Case Study



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Organ and Tissue Donation: Saving Lives

Laurie A. Wescoat, Student Nurse
San Antonio, Texas

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In the United States, there is a critical shortage of tissue and organ donation. Nurses can play a vital role in eliminating this shortage. This article will provide nurses with encouragement to become more involved in the tissue and organ donation process. The role of the nurse in the tissue and organ donation process is one of utmost importance, as nurses tend to have a closer relationship with patients and their family members than many other medical professionals. As nurses we carry a great responsibility related to patient care. We are concerned with the patient’s physical and emotional state, but also the emotional state of the family. Tissue and organ donation can have a positive impact on a patient’s family as it may provide comfort related to an impending or sudden death.

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In the United States alone there are more than 64,000 people awaiting transplants with a significant scarcity of donor organs available to them (Kralijevick, 1999; Kaihara & Vacanti, 1999). This is disturbing because one person has the potential to donate 25 organs and tissues. This can help as many as 50 recipients waiting for tissue or organ donations. In theory, there could be 300,000 to 600,000 organs available for transplantation every year. However, this is disappointing as there were only 21,000 organ transplants performed in 1998. With the help of medical professionals the number of people awaiting transplants can be diminished. The role of a nurse is one of utmost importance. Recent regulations have allowed nurses to undertake new responsibilities as organ donor educators and requesters (Roark, 2000).

As of December 19, 1997, the Health Care Financing Administration (HCFA) required every hospital to have an association with an organ procurement organization, and eye and tissue banks. HCFA also set the standard that every family of prospective donors are educated about donation possibilities. These changes have a crucial impact on nurses. There are now many programs that are educating nurses to become donation requestors. Prior to these programs nurses were required to ask families about donation when a member of their family died even if they were not trained to do this. With the new regulations, nurses must be trained as a designated requester before they are allowed to talk with a family (Roark, 2000). The training of nurses as designated requesters may have a considerable impact on the number of donors as nurses are close to prospective donors and their families. Nurses provide a vital connection in the organ donation process. Successful organ procurement may depend on the nurses’ awareness and integration of knowledge (Sque, Pane & Vlachonikolis, 2000).

Donation Criteria

The general criteria for tissues donation is not as stringent as it is for organ donation. "Almost anyone who dies can be a tissue donor" (Sheehy, 1999). The minimal exclusion criteria for tissue donation is unresolved septicemia, metastatic cancer, injectable drug use, human immunodeficiency virus positive (HIV) persons, or a history of high-risk group for HIV. The broad standards for organ donation are anyone as young as a newborn to eighty years old, brain death, an intact cardiorespiratory system, and the patient with apnea on a ventilator (Sheehy, 1999). The nurse must be aware of the policy in his or her particular agency.

Donation Process

Nurses can be advocates for tissue and organ donation. It is the nurses’ responsibility to identify potential donors and contact the appropriate source to verify if the patient is eligible for tissue or organ donation. This person of contact may be the primary physician, the medical examiner or coroner, or a tissue and organ procurement organization. In addition to notifying the above noted sources it is also helpful to locate an indication in the patient’s belongings notifying staff of their wishes to donate their tissues and organs. This is most commonly found on a person’s driver’s license, or a signed donor card. On many donor cards there is a place that allows for two people to sign as witnesses to the person’s wishes. The donor card may also list a next of kin and their phone number in order to contact them. Once contacted, the representative from the organ procurement organization will confirm the patient’s suitability for tissue or organ donation. If the person has died secondary to a cardiac arrest, he or she may be a suitable donor for tissues. A person who is brain dead, but on a ventilator, is an acceptable donor for major organs. A complete history and physical of the donor will be obtained. Once the person has been determined to be an acceptable donor, they will then be matched with waiting recipients. Recipients are matched by tissue type and blood group, percentage of reactive antibody, waiting time, medical urgency, and if awaiting a heart, kidney or liver transplant the distance will be considered (Lifelink, 2000).

Donation Educator & Requester

As a nurse, there are many responsibilities related to tissue and organ donation. A nurse must be familiar with types of donation and donation criteria, know the agency policy, contact local tissue and organ banks to determine eligibility, and be able to discuss the possibility of donation with the primary physician. In addition to this, nurses may have to discover if the patient has indication in their belongings that they wished to be an organ donor, obtain permission from the medical examiner or coroner, offer the family the option for donation, and provide bereavement support to the family of the donor (Sheehy, 1999).

