Organ Donation: the Juxtaposition of the Limitations of the Human Body and the Possibilities it may Hold for others
Mei-Ean Yeow, MD, Rush University Medical Center
Currently, more than 120,000 men, women and children are awaiting organ transplants in the United States. Scientists have long thought about the idea of replacing a diseased organ with a healthy one from a donor. This dream was realized in 1954 with the very first successful kidney transplant. Since then, organ transplantation has expanded to include liver, heart, lung, pancreas and even bowel transplantation. The limiting rate for transplants remains availability of viable organs.
Organ donation represents a unique juxtaposition of the human body reaching its limit and yet providing the possibility of continued life for others. It also brings up an interesting ethical dilemma surrounding ownership of the patient’s body during the period when the patient is identified as a donor and before organs are procured. During this time, all efforts are made to ensure organ perfusion, not for the benefit of the patient himself/herself, but for the benefit of those who may receive the organs.
As part of the work up to be an organ donor, these patients undergo invasive procedures such as liver biopsies, placement of pulmonary artery catheters and even heart catheterizations to evaluate the suitability of various organs. As professionals caring for patients, we are taught that our first and foremost responsibility is to the patient. Therefore, some clinicians feel a sense of conflict when caring for dying patients who have been identified as potential donors. We may be asked to perform procedures that improve or sustain the quality of the organs donated but do not have a direct medical benefit to the patient. These procedures can also disrupt or delay what would be the usual post-death rituals.
Central to this dilemma is consent and the question of who has ownership of the body in this time period. Often the procedures and treatments initiated in this period are dictated by protocols of the organ procurement agency. Medical providers sometimes worry that donors have not consented in the usual manner to such procedures. While patients (when alive) or families may have agreed to organ donation, many do not know the details of the procedures that are involved. One can argue that some patients and families may not want to know the details, and that the consent to organ donation is attached primarily to the act of donation, rather than the procedures associated with it.
This approach provides some comfort to medical providers and is perhaps more straightforward with donation after brain death, where many procedures and invasive tests happen after declaration of brain death. It is more controversial with donation of cardiac death which requires some of these tests and procedures occur while the patient is still alive and therefore may have consequences to the prospective donor, albeit in the short time before death.
Our challenge as health care professionals is balancing our commitment to care for the dying patient and prospective donor with dignity and compassion with our commitment to improve the lives of individuals who we not have met through this act of donation.
Organ Donation: The juxtaposition of the limitations of human body and the possibilities it can hold for others
Currently, more than 120,000 men, women and children are awaiting organ transplants in the United States. Scientists have long thought about the idea of replacing a diseased organ with a healthy one from a donor. This dream was realized in 1954 with the very first successful kidney transplant. Since then, organ transplantation has expanded to include liver, heart, lung, pancreas and even bowel transplantation. The limiting rate for transplants remains availability of viable organs.
Organ donation represents a unique juxtaposition of the human body reaching its limit and yet providing the possibility of continued life for others. It also brings up an interesting ethical dilemma surrounding ownership of the patient’s body during the period when the patient is identified as a donor and before organs are procured. During this time, all efforts are made to ensure organ perfusion, not for the benefit of the patient himself/herself, but for the benefit of those who may receive the organs.
As part of the work up to be an organ donor, these patients undergo invasive procedures such as liver biopsies, placement of pulmonary artery catheters and even heart catheterizations to evaluate the suitability of various organs. As professionals caring for patients, we are taught that our first and foremost responsibility is to the patient. Therefore, some clinicians feel a sense of conflict when caring for dying patients who have been identified as potential donors. We may be asked to perform procedures that improve or sustain the quality of the organs donated but do not have a direct medical benefit to the patient. These procedures can also disrupt or delay what would be the usual post-death rituals.
Central to this dilemma is consent and the question of who has ownership of the body in this time period. Often the procedures and treatments initiated in this period are dictated by protocols of the organ procurement agency. Medical providers sometimes worry that donors have not consented in the usual manner to such procedures. While patients (when alive) or families may have agreed to organ donation, many do not know the details of the procedures that are involved. One can argue that some patients and families may not want to know the details, and that the consent to organ donation is attached primarily to the act of donation, rather than the procedures associated with it.
This approach provides some comfort to medical providers and is perhaps more straightforward with donation after brain death, where many procedures and invasive tests happen after declaration of brain death. It is more controversial with donation of cardiac death which requires some of these tests and procedures occur while the patient is still alive and therefore may have consequences to the prospective donor, albeit in the short time before death.
Our challenge as health care professionals is balancing our commitment to care for the dying patient and prospective donor with dignity and compassion with our commitment to improve the lives of individuals who we not have met through this act of donation.
Organ Donation: The juxtaposition of the limitations of human body and the possibilities it can hold for others