Organ Donation Opportunities for Action (2006) / Chapter Skim
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In 2005, 7,593 deceased donors provided 23,249 transplanted organs in the United States, and there were 6,896 living donors. The number of organ donors has increased each year since 1988, with a steady increase in the number of organs recovered (an average of approximately 1,100 more organs are recovered each year than in the previous year)
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The need for kidney transplants is the major driving force in the increase in the waiting list, with individuals waiting for a kidney transplant constituting more than 70 percent of the individuals on the current transplant waiting list. In 2005, 44,619 transplant candidates were added to the waiting list.
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· Acceptable appeals for donations: Policies and practices designed to increase organ donation may properly appeal to a variety of motivations for donation, including altruism, community spirit, and reciprocity. · Respect for persons: Policies and practices designed to increase the rates of organ donation and the recovery of organs from deceased individuals must be compatible with four limiting conditions deeply rooted in the cultural, religious, and legal traditions of the United States: (1)
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TABLE S-1 Recommended Terms Instead of: Use the Recommended Term: Cadaver or cadaveric donor Deceased donor Harvest or procure Recover or surgically remove Life support Mechanical support or ventilated support Cardiac death Circulatory determination of death Brain death Neurologic determination of death Donation after cardiac death Donation after circulatory determination of death (DCDD) Donation after brain death Donation after neurologic determination of death (DNDD)
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For the organ donation process to be fully integrated into end-of-life care, a wide range of healthcare professionals need enhanced awareness of and training regarding the organ donation process. Recommendations: Sustain Continuous Quality Improvement Initiatives.
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HRSA, in collaboration with palliative care and other professional associations representing diverse disciplines and specialties (includ ing, but not limited to, critical care professionals, transplantation professionals, social workers, and clergy) , should strengthen train ing in end-of-life practices and organ donation, including processes of communication and decision making, with the goal of establish ing a knowledgeable and positive environment that supports organ donation.
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Such demonstration projects should include extensive public and professional education, including an emphasis on donor registry efforts, and participation by all rel evant stakeholders in the development of protocols and processes. Maintain Opportunities for Organ Donation.
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Without giving people adequate and accessible information, merely forcing them to choose to be an organ donor or not does not capture the potential of mandated choice and weakens the argument for it. A broad-based and multidimensional educational campaign is needed that confronts issues around death and dying, debunks the myths and misperceptions surrounding organ donation, and emphasizes the benefits of organ donation.
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, OPOs, and HRSA should work together to: · ensure full access to and sharing of donor registration data; · ensure that a nationwide networked system of registries that identifies self-declared organ donors is readily accessible to OPOs and healthcare professionals on a 24-hour-a-day basis, and is up dated daily. Mandated Choice Should Not Be Enacted.
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, the first step is to build sufficient social support before introducing presumed consent in the United States. This can be accomplished through intensified public education regarding organ donation, building greater trust in the healthcare system, and encouraging a general shift in societal understanding of the value and moral grounding of donation.
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Nonfinancial incentives to donate could take the form of community recognition or preferential access to donated organs. Every society draws lines separating things that are treated as commodities from things that should not be treated as "for sale." The committee believes that there are powerful reasons to preserve the idea that organs are donated rather than sold, even in a regulated market.
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The use of financial incentives to increase the supply of transplant able organs from deceased individuals should not be promoted at this time. (The term "financial incentives" refers to direct cash payments as well as contributions toward funeral expenses or to a charity of choice.)
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It is the committee's hope that this report will contribute to the development and implementation of new efforts to increase the rates of organ donation. In addition, the committee hopes that these efforts, along with concurrent actions focused on the prevention of health conditions that lead to the need for transplantation and research to explore alternatives to transplantation, will significantly reduce the size of the organ transplant waiting list in the near future.
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14 ORGAN DONATION: OPPORTUNITIES FOR ACTION TABLE S-2 Actions to Increase Organ Donation Individuals · Register as an organ donor through driver's license, donor card, or donor registry · Inform family members of organ donation decisions Families · Discuss organ donation decisions · Honor prior donation decisions made by the deceased family member · Provide consent for donation if the deceased family member did not make a decision regarding donation Healthcare, · Implement system changes emergency · Sustain mechanisms and support for continuous quality care, and improvement transplantation · Integrate organ donation and end-of-life care practices and systems services · Expand donation opportunities · Increase opportunities for donation after circulatory determination of death · Expand and enhance professional education about organ donation and end-of-life care Nonprofit · Provide multiple opportunities for donor registration and organizations, education academia, · Encourage registration through donor cards, driver's licenses, or government, donor registries media, · Promote programs to increase donor awareness employers · Improve media coverage to increase public awareness and reduce misperceptions · Increase public education · Coordinate efforts through the use of · Donor registries · Uniform state laws · Fund research on innovative approaches to increasing rates of organ donation and enhancing organ viability
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