Index
A
ABTC. See American Board for Transplant Certification
Acceptable appeals, for organ donation, 3, 79, 84–85
Access.
See also Preferential access to donated organs
to immunosuppressive medications following transplantation, 95
Accreditation, 99
American Board for Transplant Certification, 99
Association of Organ Procurement Organizations, 99
Centers for Medicare & Medicaid Services, 99
Joint Commission on Accreditation of Healthcare Organizations, 99
Organ Procurement and Transplantation Network, 99
ACOT. See Advisory Committee on Transplantation
Actions needed to increase rates of DCDD, 14, 156–160, 282
clarification of regulatory and statutory requirements, 158
developing regional infrastructures, 159
ensuring the opportunity for donation, 158
mentoring and evaluation, 158
proposed by the National Conference on Donation after Cardiac Death, 136–137
providing excellent emergency and resuscitative care, 157
providing professional education, 157–158
providing public education, 157
Actual donors, 25
Ad Council, 188
Adjusted patient survival rate, 59
Advanced cardiac life-support efforts, criteria for termination of, 132
Adverse biopsy results, 47, 50
Adverse selection problem, 256–257
Advisory Committee on Transplantation (ACOT), 136, 264, 272
Advocates
for donors, independent, 13, 275, 307
African Americans, 54, 64–65, 67, 195–196, 198, 301
Agency relationships, 237, 246
AHA. See American Heart Association
Allocating and distributing organs, 95
access to immunosuppressive medications following transplantation, 95
equitable access to transplantation, 95
Allosensitization, 59
Altruism, cultural norms and models of willingness to donate, 70–71
AMA. See American Medical Association
American Board for Transplant Certification (ABTC), 99
American Heart Association (AHA), 153–154, 156
American Medical Association (AMA), 197, 214, 225, 250, 257
American Nurses Association, 197
American Society of Transplant Physicians (ASTP), 133
American Society of Transplant Surgeons (ASTS), 33, 188, 249, 252
American Society of Transplantation (AST), 33, 188
AOPO. See Association of Organ Procurement Organizations
Appeals. See Acceptable appeals
Arguments for and against preferred-access approaches, 254–258
the adverse selection problem, 256–257
the information problem, 256
the unfair allocation problem, 257–258
Arkansas, 194
Asian-Pacific Islanders, 195
Assessment of DCDD strategies in the United States, 141–143
DCDD cases reported by OPOs, 143
deceased donors, 142
organs recovered from DCDD donors in the U.S., 143
Assessment of presumed-consent policies, 212–224
autonomy-based arguments, 218–219
chances of a presumed-consent policy being adopted in the U.S., 222–224
cost-effectiveness, 216
effectiveness in increasing the number of transplantable organs, 212–216
individual generosity, societal generosity, and mutual self-interest, 221–222
possible benefits of and barriers to presumed-consent policies, 223
reducing the burden of familial decision making, 216–218
Association of Organ Procurement Organizations (AOPO), 5, 21, 33, 97, 99, 119, 136
AST. See American Society of Transplantation
ASTP. See American Society of Transplant Physicians
ASTS. See American Society of Transplant Surgeons
Austria, 27
Autonomy-based arguments, 218–219
B
Barriers, to a futures market, 234–235
Behavioral interventions, 300–301
Brain function, controversy over, 146
Breakthrough collaborative model, 103.
See also Organ Donation Breakthrough Collaboratives;
Organ Transplantation Breakthrough Collaborative;
Transplantation breakthrough collaboratives
British Medical Association, 222n
Buying and selling of organs, 239–242
advantages of the gift model, 240–241
claims of a liberty right to sell organs, 241–242
C
California Transplant Donor Network, 109
Candidates on the transplant waiting list, growth in numbers of, 2, 16
Cardiac arrests, 138, 286–287, 308
Cardiac life-support efforts, criteria for termination of advanced, 132
CDC. See Centers for Disease Control and Prevention
CDD. See Circulatory determination of death
Centers for Disease Control and Prevention (CDC), 8, 198–199
Centers for Medicare & Medicaid Services (CMS), 32, 97, 99, 101, 119
Christianity, and deceased organ donation, 66, 193
Circulatory determination of death (CDD), 31, 83, 128.
