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Ethics Prelim 3 Terms in this set (133) Historically, medical ethics/care has focused on: • Fiduciary responsibilities to patient • Do no harm ("Primum non nocere") • Respect for persons (Treating persons as an end in themselves, not as a mea$9.99
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Ethics Prelim 3 Terms in this set (133) Historically, medical ethics/care has focused on: • Fiduciary responsibilities to patient • Do no harm ("Primum non nocere") • Respect for persons (Treating persons as an end in themselves, not as a mea
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Ethics Prelim 3
Terms in this set (133)
Historically, medical ethics/care has focused on: • Fiduciary responsibilities to patient
• Do no harm ("Primum non nocere")
• Respect for persons (Treating persons as an end in themselves, not as a means...)
But with organ transplantat...
• Fiduciary responsibilities to patient
Historically, medical ethics/care has focused
• Do no harm ("Primum non nocere")
on:
• Respect for persons (Treating persons as an end in themselves, not as a means...)
• Consent/authorization
But with organ transplantation, persons
• Potential conflicts of interest
undergo interventions to benefit others
• Using someone as a "means"
• 1954: Living kidney transplant (identical twins)
• 1967: First heart transplants Drs. Christian Barnard and Norman Shumway
• 1968: Uniform Anatomical Gift Act (revised in 1987, 2006)
History of Organ Transplant
• 1970s-80s: Modern immunosuppressive era
• 1981: Uniform Determination of Death Act
• 1984: National Organ Transplant Act (NOTA)
-National effort to unify states laws on donation
-Sets up a regulatory framework -> accepted by states
1968: Uniform Anatomical Gift Act (revised in -Established organ donor registries & acceptable documentation of gift
1987, 2006) -Clarified who can make donation decisions on behalf of others and whether families
can override prior 1st person permission
(they cannot but...)
• Cardiopulmonary: Irreversible cessation of circulatory and respiratory functions, or
1981: Uniform Determination of Death Act • Neurological: Irreversible cessation of all functions of the brain, including the brain
stem
Established:
-National waiting list and allocation program
-Illegal to compensate for organs (gift, national scarce resource)
-Uniform criteria for allocating different organs - grounded in patient's ability to
1984: National Organ Transplant Act (NOTA)
medically benefit
-Guidelines to local transplant centers (256 in US) re: wait list evaluations
-Organ Procurement and Transplantation Network (OPTN) consisting of 11 regions - 58
front line organ procurement organizations
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• Public poorly informed about different types of donation
• Assumption that the person is dead before donation occurs
Wide public support for Organ Transplant
but not necessarily deep or stable
• Decisions predicated on knowledge of wishes/family consent
• Suspicion about how organ donation decisions are made
• Donation after neurological determination of death (DNDD)
-Irreversible cessation of all functions of the brain, including the brain stem"
Two different forms of deceased organ
donation
• Donation after circulatory determination of death (DCDD)
-Irreversible cessation of circulatory and respiratory functions
Organ Procurement Process for DNDD and
DCDD
(T/F): The public is more comfortable with TRUE
the concept of organ donation after
circulatory determination of death than after
brain death while the opposite is true for
many health care professionals.
• Separation of decisions re: w/w and donation
• Pre-mortem interventions
• Impact on other end-of-life preferences
Ethical Concerns with DCDD
• Is pt deceased at time of organ retrieval?
-"Permanent" or "irreversible"
-Post-mortem interventions
• Patient must be dead before organs removed
• Procurement can not cause the patient's death
Dead Donor Rule
Challenge:
Donor must be dead, but organs must be viable
• 2014: ~ 30,000 transplants, ~6000 living donors
• Who is donating?
-Gender gap: > 60% of living donors are female
Living organ donation
-Age gap: Living donors are often younger than recipients
• Disparities in access:
-More likely to receive: white, young, wealthy, privately insured, well educated
• Directed donation (most common)
–Biological relative
–Personal or social connection (e.g. spouse, friend)
–Unrelated person who has heard about the transplant candidate’s need
Types of living donor transplants • Non-directed, altruistic donation
–Until recently, generally not accepted (1990s)
–Non-directed altruistic donations are increasing with on-line websites, social media,
public appeals
–Psychological motivation more complex
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