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.
There is an ethical balance when it comes to organ donation, respecting the grieving on one hand and taking the opportunity to attempt a once in a lifetime organ harvest that can literally save lives.
On one hand we have feelings, on the other hand we have a potential to save lives. Lets be clear as to what the stakes are...feelings v. life.
As terrible as it is I personally think we should err on the side of trying to save lives until we figure out a better system such as an opt out donation system instead of an opt in donation system.
On a side note, many people confuse what a non-profit is. A non-profit does not mean that they do not or should not obtain surplus revenue. There was just an article about how some of the most profitable hospitals are non-profits. What a non-profit means is that they reinvest their surplus income into the company or cause instead of distributing it to stakeholders or shareholders. Rules vary but non-profit does not mean poor, money losing, well-intentioned company.
First how do you start pressuring the family to make a decision about the donation when they are mourning!!!
Tough to do but that grieving family is not the only grieving family and we have a responsibility to be advocates to everyone. Sometimes you have to inflict some pain to treat an injury.
QUOTE=Orphan RN;9155275]I feel ya on this one. It seems wrong on so many levels my skin crawls. This seems like a big job for one nurse - what are your coworkers thoughts?
The patient becomes 1:1 and we help the org. per. People, sometimes assisting with line insertion.
I guess I shouldn't be surprised given the practices of the pharma companies, but I (maybe naively) thought that organ donation was sacred and not something to be celebrated with a few pizzas and some cupcakes. I'm just starting nursing school, but I don't know how I would react to a similar situation. Can anyone else tell me if this is common?
It's only happened once, since I've been an ICU nurse and it happened during that month, when we donated a lot. It didn't settle well with me. I was surprise when I saw the flier. I apologize if I used the incorrect term when I said unit parties, it's basically like a luncheon in the break room, similar to potluck parties at work. In this case, Org. Proc. brought catered food is brought to the unit.
I am guessing you would feel drastically different if you or a family member needed a new organ to survive.
I want to clarify again, I'm pro organ donation. This forum isn't about being against or pro organ donation. It's certain practices of org. procurement reps. The statement I just quoted you stating is equivalent to me saying, how would you feel as a family member, having said no already, to persist be ask while you just found out your love one died.
First how do you start pressuring the family to make a decision about the donation when they are mourning!!!
Even if there is no "pressure," the conversation has to take place while the family is mourning. There is no choice if organs are going to be donated. Certainly, compassion for the family's suffering is a must. But there is NOT going to be a "good time" to have this conversation.
QUOTE=Orphan RN;9155275]I feel ya on this one. It seems wrong on so many levels my skin crawls. This seems like a big job for one nurse - what are your coworkers thoughts?
The patient becomes 1:1 and we help the org. per. People, sometimes assisting with line insertion.
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Sorry, my question was vague - I see this situation is making you feel discomforted enough to look into the organ harvesting company's online dossiers, and other data they made public. It seems that their practices are not quite … kosher, and perhaps questionable in ethical practice in regard to the pt's used as a commodity, the families receiving pressure at a time they perhaps shouldn't, and it is making you think more and more about all that is happening (at least the organ harvesting company's actions seem that way to me).
I guess if one nurse is feeling uncomfortable, my question is how are your coworkers faring in the same situation? What are the thoughts of your coworkers about this? Making ethical change in this situation seems like an awfully big job for just one person alone, although not impossible. I just wondered if others where you work could help with that?
I too believe in organ donation, but not at the cost of grieving families being pressured at a particularly vulnerable time, or staff nurses feeling uncomfortable and forced to comply. It seems the head of this company is making an awfully large annual salary too, but maybe that is typical? I don't honestly know.
I am an organ donor when my time on this earth is over, but this decision is mine, and not my family's choice to make under pressure at a time when they will not be at their best decision making.
I am truly sorry you are being put into a position at work that makes you feel uncomfortable. I honestly don't know how I would react to the same circumstances, but I've always been one to kick over an anthill first, and then wonder what I just did later - covered in stings.
There are definitely issues surrounding organ donation but until those issues are resolved we have to err on the side of saving lives. Perfect is the enemy of good.
If a family is asked a third time and they agree, was it wrong to ask again?
I guess there's at least a couple of ways to look at that. Were they unethically badgered into submission while in a vulnerable state? Or did they receive the right information (perhaps again) at precisely the right moment for them to fully process and decide? Maybe hitting that "sweet spot" requires a few unsuccessful landing attempts first. Is it worth pursuing just a touch further if it could result in consent? I'm inclined to believe the waiting lists are filled with people who pray for these advocates to ask that one last time. I'd say the value of it all is worth at least a bit of persistence, albeit debatable as to extent.
I wonder if there's research out there that speaks to the handling of these conversations as it relates to the donor party retaining a positive feeling about the decision. (Yes, I'm sure Google could help me with that, but I'm just throwing it out there.)
As for the actual procedures involved in harvesting, yes, I think it may be fair for some to describe as gruesome. Then again, it could also be looked at as beautiful. Perhaps the tools and techniques will someday (even today) seem primitive, but I think the generosity, mercy, and grace behind it all should help to temper emotions surrounding the corporeal realities. The spirit and love is being passed on -- it's just darn hard to get to it!
As for the actual procedures involved in harvesting, yes, I think it may be fair for some to describe as gruesome. Then again, it could also be looked at as beautiful. Perhaps the tools and techniques will someday (even today) seem primitive, but I think the generosity, mercy, and grace behind it all should help to temper emotions surrounding the corporeal realities. The spirit and love is being passed on -- it's just darn hard to get to it!
I'm a little surprised by this. I do auditing of the charts for our hospital regarding tissue/organ donations.
Here it is done in the OR. A moment of silence is taken before anything is done to honour the pt. The body is treated with dignity.
Is it not possible to grieve after a donation has been completed? I don't understand this "it's predatory to talk to people when they are grieving" argument. You can grieve your loved one at any time. Donating organs doesn't change that process.
Asystole RN
2,352 Posts
Interesting topic.
There is an ethical balance when it comes to organ donation, respecting the grieving on one hand and taking the opportunity to attempt a once in a lifetime organ harvest that can literally save lives.
On one hand we have feelings, on the other hand we have a potential to save lives. Lets be clear as to what the stakes are...feelings v. life.
As terrible as it is I personally think we should err on the side of trying to save lives until we figure out a better system such as an opt out donation system instead of an opt in donation system.
On a side note, many people confuse what a non-profit is. A non-profit does not mean that they do not or should not obtain surplus revenue. There was just an article about how some of the most profitable hospitals are non-profits. What a non-profit means is that they reinvest their surplus income into the company or cause instead of distributing it to stakeholders or shareholders. Rules vary but non-profit does not mean poor, money losing, well-intentioned company.