ASIAN
INSTIT
UTE
OF
NURSI DONATION
ASSIGNMENT ON: ROLE OF A NURSE IN ORGAN
NG
SUBJECT: CLINICAL SPECIALITY 1 B
EDUCA (MEDICAL SURGICAL NURSING)
TION
SUBMITTED TO: SUBMITTED BY:
MRS RESHMA BEGUM FEBBY BORNROY LAMARE
LECTURER OF ASIAN INSTITUTE ROLL NO 13
OF NURSING EDUCATION MSc (N) 2 ND SEMESTER
ASIAN INSTITUTE OF NURSING EDUCATION
SUBMITTED ON:
18/12/2024
INDEX
SL CONTENT PAGES NO
NO
1 Introduction 1
2 Organ Donation: The Indian Scenario 2
3 Advanced Care planning and Advanced Directive 2-3
4 Facts about Donation 3
5 Organ Donation in Nursing and General Curriculum 3
6 Ethics in Organ Donation 3
7 Pivotal Role of Nurse in Organ donation 3-4
8 Conclusion 5
9 Bibliography 5
INTRODUCTION
Organ and Tissue Donation
Persons who are legally competent may choose organ donation. Any body part or the entire
body may be donated. The decision to donate organs or to provide anatomic gifts may be
made by a person before death or by an immediate family after death, Family permission
must be obtained at the time of donation.
Some people carry donor cards. The names of agencies that handle organ donation vary by
state and community. Common names for such an agency may be the organ bank, organ-
sharing network, and organ-sharing alliance. Organ and tissue donations follow specific legal
guidelines. Legal requirements and facility policies for organ or tissue donation must be
followed. The physician must be notified immediately when organ donation is intended,
because some tissues must be used within hours after death.
ORGAN DONATION: THE INDIAN SCENARIO
Diabetes and hypertension are the leading causes of end-stage kidney failure in India
and it is estimated that over 210,000 patients are suffering from end stage kidney
failure.
The increasing number of liver diseases caused by B & C viruses and alcoholism has
led to an increase rate of liver failure. Overall, it is estimated that 500,000 people in
India need kidney, liver and heart transplants, against which only around 8,000
transplants are done annually, which barely meets 1 to 2 percent of the demand for
organs.
In India around 6000 people die every day waiting for organ transplant.
Every 17 minutes someone dies waiting for transplant.
Every 13 minutes someone is added to a waiting list.
ADVANCE CARE PLANNING AND ADVANCE DIRECTIVES
Advance care planning is a process that involves having patients
(1) think through their values and goals for treatment
(2) talk about their values and goals with others
(3) document them. Advance directives are the written documents that pro- vide information
about the patient's wishes and his or her designated spokesperson
The first advance directive was known by laypersons as a living will. In the United States,
most states have replaced the idea of living wills with natural death acts, which may include
directive to physicians (DTPs), durable power of attorney for health care (DPAHC), medical
power of attorney (MPOA), and power of attorney for health care (POAH). Under the natural
death acts, an individual can tell the physician exactly what treatment is or is not desired.
Each state has its own unique requirements. Keep in mind that patients often change their
minds about desired treatments as their disease state progresses. Therefore, it is important to
reassess a patient's advance directives. For cognitively impaired older adults, consider the
person's values and manner of life to make health care decisions consistent with decisions
they made when they were cognitively intact.
Copies of state-specific forms can be obtained from local medical associations and on the
Internet. However, a person may write his or her wishes without special forms. Verbal
directives may be given to physicians with specific instructions in the presence of two
witnesses. Based on this directive, the physician may use a Physician Order for Life-
Sustaining Treatment or Medical Order for Life-Sustaining Treatment (MOLST) to outline
current treatment options that honor the person's desire for treatment
Euthanasia is the deliberate act of hastening death. In India as of now, there is complete
absence of legal guidelines on most issues related to end-of-life care. The do not resus- citate
(DNR) order and living will is still not a documented legal practice in India and the code of
medical ethics does not permit passive euthanasia also. The current law states that the doctor
has no ethical obligation to provide life- sustaining treatment if he or she feels that it is futile,
but he or she has the responsibility to inform the patient and the family about it.
The person retains a copy of the order to be used in the case of any emergency in which the
primary physician is not readily available for consultation. Attorneys and notaries may not be
required in the development of these directives. If the person is not capable of
communicating his or her wishes, the surrogate decision maker (most often family or
significant other) determines the measures that will or will not be taken. In this case, the
physician and nurse can discuss the options that are available with the family. Then it is
important to document the family's decision. This is important because often nurses and other
medical professionals do not know who can legally make EOL decisions for patients when
they no longer have decisional rights.
FACTS ABOUT DONATION:
Anybody can be an organ donor irrespective of their age, gender, caste, religion, and
community. However, anyone younger than 18 need to have agreement of parents or
guardian to be a donor.
The decision to donate the organ is based on the strict medical criteria and law.
Tissues such as cornea, heart valves skin and bones can be donated in case of natural
death but vital organ such as heart, liver, kidney, intestine, lungs and pancreas can be
donated only in case of "brain death".
Organs such as heart, pancreas, liver, kidney, and lungs can be transplanted to those
recipients whose organ are failing, because it allows many recipients to return to
normal life style.
ORGAN DONATION TO BE HIGHLIGHTED IN THE NURSING AND GENERAL
CURRICULUM:
In calculating the concept of "organ donation" should begin in primary education so
that the children get a clear understanding and need of its irrespective of myths and
fear.