See also Donation after circulatory determination of death
Clarification
of criteria for determination of death, 18–19
of regulatory and statutory requirements, 158
relevant legislation, 19
of terminology, 4
Clinical Interventions grants program, 300–301
CMS. See Centers for Medicare & Medicaid Services
Coalition on Donation, 33, 188–189, 193
Cold preservation techniques, 153
Collaborators and consultants.
See also Organ Donation Breakthrough Collaboratives
at the Washington Hospital Center, 314
Commodification, 233–234, 248–249, 255
Community coalitions, 8–9, 199–200
Community education, at the Washington Hospital Center, 154, 313–314
Community grassroots efforts, and minority populations, 195–198
Community Oversight Committee, 137, 308
Community recognition, 229, 253
Competence trustworthiness, 111–112
Confidentiality, of donor registrations, 183
Conflicts of interest, 148–149
Confucianism, and deceased organ donation, 67
Consensus Conference on the Asystolic Trauma Donor, 305
Consensus Conference on Trauma Victims and Organ Donation, 308, 314
Consent.
See also First-person consent status;
Informed consent;
Presumed consent;
Voluntary consent
at the Washington Hospital Center, 309–310
Controlled DCDD in the U.S., 128
conflicts of interest, 148–149
controversy over brain function, 146
controversy over irreversibility, 145–146
controversy over premortem interventions, 146–147
end-of-life care, 147
family interests and consent, 149–150
myths and misperceptions about, 151
withdrawal of treatment, 147–148
Controlled death, defining, 129–131
Conversion rates, among member hospitals, 105
Cost-effectiveness issues, 35, 90, 165, 216
Council on Ethical and Judicial Affairs, 214–215, 225
CPR (cardiopulmonary resuscitation), 152, 154–156
D
DCD. See National Conference on Donation after Cardiac Death
DCDD. See Donation after circulatory determination of death
Dead bodies, commodification of, 233–234, 248–249
Dead donor rule, 112
Death, defining controlled, 129–131
Deceased organ donation, 22–25
process of organ donation, 24
Deceased organ donors, 51, 142
eligible, actual, and additional, 25
increase in number of, 105
numbers of, 28
Decedents’ wishes, respect for, 87
“Decision: Donation” packet, 194
Decision making
surrogate, 116
Decisions to donate. See Facilitation of individual and family decisions to donate
Demand side of an organ market, 236–239
in family decision making, 63
in individual decision making, 62–63
Determination of death, 128–131
defining controlled and uncontrolled death, 129–131
Maastricht categories, 129
DHHS. See U.S. Department of Health and Human Services
Dispositional authority, 211
Distribution of organs. See Allocating and distributing organs
Division of Transplantation (DoT), 20, 31–32, 189, 304
DNDD. See Donation after neurologic determination of death
Documention of decisions to donate, 183–187
additional opportunities to document donation decisions, 187
driver’s license registration, 184
Donate Life Organization, 188–189
Donation after circulatory determination of death (DCDD), 6–7, 31, 100, 127–161, 165–168, 281–282
cases reported by OPOs, 143
Donation after neurologic determination of death (DNDD), 31, 128, 141–142
Donation rates, 27, 100, 249–252.
See also Expansion of the population of potential donors
comparing, 27
increasing, 288
Donation service areas (DSAs), 97
Donor advocates, independent, 275, 307
communicating decisions to family, 182
confidentiality of donor registrations, 183
honoring donor consent, 182–183
informed choice, 182
confidentiality of, 183
Donor Sabbath, 187
Donor service areas, 21
Donors.
