Elsevier

Journal of Professional Nursing

Volume 21, Issue 2, March–April 2005, Pages 97-102
Journal of Professional Nursing

The Ethics of Heparin Administration to the Potential Non-Heart-Beating Organ Donor

https://doi.org/10.1016/j.profnurs.2005.01.005Get rights and content

The increasing need and limited sources for organs has stimulated a renewed interest in non-heart-beating organ donation (NHBOD). NHBOD is the donation of organs from cadavers that have been declared dead by cardiopulmonary criteria. Emerging protocols for heparin administration to the potential non-heart-beating organ donor (NHBD) deserve scrutiny. This topic is presented within a limited discussion of organ donation in general. The definition of death has been refined to its present state because of the need for clear parameters in light of a desire to procure organs for transplant. The administration of heparin to the NHBD is intended to prevent the formation of blood clots in the kidneys and liver. Heparin at high doses is clearly not given for the benefit of the patient, and some professionals are concerned that administration may hasten death. Nurses are guided by codes that require the consideration of the ethical principles of autonomy, informed consent, beneficence, and justice while providing compassionate care. An eagerness to procure viable organs for positive transplant outcomes must not be the guiding force in protocols that allow the administration of heparin to the potential NHBD. Heparin administration is supported for these donors within specific parameters.

Section snippets

Organ donation

The people surrounding organ donation and transplantation are the organ donor, the organ donor's family, the organ donor's care providers (nurses, doctors, social workers, etc.), the organ procurement organization (OPO), the organ procurement team (technicians, surgeons, nurses), the transplant recipient, and his or her care providers and family. Each person involved approaches the circumstances of donation or transplantation with a different purpose and perspective. Although this article does

Definition of death

Before 1968, all cadaveric organ donations were from NHBDs that had been declared dead by cardiopulmonary criteria. The acceptance of brain death criteria came after a 1968 publication by the Ad Hoc Committee of the Harvard Medical School in the Journal of the American Medical Association. This document recommended that the patient be declared dead when brain function was shown to have ceased. Notably, the committee dealt with this issue partly in response to the controversy over the standards

Heparin

As with all pharmacological agents, the administration of heparin carries certain risks. Heparin is a commonly prescribed drug used for the prevention of the formation of blood clots. This is known as anticoagulant therapy. Heparin is often referred to as a blood thinner. It is administered either intravenously or subcutaneously and is most frequently used in hospital settings. It prevents blood clots from forming or growing but cannot reduce the size of an existing blood clot. Heparin that is

Ethics

When examining ethical issues, it is important to recognize that both the medical and nursing communities rely on codes of behavior that dictate how a person should act. For nurses, these include the American Nurses Association Code of Ethics for Nurses, which guides nurses to provide service with respect for human dignity and worth and to preserve, protect, and support the rights of all people. The provisions of the code direct nurses to promote, advocate, and protect the health, safety, and

Autonomy

Autonomy, or a person's right to act independently and make personal choices, allows the administration of heparin to the potential NHBD. Whether the choice is made by the donor, for example, by indicating his or her wishes in a document, or by proxy, with the decision by the next of kin, choosing to allow the administration of heparin is an example of free choice. Understandably, because heparin administration to the potential NHBD is a relatively new modality, it is unlikely that an

Discussion

All treatment options for potential organ donors deserve dialogue and scrutiny by medical professionals, theologians, society members, and legal scholars, and new treatments should be presented to the public as they emerge.

For the organ procurement and transplant communities, it is important that their activities are communicated to the public clearly and openly. Public trust in organ donation practices directly affects the number of organ donations and transplantations; therefore, transplant

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