Organ Donation After Circulatory Death - Essay Example

?Running head: ORGAN DONATION Organ Donation After Circulatory Death: Vital Partnership Number) (Date of Submission) Organ Donation After Circulatory Death: Vital Partnership Introduction As individuals working on a science that deals with actual human lives, nurses are bound to encounter ethical dilemmas that warrant the nurse’s professionalism as well as compassion. An example of an ethical dilemma is the case of organ donations, specifically “organ donation after circulatory death (DCD)”. A DCD involves a legal basis for harvesting organs from a patient that cannot be declared brain dead, but who has undergone irreversible cardiopulmonary death (Institute of Medicine [IOM] and Committee on Increasing Rates of Organ Donation, 2006). In relation, this paper will explore the different ethical issues connected with DCD, in relation to a case published in the American Journal of Nursing (Beach, Hallett, & Zaruca, 2011). This paper will explore the said issue by first presenting an overview of the case, the ethical dilemma present, and the possible alternatives that could have been used to solve the problem, all with the aid of the Decision-Making Model (Bohinc & Gradisar, 2003). Case Overview Sharon, a 50-year old female, presented unconscious to the Emergency Department after a car accident. Within a few hours after admission, Sharon’s condition declined, to a point where she had no facial and corneal reflexes, she posture was decerebrate, and she did not respond to any stimuli. According to the institution’s policy, Sharon was candidate for DCD and so the protocol for harvesting was activated. Upon learning the patient’s desire not to be “hooked to tubes” (via a living will) and her wish to donate her organs, the family signed an informed consent for DCD. The patient was then removed from the supportive devices to await death. However, since the patient was able to live through the recommended time for death to maintain organ viability, Sharon was unable to donate her organs in the end. The ethical problems in this case will be expounded on in the next portion of the paper. Ethical Problems and Personal Ethical Views/Values In looking at the case of Sharon, three main ethical principles come to the fore: the principles of nonmaleficence and sanctity of live versus the principles of beneficence and double effect. Nonmaleficence argues that above everything else, nurses must do no harm to their patients, while sanctity of life posits that life is sacred and withdrawing life support would inadvertently counteract this principle (Burkhardt, Nathaniel, & Walton, 2010). On the other hand, beneficence involves a decision wherein one person’s interest may be sacrificed provided that the effect benefits a bigger majority, or for the greater good (Sorrell, 2008). In addition, the principle of double effect puts forward that in cases where in an action’s harmful effects cannot be separated from the good effect, then the said action is justified provided that the act in itself is morally good, and the good effect greatly outweighs the bad effect in a situation that is adequately serious or severe, to truly justify the condonement of the negative effect (Cavanaugh, 2006). Nonmaleficence enters in the case in the fact that withdrawing support would inevitably harm the patient, and withdrawing life support would cause the patient’s death, which goes against the principle of ‘sanctity of life’. In opposition to this, the principles of beneficence and double effect actually justify the withdrawal of the life support, especially since the patient can be basically considered dead in terms of her cardiopulmonary functions, and the organs to be harvested could have helped a large number of individuals in need of organs. Thus, the withdrawal of the life support can actually be justified by the idea that the benefit was much greater than the bad effect. However, in looking at the case, all the emotional stress placed by the decision-making for the case of Sharon was actually made useless by the fact that Sharon did not die within the required timeframe of 60mins. Therefore, all the efforts of the healthcare team, the organ procurement organization, and even the patient’s family became. In the end, it can perhaps be said that Sharon’s organs became useless, and the large number of lives that could have been saved by her organs will have to undergo another cycle of despairing waiting. With these problems, some alternatives will then be presented below. Alternatives Given that the patient has consented before her death to the harvesting of her organs, one possible, although not so acceptable, alternative would actually be to truly wait for the patient to die. This can be achieved in two ways: one is to lower the ventilator’s assistive capacity to the minimum without removing the machine, or induce euthanasia. The first method would allow the body to die a “natural death”, while at the same time attempting to maintain the viability of the organs. However, this would require a longer period of time and can actually cause greater stress for the family. Nevertheless, another positive side of this method is that it may give the body ample time to recover and function on its own. As for the second method, the unethicality of inducing brain death in the patient may actually cause healthcare providers to refuse it, especially since doing so would incur great ethical and legal repercussions. Still, another option that could have been used for Sharon was the use of “directed donation”, a method very much similar to when a live person gives a portion of a large organ or a single member in a pair of organs. This method is very much doable and would have been more acceptable with the least possible issue, especially since Iltis and Cherry (2010) noted that in DCD, it is usually only the kidneys, liver, and pancreas that are procured. Still, perhaps the best solution for the case of Sharon would have been to keep her in ventilator support until her body recovers. This is after the fact that studies have revealed a possible means of revival even after cardiac asystole (Adhiyaman & Sundaram, 2002), and several methods including hypothermia (Webb & Samuels, 2011) and extracorporeal circulatory support (Younger, et al., 1999) may actually reverse cardiac death. Plan of Action Given these possible alternatives, a plan of action can then be taken by the nurse. Having established that revival may be possible with the use of appropriate resources, every available option for the family should be explained to them. Depending on the family’s decision, the nurse can then conduct a quick search of evidences for replicating revival methods in the study by (Adhiyaman & Sundaram, 2002), or hypothermia and extracorporeal support. With whatever methods the family chooses, the nurse must be prepared to respond and assist the family. It should be noted that there can really be no real singular plan for dealing with the patient’s case since every step can change depending on the family’s decision because at the end of it all, the patient and her family should be the priority of the health care team, and not the possible recipient of the organs Sharon would have supposedly been able to supply. Evaluation and Conclusion In deciding to go with the decision of the family and in deciding to prioritize Sharon above the possible recipients of her organs, I believe that I did the right thing. Indeed, this decision is the most ethical since the nurse’s responsibility is to Sharon and her family, and not to some strangers that would have received the patient’s organs. Certainly, no matter how difficult it may appear sometimes, the nurse’s foremost responsibility is to her patient. Word Count: 1,248 References Adhiyaman, V., & Sundaram, R. (2002). The Lazarus phenomenon. J. R. Coll. Physicians Edinb, 32, 9-13. Beach, P. R., Hallett, A. M., & Zaruca, K. (2011). Organ Donation After Circulatory Death: Vital Partnerships. American Journal of Nursing, 111 (5), 32-38. Bohinc, M., & Gradisar, M. (2003). Decision-Making Model for Nursing. Journal of Nursing Administration, 33 (12), 627-629. Burkhardt, M. A., Nathaniel, A. K., & Walton, N. A. (2010). Ethics & issues in contemporary nursing. Toronto: Nelson Education. Cavanaugh, T. A. (2006). Double-effect reasoning: doing good and avoiding evil. New York: Oxford University Press. Iltis, A. S., & Cherry, M. J. (2010). Death revisited: rethinking death and the dead donor rule. Journal of Medical Philosophy, 35 (3), 223-41. Institute of Medicine (IOM) and Committee on Increasing Rates of Organ Donation. (2006). Organ donation: opportunities for action. (J. F. Childress, & C. T. Liverman, Eds.) Washington, D.C.: National Academies Press. Sorrell, J. M. (2008). Ethics: Ethics in Healthcare Organizations: Struggling with New Questions. Online Journal of Issues in Nursing, 13 (3), 5. Webb, A. C., & Samuels, O. B. (2011). Reversible brain death after cardiopulmonary arrest and induced hypothermia. Critical Care Medicine, 39 (6), 1538-1542. Younger, J.G., et al. (1999). Extracorporeal resuscitation of cardiac arrest. Acad Emerg Med, 6, 700-7. Read More