See also Actual donors;
Additional donors;
Deceased organ donors;
Eligible donors;
Living donors;
Organ donors;
Potential donors
altruism, cultural norms, and models of willingness to donate, 70–71
family discussions regarding organ donation, 68–69
financial costs to, 270
individual and family decisions, 62–71
quality of health care and trust in the healthcare system, 69–70
Donor’s loss, 232
DoT. See Division of Transplantation
Driver’s license registration, 184, 194
DSAs. See Donation service areas
Durable powers of attorney, 116
E
Economic considerations, 159–160, 286
Economic value of increasing the organ supply, 33–35
Education. See Public education;
Training
Effectiveness
of the healthcare system, 94
in increasing the number of transplantable organs, 212–216
Efficiency, of the healthcare system, 94
Eligible donors, 25
Emergency medical services (EMS), 154–155, 159–160
End-of-life care, 23, 87, 115–117, 147
communication and decision making in, 117–119
End-of-life communication, training in, 117–119
End-stage renal disease (ESRD), 53, 98
End-Stage Renal Disease program, 220n, 246
Equipment. See Facilities and equipment
Equitability
of access to transplantation, 95
of the healthcare system, 94
ESRD. See End-stage renal disease
Ethical considerations, 28–29, 143–154
for expanded-criteria organ donation, 165
Ethical considerations in living donation, 12–13, 263–279
living donor follow-up, 276
other ethical considerations, 270–274
recommendation concerning facilitating living donor follow-up, 13, 277
recommendation concerning protecting living donors, 13, 276–277
relationships between living donors and recipients, 265–266
Ethical issues pertinent to controlled DCDD
myths and misperceptions about, 151
Ethical issues pertinent to uncontrolled DCDD, 150–154
myths and misperceptions about, 152
See also individual racial and ethnic groups
donors, transplants, and waiting list by, 50
family decision making, 65
individual decision making, 64–65
European Resuscitation Council, 153
Eurotransplant International Foundation, 27
Evaluation, 158
of HRSA’s extramural research grants, 303–304
of proposed changes, criteria for, 90–91
Evolution of the request process, 106–110
formulation of the request, 107
Excellence, in emergency and resuscitative care, 157
Expanded criteria for organ donation, 160–167
ethical considerations for expanded-criteria organ donation, 165
next steps for expanded criteria, 166–167
organ quality, 166
organ screening, 167
targeted research needs, 166–167
UNOS definition of expanded-criteria kidney donors, 162
Expansion of the population of potential donors, 6–7, 39, 127–173
actions needed to increase rates of DCDD, 157–159
assessment of DCDD strategies in the United States, 141–143
background and issues, 128–140
common criteria for termination of advanced cardiac life-support efforts, 132
demonstration projects, 160
determination of death, 128–131
economic considerations, 159–160
encouraging and funding DCDD demonstration projects, 7, 168
expanded criteria for organ donation, 160–167
general considerations, 131–133
general ethical considerations, 143–154
implementing initiatives to increase rates of donation after circulatory determination of death, 6–7, 168
increasing research on organ quality and enhanced organ viability, 7, 168
learning from past experience and international models, 136–140
prior reports and recommendations, 133–136
recommendation concerning maintaining opportunities for organ donation, 6–7, 167–168
reexamination of uncontrolled DCDD, 154–156
Expected donations, 107, 111, 216
Explicit consent, 28
Extramural research program, 299–304
clinical interventions, 301
media-based interventions, 301
overview of HRSA’s extramural research program, 299–303
social and behavioral interventions, 300–301
F
Facilitation of individual and family decisions to donate, 7–9, 39, 175–203
additional opportunities to document donation decisions, 187
donor registries, 9, 185–187, 200
driver’s license registration, 184
framework for informed choice, 176–177
opportunities for people to record their decision to donate, 9, 181–187, 200
public understanding of and support for organ donation, 8–9, 199
Fairness, 3, 79, 89–90, 219–221
Faith-based organizations, 8, 199
False-negative and -positive responses, 218–219
Familial decision making, 63, 65
discussions regarding organ donation, 68–69
family interests and consent, 149–150
reducing the burden of, 216–218
Financial costs, to donors, 270
Financial incentives within a donation framework, 149, 247–252
the commodification issue, 248–249
impact on donation rates, 249–252
payments to families for funeral expenses, 249–250
Finland, 27
First-person consent status, and organ donor registry participation, 289–292
First steps, 113–119, 274–276.
