting to maximize donations (and save lives) while minimizing any potential harm to the family- both for their own sake, and to protect the reputation of organ donation as a process. The slight possibility of changing a single grieving family's rejection to a yes is not worth the risk to the organization or to the entire field of organ donation if an angry family were to take up a crusade against them after a negative experience, and they are acutely aware of that.

In all the training and real-life experience I've had with this, they've stuck firmly to this principle. I've never seen them badger a family who gave them a no, and really- how many times *could* they "meet" in the limited window for discussion?

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.

[dangerous1]

@CelticGoddess, BSN, RN

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?

[OCNRN63, RN]

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.

@dangerous1: I understand how you feel. We had a similar policy when I worked in the ED, and it didn't sit well with me either. I remember watching a video where they showed the representative from the organ donation center approaching a grieving family shortly after they'd gotten the news about their loved one being brain dead. It was supposed to be a positive representation, but it really put me off.

I don't think you're unintelligent for questioning these procedures. Better to question than to blindly follow.

[Ruas61, BSN, RN]

It sounds outright ghoulish to have a thank you party for organ harvesting.

[OCNRN63, RN]

What are these lengthy, multiple request situations you're describing? I have never seen the organ donation representative approach a family a second time after a refusal- in fact in our training on donation protocol they emphasize that part of the reason only they are to speak to the family, aside from decoupling the treatment team from the donation process and protect us, is that they have to strike the delicate balance between attempting to maximize donations (and save lives) while minimizing any potential harm to the family- both for their own sake, and to protect the reputation of organ donation as a process. The slight possibility of changing a single grieving family's rejection to a yes is not worth the risk to the organization or to the entire field of organ donation if an angry family were to take up a crusade against them after a negative experience, and they are acutely aware of that.

In all the training and real-life experience I've had with this, they've stuck firmly to this principle. I've never seen them badger a family who gave them a no, and really- how many times *could* they "meet" in the limited window for discussion?

I've never seen them badger a family, but I was harassed a few times by the reps. of our organ procurement agency. "They said no? Are you sure they understood what organ donation meant? Are you sure they really meant no?" Geez Freaking Louise...I am not a mind reader, and I was taught that in that circumstance if the family said "No," then that was the end of the conversation.

I'm sure this is not how all organ donation agency staff behave, but it sure made me hate to have to call ours.