The Ethics of Heparin Administration to the Potential Non-Heart-Beating Organ Donor
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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2021, Transplantation ReviewsCitation Excerpt :The primary risk in EV/NTV is that if a patient intubated for possible organ donation after a devastating brain injury does not progress to brain death, and instead recovers some brain stem function, the result could be a PVS or a deep, minimally responsive coma. Some authors regarded PVS as a fate worse than death, such that any PMI with even a slight risk of this outcome would be precluded [33–39]. Others argued some patients would accept the risk of PVS and that an SDM could give valid consent to assume this risk [26,40].
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2012, Annals of Emergency MedicineCitation Excerpt :Opinions are divided over whether temporary organ preservation measures are ethically acceptable without previous consent. One view is that temporary organ preservation actually maximizes respect for autonomy by preserving the opportunity to donate while efforts are made to identify patient and family wishes.9,33,35,36 Without temporary organ preservation, the opportunity to donate would be lost, and individuals who are later found to have wanted to become organ donors will not have had their last wish upheld.
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2019, Transplantation ProceedingsCitation Excerpt :Interestingly, Hessheimer et al recently demonstrated the anti-inflammatory and cytoprotective effects of heparin given prior to cardiac arrest compared to the administration of fibrinolytics during postmortem regional perfusion in a stringent DCD LTx pig model [34]. However, biological interventions in potential DCD donors before circulatory arrest has occurred are ethically and legally controversial [35]. For this reason, the Human Tissue Act in the UK prohibits giving heparin.
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