See also Actions needed to increase rates of DCDD
enhancing training in end-of-life communication and decision making, 117–119
for expanded criteria, 166–167
facilitating and documenting decisions to donate, 183–187
integrating organ donation and end-of-life care, 114–117
regarding mandated choice, 180–181
sustaining continuous quality improvement, 113–114
Florida, 206
Formulation of requests, 107
Framework
France, 26
Free market in organs
demand side of an organ market, 236–239
supply side of an organ market, 232–236
G
Gender disparities, 273
Gift model, 12
Gift of Life initiatives, 32, 69
Grassroots efforts, and minority populations, 195–198
Greenwall Foundation, The, 3, 17
Growth
in numbers of transplants and in numbers of candidates on the transplant waiting list, 2, 16
of the transplantation field, 20–22
H
Haddon matrix, 36
Health Care Financing Administration (HCFA), 101
Health Resources and Services Administration (HRSA), 3–9, 13, 17, 102–103, 120, 141, 176, 189, 198–200, 236, 264, 299–304
evaluating HRSA’s extramural research grants, 303–304
extramural research program, 299–304
Healthcare professionals.
See also Professional societies
enhancing training for, 6, 120
adjusted patient survival rate, 59
Hemodialysis, 53
Hinduism, and deceased organ donation, 67
History
of the current U.S. system, 18, 230, 293
deceased organ donation, 22–25
growth and organization of the transplantation field, 20–22
illicit markets for bodies in, 233
HLA. See Human leukocyte antigen matching
Hollywood, Health & Society, 189
Honoring donor consent, 182–183
Hospital Clinico San Carlos (Madrid), 138–140
Hospitals, 104, 109, 160, 198–199, 304.
See also Donor hospitals
HRSA. See Health Resources and Services Administration
Human dignity, respect for, 86
Human leukocyte antigen (HLA) matching, 54–55, 59
Human remains, respect for, 88
I
Iceland, 27
ICUs. See Intensive care units
IHI. See Institute for Healthcare Improvement
Illicit markets for bodies, 233
Immunosuppressive therapies, 51
Improvement aims for the healthcare system, 93–94
effectiveness, 94
efficiency, 94
equitability, 94
patient centeredness, 94
safety, 93
timeliness, 94
Incentives for deceased donation, 10–12, 39, 229–262, 285
financial incentives within a donation framework, 247–252, 286
nonfinancial incentives, 253–258
payments as a token of gratitude, 252–253
preferential access to donated organs, 253–258
recommendation concerning financial incentives, 12, 259
recommendation concerning preferential access, 12, 259
regulated commerce in organs, 239–247
why a free market in organs is problematic, 231–239
Independent donor advocates, 13, 275, 307
Individual decision making, 62–65, 286
Individual generosity, 221–222
Information problem, 256
Informed choice, 182
Informed consent, 153–154, 270–272
robust, 271
Innovative system changes, increasing research on, 5, 120
Institute for Healthcare Improvement (IHI), 103
Institute of Medicine (IOM), 3, 17, 93–95, 115, 127, 143, 289
Integrated approaches, 115
Integration of organ donation and end-of-life care, 114–117
emphasis on patient and family relationships, 116–117
use of interdisciplinary healthcare teams, 117
Intensive care units (ICUs), 100
donor protocol (controlled donors) in, 307–308
Interdisciplinary healthcare teams, 112, 117
Interdisciplinary training, 118
Intermountain Donor Services, 69
International models, learning from, 136–140
International perspective, 26–29, 285
comparing rates of organ donation, 27
ethical, social, and cultural issues, 28–29
numbers of deceased donors, 28
IOM. See Institute of Medicine
Iowa, 194
Ireland, 27
Irreversibility, controversy over, 145–146
Islam, and deceased organ donation, 66
J
Japan, 29
JCAHO. See Joint Commission on Accreditation of Healthcare Organizations
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 5, 33, 97, 99, 119
Judaism, and deceased organ donation, 66–67
K
Kentucky, 188
Kidney transplants, 16, 46, 130
living kidney donors, 264, 266
obtained as a result of DCDD, 140
L
Learning from other public health efforts, 189–192
correcting myths and misperceptions, 190–191
public health intervention strategies, 192
Learning from past experience and international models, 136–140
kidneys obtained as a result of DCDD, 140
Modified Madrid Criteria, 139
Legislation on criteria for determination of death, 19
National Organ Transplant Act, 19
Omnibus Budget Reconciliation Act, 19
Organ Donation and Recovery Improvement Act, 19
Uniform Anatomical Gift Act, 19
Uniform Determination of Death Act, 19
Libertarian argument, 241
Liberty right, to sell organs, claims of, 241–242
Life Gift, 109
Life Point, 109
criteria for termination of advanced cardiac, 132
LifeNet, 69
Line placement techniques, 310–311
Linking organ recovery and distribution, 80
Living donations, 287
ethical considerations in, 263–279
following-up with, 276
Local governments, 9
Louisiana, 194
Luxembourg, 27
M
Maastricht categories, 129, 141, 155
Madrid Criteria. See Modified Madrid Criteria
Maine, 194
timing and family involvement, 180
Markets.
