Transplantation Flashcards
Why are all patients not put on the waiting list for a donor?
Only on the list if have a chance of getting one to prevent giving false hope e.g. condition too progressive to survive the wait, high chance of rejection
Why is the waiting list increasing for liver, kidney and heart?
Due to change in lifestyles e.g. alcohol and smoking
Which age group is the best for donation?
Young people donations have the best possible outcomes and are more likely to be in accidents and so organs are usually of good condition.
Why is the number of donations significantly lower than the number of donors?
Donors must die within a controlled environment and must die in a way that organs are still usable. However one donor can make multiple donations.
What is the ethical issue with donor availability?
There are life saving resources available in all bodies, so should they be used or not without consent. If the body isn’t donated it will be buried or burned and this is a waste of resources.
What is the role of consent in donation?
UK - opt in system. Wales - Opt out system
Individuals can choose whether to donate.
Next of kin will be asked if they agree with your decision, it can overrule Pt but try best to follow patient wishes e.g. Donor card will overrule next of kin. Verbal pt wishes will not overrule.
Donation will never go ahead without consent.
Why is consent important?
Respect for autonomy - control over body alive and dead. Must not be coerced.
Respect for values and beliefs - Religious objections or distressing
Concern for family - may distress relatives if organs are taken without consent and exaggerate the bereavement process
What were the consequences of the Alder Hey scandal (1990)?
Caused distress to parents and damaged reputation of NHS and donation.
This led to the introduction of the Human Tissue Act 2004.
What are the main points about the Human Tissue Act?
Make consent a crucial part of the process.
It deals with removal, storage and use.
Relatives must be fully informed.
Who can give consent for donation in accordance with Human Tissue Act?
Live donation: Children who are competent. If not parent can consent, but only if in their ‘best interest’. Adult must give consent but must ensure their is no coercion from HCP or family.
Deceased donation: Competent children can give an advanced declaration but otherwise requires parental consent. An adult must make an advanced declaration and state situations regarding brain stem death, it is the overriding factor for all. If there is no advanced declaration it can be obtained from a nominated person or next of kin.
what is the human tissue authority and what does it do?
Oversees donation and storage of all tissues but reproductive.
They license, issue code of practice and regulate the transplant to inhibit commercial dealing.
What is the law on preservation and use of tissue?
Lawful for a hospital to take minimum steps to preserve organs whilst consent s obtained.
What are the moral concerns with transplantation?
Who should receive the transplant and who gets to decide. Is quantity or QoL more important.
The public may have more empathy for children over alcoholics.
Why do views need to be balanced in order to have successful donation and transplantation?
Drs know about compatibility and risks. Bioethicists know about the ethical principles. The public may not donate if the feel their organs are not being used for the best outcomes.
