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USMLE Step 3 - Ethics_Legal_Professionalism SUMMIT REVIEW SESSION) ANSWERED
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USMLE Step 3 - Ethics_Legal_Professionalism SUMMIT REVIEW SESSION) ANSWERED
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8/12/24, 12:32 PMUSMLE Step 3 - Ethics/Legal/Professionalism
Jeremiah
Terms in this set (101)
Apnea must be present
Organ donation must obey the dead donor rule:
patients must be declared dead prior to organ
Cardiac (Circulatory) Death
retrieval. This is based on the principle of
nonmaleficence: the act of organ procurement
cannot cause the death of the patient.
Apnea must be present
Organ donation must obey the dead donor rule:
Brain Death patients must be declared dead prior to organ
retrieval. This is based on the principle of
nonmaleficence: the act of organ procurement
cannot cause the death of the patient.
Patients with brain death can have spontaneous movements, but these originate from
peripheral nerves or the spinal cord.
Possible reflexes include:
- finger flexion
- truncal movements (eg, superficial and deep abdominal muscles)
- triple flexion response (flexion at the hip, knee, and ankle with foot stimulation)
- plantar reflexes (Babinski sign)
Normal Movement During Brain Death
- limb movements to painful stimuli
alternating flexion-extension of the toes.
Explain that movement is normal, proceed with evaluation of brain death
*Absence of cerebral or brainstem reflexes: pupillary, oculocephalic, oculovestibular,
corneal, gag, sucking, swallowing, extensor posturing*
1/14
, 8/12/24, 12:32 PM
1. Clinical Exam
2. Neurological Exam
3. Apnea Test (8-10 min)
- If inconclusive then can do ancillary testing (brain
imaging, EEG, etc.)
Diagnosis of Brain Death Pathway 4. Meet Local Legal Requirements
5. Diagnose Brain Death
Absent Cough Reflex
Irreversible Absence of Cerebral and Brainstem
Reflexes
Discuss Brain Death Diagnosis with Family AND
DEFER Donor Discussion to the Organ
Procurement Organization (OPO)
At this juncture, there are 2 pathways for organ
donation eligibility:
- The patient continues to receive life-supportive
care until further neurologic deterioration occurs
and brain death is formally diagnosed with apnea
testing and documented absence of all brainstem
reflexes; organ procurement can proceed at that
point (ie, donation after brain death [DBD]).
- Care is withdrawn (eg, extubation under palliative
sedation) in the operating room and the patient is
allowed to expire naturally. After an observation
period of several minutes (ensuring irreversibility),
Pathways for Organ Donation Eligibility death is declared and organ procurement may
proceed (ie, donation after cardiac death [DCD]).
DBD presently accounts for >80% of all organ
donations. Because circulation and perfusion are
maintained in DBD, donor graft function is
significantly improved compared to DCD.
OPO conducts donor discussions, assumes medical
care after death, evaluates the suitability of organ
donation, and provides counseling and support.
*Multiple studies have shown that decoupling
physicians' discussion of brain death from the OPO's
request for organ donation fosters family
acceptance of the donation process, promoting
higher rates of donation and thereby achieving the
best shared outcome to address the present-day
continuous shortage of organs*
Most Important Matching is HLA and ABO
Living Kidney Donation
Risk Living > Dead Donor
Absolute CI
Better if before patient requires dialysis
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