See also Free market in organs;
Organ markets
for bodies, illicit, 233
print, 246
Media-Based Interventions program, 300–301
Medicare coverage, 20, 53, 97–98, 158, 220n, 246
Medlantic Healthcare Group, 306
Medlantic Research Institute (MRI), 305, 313–315
MELD. See Model for End-Stage Liver Disease
Mental capacity issues, 219
Mentoring, 158
Minnesota, 194
Minority populations, 2
community grassroots efforts and, 195–198
Misperceptions. See Myths and misperceptions
Missouri, 186
Mistaken removals and nonremovals, 219
Model for End-Stage Liver Disease (MELD), 57
Modified Madrid Criteria, 139, 155–156, 167
Mortality
confronting one’s own, 189
postoperative, 35
Motor vehicles departments, 9, 184, 185
MOTTEP
See National Minority Organ and Tissue Transplant Education Program
MRI. See Medlantic Research Institute
Multi-organ transplant, 61
Multistakeholder consensus conferences, 145
Myths and misperceptions
about controlled DCDD, 151
about uncontrolled DCDD, 152
N
Nanotechnology, 37
NATCO. See Organization for Transplant Professionals
National Association of Hispanic Nurses, 197
National Black Nurses Association, 197
National Bone Marrow Donor Registry, 299
National Center on Minority Health and Health Disparities, 5, 32, 120, 195n, 197
National Committee for Quality Assurance (NCQA), 5, 119
National Conference on Donation after Cardiac Death (DCD), 136, 146, 150
National Consensus Project Steering Committee, 117
National Donor Family Council, 30
National Hispanic Medical Association, 197
National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), 32, 195n
National Institutes of Health (NIH), 5–8, 32, 120, 168, 195, 198–199
National Kidney Foundation (NKF), 33, 245, 250
National Medical Association, 197
National Minority Organ and Tissue Transplant Education Program (MOTTEP), 32, 189, 195–197
National Organ Transplant Act (NOTA), 19–20, 153, 231, 239, 265, 273
National Survey of Organ Donation, 181–182, 215, 224, 244
Native Americans, 195
NCQA. See National Committee for Quality Assurance
NDD. See Neurologic determination of death
Nebraska Health System, 117
Nephrectomy, 312
Neurologic determination of death (NDD), 29, 31, 70–71, 131, 193.
