Organ/tissue donation question

Editorial Team / Admin · Nov 30, 2009

Why are families asked for consent? Because the living can sue while the dead cannot. Plus, facilities require signed consent. If the patient is brain dead, he or she is unable to sign, so just like any other procedure that falls to the next of kin or POA if there is one.

Techinically, brain death equals death. Were it not for the ventilator and other life support, the heart and lungs would fail quickly once the brain stops functioning. The patient has already been pronounced, and when taken to the OR for organ procurement, the death certificate has already been filled out (at least in my facility).

There are those who believe that brain death does not equal death, possibly for religious reasons or just because they can see that EKG tracing and the chest rise and fall. Others may be in denial that their loved one will not recover.

TheFuture09 · Nov 30, 2009

I see, make sense what you have said, Thank you very much for your response.

Can I ask you a question though?....when i read on asystolee being that u can only take tissue out cause of no perfusion to viseral organs, okay so when a patient passes away, they are pronounced dead, from the time they leave the hospital icu bed/ room bed to the OR there heart is still pumping? and is it pumpinng because of the machine?.....also like what if u said u agreed to donate and ur family also said it but when they get to the OR your heart is not pumping? so that means they wont donate the organ anymore?........does the hospital staff tell the family there heart is still pumping or do they assume that they know they are dead and thats just to get the ORGAN out?

sorrrrrrrry this may sound silly/long but your answer helped just wanted to ask these questions from what u told me if u didnt mind.

anyone else is free to give responses they all help in the end....going through agressive nursing student days...

tiffanyleigh0212 · Nov 30, 2009

These posts have brought up a question for me, completely non nursing related, but I feel very strong about organ donation and think it's a wonderful thing and I have on my license for my organs to be donated. I have told my mom this and that that's what I want done. But what if that time came and she said she did not want my organs donated, would they donate them anyways because I signed for it on my license, or would they go by her wishes? I live in the state of TN and currently the only requirement to be eligible for organ donation is to apply on your drivers license.

Editorial Team / Admin · Nov 30, 2009

There are basically two types of organ donation- those after brain death has occurred but before cardiac death has occurred and donation after cardiac death. In brain death, the brain stem is no longer functioning, and if life support were to be turned off, cardiac death would occur. Those who have been declared brain dead and are donating organs, they are taken to the OR on a ventilator and multiple drips. If all organs are in good condition, they will be transplanted (heart, lungs, kidney, liver, pancreas). However, the lungs and heart must be perfused as long as possible (kidneys can be donated up to I believe 24 hours after cardiac death- feel free to correct if wrong). The surgeon(s) dissect out as much as possible, then clamp the aorta. Cardiac function stops. After the aorta is clamped, anesthesia turns off their machines and leaves the room. Then things happen quickly- the lungs are removed first and taken either by ambulance or helicopter to the hospital the recipient is in. The heart is second, then abdominal organs.

Donation after cardiac death is different. The heart and lungs are not taken. Big ethical issue- if you can restart the heart in another body, why couldn't you restart it in the donor (who is not declared dead prior to transport to the OR)? The patient is taken to the OR on life support, the OR team completely sets up and preps the patient, then steps out. If desired, family members may then come in, and life support is turned off. We then wait for cardiac death to occur. The patient is pronounced by a physician, the family is escorted out, and 5 minutes later, incision is made.

Time of death is different for both types. Let's say Jane Doe is pronounced brain dead at 10:00 AM. At this point she is legally considered deceased even though cardiac function continues. If she were not on life support, she would not be able to breathe, no oxygen would get to her organs, and cardiac muscle would begin to die and the heart stop beating. John Doe is our donor after cardiac death. He arrives in the OR at 8:00 AM. He is still legally considered alive. Life support is withdrawn at 8:05. Cardiac function stops at 8:30. He is legally considered deceased at 8:30.

As to whether or not organ donation will occur if you list it on your driver's license, again, consent from the family is required. They may override your wishes and choose not to donate. The best way to ensure that your wishes are followed is to discuss it with your family, and have a durable power of attorney that you believe will follow your wishes should you become incapacitated or declared brain dead.

Lisa Dinhofer · Nov 30, 2009

As someone who has been working directly in organ and tissue donation for over 12 years and also serves as an expert witness/consultant on lawsuits pertaining to informed consent, I'd like to clarify a few things mentioned in both the original question and the responses. Anyone who has designated themselves to be a donor of any kind during their lifetime through a state registry, a motor vehicle registry, a living will, a donor card, advanced directives, even a handwritten letter, by law, can not have their decision overturned by family, a healthcare surrogate or a Healthcare Power of Attorney. The donor themselves must reverse their decision before death and do so in writing or in front of 2 witnesses, one of which in some states needs to be a 'disinterested witness.' Under the law, specifically the Uniform Anatomical Gift Act that every state adopted back in 1968 when first drafted and was most recently revised in 2006, a patient's autonomy supersedes death and can not be revoked. Many organ and tissue recovery agencies are now moving forward with recovery in spite of family opposition because the law requires it and was supposed to be doing this going back to the first UAGA 1968. A hospital and or OPO/tissue bank can be sued for NOT doing a registered donor. Families unwilling to support their loved one's decision can threaten to sue but they will lose as both hospital and recovery org are protected under the 'Good Faith' clause and the clause stipulating the supremacy a donor's designation both within the UAGA. To date, no family has prevailed under this type of suit.

