Organ and Tissue Donation Information for Health Care Professionals

Mary N. Perry, RN, MSN

More than 92,000 people in the United States are waiting to receive donated organs and/or tissues. The lack of anatomical gifts results in organ waiting lists that increase daily by one potential recipient every 13 minutes; 17 individuals die each day waiting for organs to become available.¹ The purpose of this tutorial is to enlighten physicians about the existing need for human tissue and organ donation and their responsibility concerning family end-of-life issues. Caring for the bereaved family and offering hope to a waiting recipient enable health care professionals to better fulfill their Hippocratic Oath.

Organs and Tissues for Transplantation

The shortage of organs and tissues is readily apparent when confronted with the statistics reported by organizations responsible for compiling and storing the latest informational data. The Organ Procurement and Transplant Network (OPTN) reported that 14,697 organ transplants were performed in the United States between January 2006 and June 2006; these consisted of 11,266 cadaveric donors and 3,431 living donors.² The New York Organ Donor Network (NYODN) reported that the number of living donors surpassed cadaveric donors from 2001 through 2003.¹ Although these figures seem discrepant, they make sense: One cadaveric donor can donate multiple organs and tissues, while a healthy individual becomes a living donor by gifting a kidney, liver segment, lung lobe, or a segment of a pancreas.

Intensifying public education might enlighten the public and highlight the necessity of increasing cadaveric donations, subsequently decreasing the dependency on living donations. Organ and tissue transplantation is dependent upon the altruism of families to donate the organs and tissues of their loved ones upon death.³

Ophthalmology and Transplantation

The Eye Bank Association of America (EBAA) notes that, in 2005, eye banks within the United States distributed 44,329 corneal tissues from donations made by more than 42,000 eye donors. As a result of these donations, 31,952 corneal transplants were performed in the United States. Exported corneal tissue distributed internationally accounted for the remaining 12,377 corneal transplants.⁴

Tissue Banks International (TBI) founded the International Federation of Eye and Tissue Banks (IFETB) in 1989. The IFETB was formed as an outreach program designed to combat world blindness. Outside the United States, corneal disease and trauma account for 25% of all blindness, afflicting 10 million people worldwide, most younger than 30 years. The formation of the IFETB, as well as organizations such as the EBAA, has helped thousands of people receive the gift of sight affording a fuller and more productive lifestyle.⁵

Benefits of Transplantation

One organ donor can save the lives of eight potential recipients by the donation of organs such as the heart, lung, liver, kidney, pancreas, and intestines, enabling recipients to have a second chance at life.¹ One tissue donor can benefit the lives of 50 recipients through the donation of eyes, bone, skin, musculoskeletal tissue, and cardiovascular tissue.¹ Tissue donations improve the quality of life of individuals through surgical procedures that help to alleviate pain, improve health and mobility, restore sight, repair deformities, improve hearing, and save lives.⁶

Laws and Regulations of Organ and Tissue Donation and Transplantation

Federal and state laws and regulations have been proposed over the last 2 decades in an effort to decrease the length of time a candidate is on the national organ waiting list. The Routine Referral Law is the landmark legislation passed in 1998 to increase organ and tissue donation, acknowledging the rights of the family to consider the donation of anatomical gifts.

This law also enacted the formation of a certification program for designated requestors.⁷ Pro-donation hospitals enlist the services of designated requestors from their staff of registered nurses, physicians, social workers, and pastoral care members. Nurses, however, are considered to be the vital link to the donation process because of the trusting relationship nurses establish with families and patients under their care. Physicians can be instrumental in this process by exhibiting a pro-donation attitude.^8,9

Knowledge, Attitudes, and Beliefs of Health Care Professionals Regarding Organ and Tissue Donation and Transplantation

Health care professionals acknowledge organ and tissue donation and transplantation as procedures performed in the medical arena and view them as positive aspects of health care. Ingram, Buckner, and Rayburn¹⁰ report that a correlation exists between health care professionals' positive attitudes concerning organ donation and their level of knowledge about the donation process. In the majority of cases, health professionals' attitudes toward organ donation are positive; however, such beliefs do not motivate them to act on behalf of organ and tissue donation.^10,11

Physicians who support organ and tissue donation often make a personal commitment to promote the process in several ways. Many carry a donor card or sign the back of their driver's license, indicating their desire to be organ and tissue donors. Organ and tissue donation supporters can also speak positively about the process with their families, expressing their desire to be a donor and educating family members so that they might do the same.

Nurses interested in the role of a designated requestor can seek educational opportunities, such as the certified training program for designed requestors, to advance their knowledge about the donation process. Nurses who become designated requestors are self-assured and comfortable working with grieving families and offering them the opportunity of donation. Matten et al¹² found that nurses' knowledge, attitudes, and beliefs regarding support or opposition of organ and tissue donation directly correlate to the attitudes of physicians. To increase the number of donors, physicians should support the pro-donation attitudes of nurses.^10,12

Families of Organ and Tissue Donors

The pro-donation environment in many hospitals often sets the tone for the culture of the institution. Organ and tissue donation in such hospitals is viewed as a social good and "the right thing to do." The donation process becomes inculcated into the objectives and mission of the hospital, which is to provide caring and supportive services for patients and their families. The hospital staff supports the mission of the institution and regards donation as a valuable service and a patient's right; this is noted in New York's Patients' Bill of Rights.¹³ Offering bereaved family members the option of donation can be rewarding; many families view donation as a chance to see something good come out of a hopeless situation.^12,13

It is the family's right to decide if an anatomical gift should be donated; the decedent may have signed a donor card or expressed his/her desire to be a donor to family members. At a time when families have few choices, the decision of donation should rightfully be left to the discretion of the family,⁸ not the hospital.