See also Donation after neurologic determination of death
Neutral-choice policy, 214
Newman v. Sathyavaglswaran, 88
NHBDs. See Non-heart-beating organ donations
NIDDK. See National Institute of Diabetes & Digestive & Kidney Diseases
NIH. See National Institutes of Health
NKF. See National Kidney Foundation
Non-heart-beating organ donations (NHBDs), 152, 305, 313
Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement, 133–134
Non-Heart-Beating Organ Transplantation: Practice and Protocols, 134
Nonfinancial incentives, 253–258
arguments against preferential access, 255–258
arguments for preferred-access approaches, 254–255
Nonprofit organizations, 9, 200
Normative trustworthiness, 112–113
North Carolina, 184
Norway, 27
NOTA. See National Organ Transplant Act
O
ODA. See Office of Decedent Affairs
Office of Community Affairs, 306
Office of Decedent Affairs (ODA), 306–307, 309, 313
Office of Minority Health Research, 195n
Ohio, 194
Omnibus Budget Reconciliation Act, 19
Opinions of healthcare professionals, 245
OPOs. See Organ procurement organizations
Opportunities for action, 13–14, 281–282
to document donation decisions, 187
to ensure donations, 158
to increase organ donations, 14, 282
Opt-in approach, 154, 214–215, 280
Opt-out approach, 28, 210, 214
OPTN. See Organ Procurement and Transplantation Network
OPTN/UNOS policy, 136–137, 161–164
waiting list under, 47
Organ brokers, 238
Organ Donation and Recovery Improvement Act, 19, 270
Organ Donation Breakthrough Collaboratives, 5, 32, 102, 110, 118–119, 158, 181, 199, 236, 243, 258–259, 288, 301–302
Organ donation systems, 26, 93–125
context of the current U.S. organ donation system, 95–101
conversion rates among member hospitals, 105
improvement aims for the healthcare system, 93–94
increase in number of deceased organ donors, 105
initiatives in, 4
issues in allocating and distributing organs, 95
ongoing evolution of the request process, 106–110
organ donation and transplantation breakthrough collaboratives, 101–106
quality improvement in health care, 102
Organ donations
acceptable appeals for, 3, 79, 84–85
decision-making policies, 211
and quality end-of-life care practices, 6, 120
Organ Donor Leave Act, 270
deceased donors, 51
by donor type, 48
by ethnicity, 50
OPTN/UNOS waiting list, 47
waiting list additions, 48
Organ exchange organizations, 26
Organ markets
buying and selling in, 239–242
problems with a free market in, 231–239
Organ Procurement and Transplantation Network (OPTN), 1n, 6, 13, 15–16, 20, 31, 46, 53, 57–61, 99, 136, 168, 238, 265–266, 299
Organ procurement organizations (OPOs), 4–9, 20, 69, 93, 96–100, 141, 160, 168, 198–200, 217, 245, 288, 301, 304
donation rates, 100
Organ recovery
from DCDD donors in the U.S., 143
at the Washington Hospital Center, 311–313
Organ Transplantation Breakthrough Collaborative, 106
Organization for Transplant Professionals (NATCO), 33, 188, 250
Organization of the transplantation field, 20–22
donor service areas, 21
See also Organ donation systems
quality of, 166
screening, 167
Out-of-pocket costs, 272
P
Pacific Islanders, 195
Past experience, learning from, 136–140
Patient and family relationships, emphasis on, 116–117
Patient centeredness, of the healthcare system, 94
Patient survival rate, adjusted, 59
“Paying for Organs,” 249
Payments
to families for funeral expenses, 249–250
as a token of gratitude, 252–253
Pediatric End-Stage Liver Disease (PELD), 57
PELD. See Pediatric End-Stage Liver Disease
Perceptions. See Myths and misperceptions
Perfusion catheter, line placement by, 310–311
Peritoneal lavage, line placement by, 310
Persons, respect for, 3
Peter Brent Brigham Hospital (Boston), 264
PHASE. See Pre-Hospital Arrest Survival Evaluation data set
Physician’s Orders for Life-Sustaining Treatment, 187
Poor people, risk of exploiting, 255
Potential donors, 308
expanding the population of, 127–173
issues in expanding the population of, 128–140
Powers of attorney, durable, 116
Pre-Hospital Arrest Survival Evaluation (PHASE) data set, 155
Precedent autonomy, 87
Preferential access to donated organs, 229, 253–258
Premortem interventions, 144
Preservation, 308.