Brain death is death, period. It is defined as death by neurological criteria that was concretized in 1968 by the Harvard Committee on Brain Death. Organ donation can occur with both brain death and donation after cardiac death where the ventilator is removed within the OR after a diagnosis of an irreversible brain injury has been made and the family has consented to termination of ventilation support. Different hospitals and OPO's have different criteria for how long a time must pass before waiting for asystole to occur. Tissue donation occurs subsequent to cardiac death (and brain death or DCD but after asystole) and retrieval must occur within 24 hours of asystole. Criteria for acceptance is more stringent for Tissue donation than organ donation yet your chances of being a tissue donor are far greater than for organ donation.

Daytonite, BSN, RN · Nov 30, 2009

In most states the law is that when a person dies their body becomes the property of the legal next of kin who has the legal authority over what is done with the body. This legal authority passes from generation to generation. The people who work in the funeral and cemetery businesses are most familiar with it because it involves interment and the moving of bodies that are buried.

Lisa Dinhofer · Nov 30, 2009

State law concerning disposition of remains and cremation that Funeral Directors are required to follow does not apply to anatomical donation. The UAGA, which each state has, is the stipulating set of regulations for organ, eye, tissue and whole body donation be it for transplantation and/or research and education. The hierarchy under the UAGA for who is considered NOK, in what order and under what circumstances is clear, involiable and does not match what Funeral Directors typically follow.

Editorial Team / Admin · Nov 30, 2009

As someone who has been working directly in organ and tissue donation for over 12 years and also serves as an expert witness/consultant on lawsuits pertaining to informed consent, I'd like to clarify a few things mentioned in both the original question and the responses. Anyone who has designated themselves to be a donor of any kind during their lifetime through a state registry, a motor vehicle registry, a living will, a donor card, advanced directives, even a handwritten letter, by law, can not have their decision overturned by family, a healthcare surrogate or a Healthcare Power of Attorney. The donor themselves must reverse their decision before death and do so in writing or in front of 2 witnesses, one of which in some states needs to be a 'disinterested witness.' Under the law, specifically the Uniform Anatomical Gift Act that every state adopted back in 1968 when first drafted and was most recently revised in 2006, a patient's autonomy supersedes death and can not be revoked. Many organ and tissue recovery agencies are now moving forward with recovery in spite of family opposition because the law requires it and was supposed to be doing this going back to the first UAGA 1968. A hospital and or OPO/tissue bank can be sued for NOT doing a registered donor. Families unwilling to support their loved one's decision can threaten to sue but they will lose as both hospital and recovery org are protected under the 'Good Faith' clause and the clause stipulating the supremacy a donor's designation both within the UAGA. To date, no family has prevailed under this type of suit.
Brain death is death, period. It is defined as death by neurological criteria that was concretized in 1968 by the Harvard Committee on Brain Death. Organ donation can occur with both brain death and donation after cardiac death where the ventilator is removed within the OR after a diagnosis of an irreversible brain injury has been made and the family has consented to termination of ventilation support. Different hospitals and OPO's have different criteria for how long a time must pass before waiting for asystole to occur. Tissue donation occurs subsequent to cardiac death (and brain death or DCD but after asystole) and retrieval must occur within 24 hours of asystole. Criteria for acceptance is more stringent for Tissue donation than organ donation yet your chances of being a tissue donor are far greater than for organ donation.

Really? Because if the family refuses, who's signing the consent? It certainly isn't the patient, and we do not proceed without a signature. We even require consent for each individual organ/corneas/tissue/bone/skin. The consent was created and is provided by the agency responsible for organ procurement.

Lisa Dinhofer · Nov 30, 2009

Consent by NOK is required if the patient did not designate themselves to be a donor during their lifetime. If they did register their wishes, either to be or not be a donor, than legally NOK do not have the legal authority to over ride that decision. They may expand on it to include other organs/tissues etc. that the patient did not specifically stipulate IF the patient did not register any exclusions with their registration. This is clearly outlined within the UAGA under the revocation, revision and amendment section. The UAGA is also clear that the donation of one part or exclusion of one part does not equal the exclusion of another part thereby allowing recovery agencies to query families about expansion if that is a clinical possibility and the donor did not list exclusions. Some states allow individuals to list exclusions and some do not. In the case of a registered donor, OPO's, Eye Banks and Tissue banks should be using a 'Disclosure' document not a consent/authorization form, unless the NOK is consenting to something in addition to what the donor stipulated. An example would be research. Many states don't allow individuals to pre-register to donate for research if transplantation is not a possibility at the time of death. In that instance a consent for research, not what was pre-registered by the donor, is necessary.