It is beneficial for the nurse to be familiar with all the possible types of transplantations as this will allow him or her to better inform the family of all the possibilities. There are multiple tissues and bones that can be donated. The eyes, cornea, heart valves, bone, skin, the saphenous vein, pericardium, fascia, veins, dura, tendons, and cartilage are the different type of tissues that can be donated (Sheehy, 1999). Many times people fail to understand that bone and tissues are needed for donation as well as major organs. If nurses are educated on the different type of tissues available for donation, they will be more helpful in encouraging families to donate. The organs available for donation are: the heart, lungs, kidneys, pancreas, and liver (Potter & Perry, 1997).

The process of requesting tissue and organ donation can be a technical one. Therefore, it is important for the nurse not to forget family bereavement support. Some families can find comfort in their grief from their religious community. For example, the Catholic faith states, "We encourage donation as an act of charity. It is something good that can result from tragedy and a way for families to find comfort by helping others." (Gallagher, 1997).

Nurses are sometimes intimidated to ask for donation because of their fear of insulting people of particular faiths. It is important for nurses to become familiar with different religious positions regarding tissue and organ donation. Gallagher comprised a list of thirty different religions and their beliefs on organ and tissue donation. The only two on Gallagher’s list that were against donation were Gypsies, and the Shinto, who believe "the dead body is considered to be impure and dangerous…injuring a dead body is considered to be a serious crime" (Gallagher, 1997). The other twenty-eight religions either encouraged organ and tissue donation, left it up to the individual, or did not have an official position on the topic.

Educated nurses are also in the position to deflate myths, and encourage the truth about tissue and organ donation to society. Some people believe it costs money to donate. This is not true. The donor family is not charged for any of the medical costs related to the donation. If families are informed of this, they may be more willing to donate. There may be some people who fear signing a donor card or indicating they are a donor on their driver’s license because they believe the doctor or hospital staff may allow them to die in an effort to get their organs. One way to reassure individuals is to educate them. Individuals should be informed that the doctors treating patients at the time of death are focused on the patient’s medical management. The public should be reassured that every effort will be made to save life before donation is considered. Another common concern of the family is that the donation will disfigure the body and delay the funeral. The organs and tissues are removed surgically and the body is carefully reconstructed. Most often donations occur within 24 hours, therefore funeral arrangements are not delayed (LifeLink, 2000).

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The nurse is a vital link in the organ and tissue donation process. Nurses have a special connection to families and potential donors. If the option of tissue donation is presented to the family in a positive and supporting style the possibility of the family embracing such a decision are much more likely. Many people have expressed a great amount of appreciation when given the opportunity to give the gift of life. This giving can be consoling to the family of the donor. Melody, a woman from Georgia, stated it best when speaking of the tragic death of her young daughter, "I am glad we were given the opportunity to choose to help others even through our tremendous grief. She would have wanted it that way." She goes on to state how the gift of her daughter’s organs has allowed a physician who was previously on dialysis go back to work and help others, a father will see his daughter get married, another person is now able to see, and a grandmother will be able to spend more time with her grandchildren. All of these opportunities were possible because she was given the option to give the gift of life, and she choose to give the gift of life (LifeLink, 2000).

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Gallagher, C. (2000). Religious Views on Organ/Tissue Donation and Transplantation. http://www.lifelinkfound.org/religion.html

Kaihara, S. & Vacanti, J.P. (1999). Tissue Engineering: Toward New Solutions for Transplantation and Reconstructive Surgery. Archives of Surgery, 134 (11), 1184-1188.

Kraljevich, M. (1999) Liver donation by a trauma patient: A case study in placement. Journal of Transplant Coordination 9 (3), 153-155.

LifeLink. (2000). About Organ & Tissue Donation. The Organ Procurement Process. http://www.lifelinkfound.org.

Potter, P.A, & Perry, A.G. (1997). Fundamentals of Nursing. St. Louis, MO: Mosby, Inc.

Roark, D. C. (2000). Overhauling the Organ Donation System. American Journal of Nursing, 100 (6), 44-48.

Sheehy, S.B. & Lenehan, G.P. (1999). Manual of Emergency Care. St. Louis, MO: Mosby, Inc.

Sque, M., Payne, S., &Vlachonikolis, I. (2000). Cadaveric donotransplantion: nurses’ attitudes, knowledge and behaviour. Social Science & Medicine 50 (4), 541-552.

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I acknowledge the assistance of, Judy A. Criner, MS, RN, with the submission of this article.

Judy A. Criner, MS, RN
Assistant Professor/ Clinical
School of Nursing
University of Texas Health Science Center
7703 Floyd Curl Drive
San Antonio, TX 78284-7975
(210) 567-2992

Copyrightę by The University of Arizona College of Nursing; All rights reserved.