See also Cold preservation techniques;
Kidney preservation
Presumed consent, 9–10, 28, 107, 205–228, 303
recommendations concerning, 226–227
Presumed-consent policies
autonomy-based arguments, 218–219
chances of its being adopted in the U.S., 222–224
cost-effectiveness, 216
effectiveness in increasing the number of transplantable organs, 212–216
individual generosity, societal generosity, and mutual self-interest, 221–222
organ donation decision-making, 211
possible benefits of and barriers to, 223
reducing the burden of familial decision making, 216–218
Prevention
organ transplantation prevention matrix, 37
Primum non nocere (above all do no harm), 12, 263
acceptable appeals for organ donation, 3, 79, 84–85
common stake in a trustworthy system, 3, 79–84
criteria for evaluating proposed changes, 90–91
respect for persons, 3, 79, 85–89
Print media campaigns, 246
Prior reports and recommendations, 133–136
actions proposed by the National Conference on Donation after Cardiac Death, 136–137
recommendations of Non-Heart-Beating Organ Transplantation, 134–135
Process, of organ donation, 24, 236, 310–313
Professional education, 157–158
Protocol for the Rapid Organ Recovery Program, 150
Public education, 135, 157, 179, 187–199
Coalition on Donation, 188
community grassroots efforts and minority populations, 195–198
driver’s license registration, 194
learning from other public health efforts, 189–192
next steps for public education, 198–199
workplace efforts, 193
Public health
intervention strategies, 192
learning from previous efforts, 189–192
Q
Quality improvement
in health care, 102
sustaining continuous, 5, 113–114, 119
and trust in the healthcare system, 69–70
Quantifying self-interest in organ donation, 293–297
notation, 294
risk of being placed on a waiting list, 297
Question of whether payments would actually increase the organ supply, 242–245
opinions of healthcare professionals, 245
religious group opinion, 245
Question of whether payments would be a cost-effective policy, 245–247
R
Race. See Ethnicity;
individual racial and ethnic groups
Rapid Organ Recovery Program, 306, 313
protocol for, 150
Rapid organ recovery program transplantation services
design and methods for, 306–313
fatal trauma victim protocol (uncontrolled donors) in, 308
kidney preservation, 313
line placement technique, 310–311
Rates. See Donation rates;
Expansion of the population of potential donors
Reciprocity model, 12, 80–81, 254–255, 257
Recommendations, 119–120, 199–200, 226–227, 258–259, 276–277
encouraging and funding DCDD demonstration projects, 7, 168
enhancing donor registries, 9, 200
enhancing training for healthcare professionals, 6, 120
facilitating living donor follow-up, 13, 277
implementing initiatives to increase rates of donation after circulatory determination of death, 6–7, 168
increasing opportunities for people to record their decision to donate, 9, 200
increasing public understanding of and support for organ donation, 8–9, 199
increasing research on innovative system changes, 5, 120
increasing research on organ quality and enhanced organ viability, 7, 168
maintaining opportunities for organ donation, 7, 168
from Non-Heart-Beating Organ Transplantation, 134–135
protecting living donors, 13, 277
strengthening and integrating organ donation and quality end-of-life care practices, 6, 120
sustaining continuous quality improvement initiatives, 5, 119
terms, 4
Referrals, required, 101
Regional infrastructures, 159
Regulated commerce in organs, 99, 239–247
allowing buying and selling of organs, 239–242
American Board for Transplant Certification, 99
Association of Organ Procurement Organizations, 99
Centers for Medicare & Medicaid Services, 99
Joint Commission on Accreditation of Healthcare Organizations, 99
Organ Procurement and Transplantation Network, 99
question of whether payments would actually increase the organ supply, 242–245
question of whether payments would be a cost-effective policy, 245–247
Relationships between living donors and recipients, 265–266
Religion and deceased organ donation, 66–67, 257
Confucianism, 67
group opinion in, 245
Hinduism, 67
Islam, 66
Taoism, 67
Requests and requesters, 108–110
formulation of, 107
required, 101
Respect for persons, 3, 79, 85–89
for decedents’ wishes, 87
for human dignity, 86
for human remains, 88
Risk of being placed on a waiting list for an organ transplant, by cause of death, 297
Robust informed consent, 271
Routine-removal policies, 205–208
S
Safety, of the healthcare system, 93
Scandiatransplant, 27
SCCM. See Society of Critical Care Medicine
Scientific Registry of Transplant Recipients (SRTR), 31, 98, 299
“Second Chance” Volunteers, 188
Self-interest, mutual, 221–222
Self-interest in organ donation, quantifying, 293–297
Selling. See Buying and selling of organs
Social and Behavioral Interventions grants program, 190–191, 299–301
Society of Critical Care Medicine (SCCM), 146
religion and deceased organ donation, 66–67
SRTR. See Scientific Registry of Transplant Recipients
See also individual states
Strong presumed consent, 210–212
organ donation decision-making policies, 211
Supply side of an organ market, 232–236
barriers to a futures market, 234–235
commodification of dead bodies, 233–234
Surrogate decision making, 116
Survival. See Patient survival rate
Sweden, 27
Systems
changing, 286
trustworthiness of, 3
Systems approach recommendations, 4–6.