Gradually its scope can be widened till the professional education. Printed message on
notebook, short films, leaflets, role plays are the effective communication media for
students.
ETHICS OF ORGAN DONATION
1. There are guidelines for nurses who work in areas where organ donation and
transplant occur. She should be the "whistle blower" if any unethical things happen.
2. The nurses first obligation is the well-being of the patient entrusted to our care.
3. The act of procuring organs should never be the explicit causes of a person's death.
4. Nurses understand the good of organ donation itself.
PIVOTAL ROLE OF NURSE IN ORGAN DONATION
Registered professional nurse are often the primary care givers for patients
approaching the final stage of life.
It is the nurse who facilitates the coping of patients and their families. In general, the
work of transplant nurse is anchored on counseling and facilitating the process for
organ or tissue donation by educating and guiding to the donor families without
doubt, a difficult, heart wrenching process.
The nurses stay with the patients and help the family to understand the organ donation
process, which includes keeping the brain-dead patient's body functioning until the
organ been collected.
ROLE OF NURSING IN DONATION PROCESS
Nurses frequently are the first health care professionals to identify a potential
organ donor and make appropriate referrals. The ongoing physical assessment
and hemodynamic monitoring provided by critical care nurses help direct care
to maintain transplantable organs and tissues in optimal condition. Nurses are
in best position to provide compassionate support.
Psychosocial Implications: There are many sources of stress for nurses
involved in the organ donation/procurement procedures. One major stress is
the declarative of brain death and the issues surrounding the termination of
treatment. Other stressor includes questions of professional competence
because of the inability of the health care team to save the life of this
previously healthy individual. Further conflict arises because these nurses are
responsible for other critically ill patients in the critical care unit. Caring fort
the organ donor requires intensive hemodynamic monitoring and careful
management to preserve organ viability. Participation in donor care is
emotionally draining because of the support and comfort needed by family. It
is time consuming and requires intense monitoring and expent application of
physical and psychosocial assessment skills.
Transplantation: Once the transplantable organs have been surgically removed
and preserved in a sterile iced electrolyte solution and transported to the
respective transplant center, kidneys c maintain viability as long as 72 hours.
Blood type compatibility is mandatory. Then hist compatibility is tested.
Priority is given potential recipients who are medical emergencies. For a renal
transplant medical emergency is the inability to maintain artery venous access
for hemodialysis.
Perioperative Period
Living Related Donor Selection and Preparation: Living related donors
are preferred in most of the centers in the country. Living related
donors are usually siblings, parents or children. Physiologic and
psychological assessments of a potential donor are done.
Histocompatibility (Tissue typing) studies and blood typing are done
first. A donor must have a compatible blood type with the recipient and
A similar tissue type to prevent rejection. If matching is found an
initial testing the donor undergoes extensive assessment which
includes physical examination including chest x-ray, urinalysis, urine
culture, intravenous pyelogram, complete blood count, electrolyte
studies, glucose tolerance tests, BUN, Serum creatinine, creatinine
clearance, aortogram and renal arteriogram.
Cadaveric Donors: Donations are received mainly from trauma
victims. Donors must be free of systemic diseases.
Recipient Selection and Preparation: A successful transplant can be
achieved even in complicated cases. Strict criteria are followed before
deciding on surgery, then the histocompatibility studies and also typing
is done to assess the compatibility with donors.
A tissue typing cross match uses serum from the recipient mixed with
donor lymphocytes to test for any preformed cytotoxic antibodies to
the donated kidney. A positive cross match indication to
transplantation. If transplanted, this type of kidney will undergo
hyperacute rejection.
Preoperative Dialysis: If the patient is on hemodialysis pre- operatively it is to
be carried out within 24 hours prior to surgery, the purpose of which is to
correct hyperkalemia and hypovolemia.
Infection: Possible site of infection such as lungs, urinary tract and vascular
access site should be carefully treated with appropriate antibiotics.
Living Related Donor
Frequently bloc catheter. If catheter is present, use aseptic technique.
The usual postoperative care is similar to that after a nephrectomy.
Often the donor is forgotten as all attention is diverted to recipient.
Pain of a nephrectomy patient is more than a recipient as it requires
partial rib resection. The renal transplant requires to maintain more
than 120/80 mm renal.
Recipient
The nursing care of recipient is similar to that of any other patient
undergone a major surgery
CONCLUSION
Nurses play a pivotal role in the organ donation process, acting as crucial advocates for
potential donors by identifying suitable candidates, providing sensitive support to families
during a difficult time, facilitating communication with the organ procurement team, and
ensuring optimal donor care, ultimately contributing significantly to increasing organ
donation rates and saving lives through transplantation; their knowledge, empathy, and
proactive approach are essential for navigating the complex emotional and medical aspects of
organ donation.
BIBLIOGRAPHY
Book References
i. Ansari J, Kaur D, "Medial Surgical Nursing", PeeVee Publications, Jalandhar, 1st
edition, 2015 Pages no: 560-564.
ii. Harding, Kwong, Roberts, Hagler, Reinisch, “Lewis’s Medical -Surgical Nursing”,
Elsevier Publications, Fourth South Asia edition, 2017, Pages no: 1046-1048.
iii. Kuruvilla J, “Essentials of Critical Care Nursing”, Jaypee Publications, 1st edition,
2017, Pages no: 353-355
Website References
Role of a Nurse in Organ Donation, Sambad J, January 22, 2018.
https://www.slideshare.net/slideshow/role-of-nurse-in-organ-donation-
8652051/86525051/