Families That Choose Donation

The reasons people choose to donate vary from case to case. Beaulieu¹⁴ reported several studies showing the existence of some commonalities regarding donation. The approach, timing, experience, and knowledge of a requestor can have a significant effect on the acceptance rate. More donations are received when the decedent is younger than 50, as family members are less likely to donate the organs and tissues of patients older than 60.¹⁴ Ehrle, Shafer, and Nelson reported that this may be due more to the approach method or lack of information about the donation process than the age of the potential donor.¹⁰

In consenting to donation, family members often find themselves easing the burden of grief by knowing that a part of their loved one lives on in another individual. Families of donors who expressed their desire to donate often find comfort in knowing that they carried out the wishes of a loved one.^15,16

Families That Choose Not to Donate

Verble and Worth¹⁷ conducted a survey of 180 experienced coordinators (nurse requestors) to note the most common fears and concerns of family members during the discussion phase of the donation process. Fears and concerns identified included concern over the appearance of their loved one; worry about a delay in funeral arrangements; concern that donation was against their religion; worry about the cost of donation and the possibility of it being added to the hospital bill; fear that their loved one may feel pain; concern that others might make money from the donation; and concern that their loved one may need the body part in the afterlife. These findings are important to the education of nurse requestors and physicians; knowing what a family's concerns might be enables physicians to address them in discussion. Presenting potential donor families with accurate and appropriate information might provide the impetus needed to encourage more families to consent to donation.¹⁷

Conclusion

Many people in need of a transplant die before a compatible organ can be matched, and individuals on the national waiting list for organs have no way of knowing how long they will wait. Educating health care professionals and the general public about organ and tissue donation and transplantation could help ameliorate the organ and tissue shortage, as might encouraging individuals to sign a donor card or discuss with family members their wishes to donate. Organ donation can save the lives or enhance the quality of life for potential recipients. Donation is seen as altruistic, not only to recipients, but to the donor family members, whose grieving may be lessened by the knowledge that their loved one's death helped others in need.¹⁸

For more information on donation, visit these Web sites:

• Coalition on Donation at www.shareyourlife.org
• Eye Bank Association of America at www.restoresight.org
• New York Organ Donor Network at www.nyodn.org
• Tissue Banks International at www.tbionline.org
• United Network of Organ Sharing at www.unos.org

References

1. New York Organ Donor Network. Available at: www.donatelifeny.org/organ/o_statistics_overview.html. Last accessed September 15, 2006.
   
   
2. Organ Procurement and Transplantation Network. Available at: www.optn.org/data/. Last accessed September 15, 2006.
   
   
3. Molzahn AE, Starzomsk R, McCormick J. The supply of organs for transplantation: Issues and challenges. Nephrol Nursing J. 2003;30(1):17-28.
   
   
4. Eye Bank Association of America. Newsroom: The goal is sight. Available at: www.restoresight.org/newsroom/newsroom.htm. Last accessed September 15, 2006.
   
   
5. Tissue Banks International. Available at: www.tbionline.org. Last accessed September 15, 2006.
   
   
6. Tissue Banks International. Who We Are. Available at: www.tbionline.org/ who/intl-federation.htm. Last accessed September 15, 2006.
   
   
7. New York Organ Donor Network. Legislation passed into law. Available at: www.nyodn.org/organ/l_legipass_8.html. Last accessed September 15, 2006.
   
   
8. United States Department of Health and Human Services. The organ donation breakthrough collaborative: Best practices final report. Available at: www.organanddonor.gov/bestpractice.htm. Last accessed September 15, 2006.
   
   
9. Ehrle RN, Shafer TJ, Nelson KR. Determination and referral of potential organ donors and consent for organ donation: Best practice - a blueprint for success. Critical Care Nurse. 1999;19(2):21-30,32-33,35-36.
   
   
10. Ingram JE, Buckner EB, Rayburn AB. Critical care nurses' attitudes and knowledge related to organ donation. Dimens Crit Care Nurs. 2002;21(6):249-255.
    
    
11. Kent B. Psychosocial factors influencing nurses' involvement with organ and tissue donation. Int J Nurs Stud. 2002;39(4):429-440.
    
    
12. Matten MR, Sliepcevich EM, Sarvela PD, et al. Nurses' knowledge, attitudes, and beliefs regarding organ and tissue donation and transplantation. Public Health Rep. 1991;106(2):155-166.
    
    
13. New York State Department of Health. Patients' Bill of Rights. Available at: www.health.state.ny.us/professionals/patients/patient_rights/docs/english.pdf. Last accessed September 18, 2006.
    
    
14. Beaulieu D. Organ donation: The family's right to make an informed choice. J Neurosci Nurs. 1999;31(1):37-42.
    
    
15. Batten HL, Prottas JM. Kind strangers: The families of organ donors. Health Aff. 1987;6(2):35-47.
    
    
16. Dunn D. Motivations for giving: Consent for the donation of organs and tissues. J Transpl Coord. 1995;5:2-8.
    
    
17. Verble M, Worth J. Fears and concerns expressed by families in the donation discussion. Prog Transplant. 2000;10(1):48-55.
    
    
18. Prottas J, Batten HL. Health professionals and hospital administrators in organ procurement: Attitudes, reservations, and their resolutions. American J Public Health. 1988;78(6):642-645.