See also Organ donation systems
enhancing training for healthcare professionals, 6, 120
increasing research on innovative system changes, 5, 120
strengthening and integrating organ donation and quality end-of-life care practices, 6, 120
sustaining continuous quality improvement initiatives, 5, 119
Systems of care, an organizational perspective, 96–101
OPO donation rates, 100
regulation and accreditation, 99
T
Taoism, and deceased organ donation, 67
Tax incentives, 247
Termination of advanced cardiac life-support efforts, criteria for, 132
recommendations concerning, 4
Timeliness, of the healthcare system, 94
Timing
and family involvement, 180
Training
in end-of-life communication and decision making, 117–119
for health professionals, 157–158
interdisciplinary, 118
Transparency, 84
Transplant centers, 6, 21, 26, 166, 168, 264–265
Transplant waiting lists, 1–2, 16, 54
additions, 48
growth in numbers of candidates on, 2, 16
risk of being placed on, by cause of death, 297
Transplantation breakthrough collaboratives, 101–106
conversion rates among member hospitals, 105
increase in number of deceased organ donors, 105
quality improvement in health care, 102
Transplantation services
growth and organization of, 20–22
Washington Hospital Center’s rapid organ recovery program, 305–315
Transplants, growth in numbers of, 2, 16
organ donation statistics and trends, 45–62
who donates—individual and family decisions, 62–71
Trustworthiness of a system, 3, 29, 79–84
common stake in, 3
link between organ recovery and distribution, 80
transparency, 84
U
UAGA. See Uniform Anatomical Gift Act
UDDA. See Uniform Determination of Death Act
UK Transplant, 27
Uncontrolled DCDD, 128
estimation of potential donors, 155–156
myths and misperceptions about, 152
Uncontrolled death, defining, 129–131
Unfair allocation problem, 257–258
Uniform Anatomical Gift Act (UAGA), 19, 22–23, 84, 138, 175, 177, 209, 230
Uniform Determination of Death Act (UDDA), 18–19, 144–146
United Kingdom, 26–27, 193, 217
United Network for Organ Sharing (UNOS), 8, 20, 53–55, 104, 136, 199, 238, 245, 253, 257–258, 267, 313
definition of expanded-criteria kidney donors, 162
United States (U.S.), 290–292.
See also State governments;
individual states
University of Pennsylvania, 303
University of Wisconsin, 132, 303
UNOS. See United Network for Organ Sharing
U.S. Department of Health and Human Services, 7, 20, 100, 133, 136, 168, 264, 272
U.S. efforts to increase organ donation, 31–33
funding the HRSA Division of Transplantation, 32
U.S. organ donation system
context of the current, 95–101
required request and required referral, 101
systems of care—an organizational perspective, 96–101
U.S. Renal Data System, 53
U.S. Supreme Court, 148
V
Vacco v. Quill, 148
Voluntary choice
expanding opportunities to document donation decisions, 181–187
facilitating and documenting decisions to donate, 183–187
key issues for donor choice, 182–183
Voluntary health organizations, 8, 199
W
Waiting lists. See Transplant waiting lists
Washington Hospital Center (WHC), 137–138
protocol for the rapid organ recovery program, 305–315
transplantation services, 305–315
Washington Regional Transplant Consortium (WRTC), 311
Weak presumed consent, 210–212, 217
WHC. See Washington Hospital Center
Wisconsin, 194
Withdrawal of treatment, 147–148
Workplace efforts, 193
Workplace Partnership for Life, 193
WRTC. See Washington Regional Transplant Consortium
X
Xenotransplantation, 38
Y
