Can You Spare A Kidney?

I am submitting three discussion post from three different individuals and I need you to provide constructive and insightful comments that go beyond that of agree or disagree. I need individual responses. 1)this post is from Shana:Some ethical considerations associated with living donors include is it reasonable to ask a healthy individual to undergo surgery for the benefit of another? Transplantation of an organ from a living donor seems to violate the traditional first rule of medicine-primum non nocere (above all, do no harm)-because this procedure involves the removal of a healthy organ from one person for implantation into another person. One person becomes a patient in order to benefit another person who is already a patient. (Childress & Liverman, 2006) Donors could face potential future medical issues and financial risks as well. Every surgery comes with certain risks such as infection, blood loss, and possible damage to surrounding organs/tissues, adverse effects to anesthesia, and recovery complications. If a person consents to donate a kidney to an individual the donor will have to be off of work for at least six weeks to recover sufficiently from the surgery. This could cause an economic hardship for the donor if they do not have sufficient savings to pay bills, or if their job should be eliminated related to their time off work. Some advantages regarding a legal mandate to declare organ donation choice on the driver's license include the persons wish to give life to someone else. By having this declared on your driver's license it will take the burden of the decision out of your families hands, and by being an organ donor you could potentially save eight lives. On the flip side of this are some disadvantages include your family does not get to make the decision regarding your organs. Some religions and/or cultures have beliefs that do not include receiving an organ from another individual. Also some people believe if you put this distinction on your driver's license that medical personal will not try as hard to save your life in an emergency situation. I did not find any one specific reason why the need for donated kidneys is more than the amount available, but it stands to reason that people are not donating their organs at the end of life. There are still some individuals that believe that if you donate a loved one's organs that you are responsible for paying for the surgery to remove the organs. Another reason could be when a loved one dies unexpectedly and the family is approached by Life Gift regarding organ donation the family is emotional and may regard being asked to donate their loved one's organs as an intrusion into their grief and/or privacy. The RN's role in organ donation is complex. In the emergency room setting it is the role of the RN to contact Life Gift in the event of a patient being declared brain dead especially in order to procure a heart, liver, lung, or kidney. Life Gift will come and discuss organ donation with the patient's family. The RN in this situation would need to offer emotional support to the family. If the RN works on a floor that cares for renal transplant patients he/she would need to be knowledgeable on the process involved in preparing a potential recipient and/or donor for the surgery as well as have the skill set to monitor a post-op transplant patient. Post-op transplant patients require close monitoring of their CVP (central venous pressure), hourly urinary output from the foley catheter versus IV intake, adjustment of the IV fluids related to the urinary output per doctors orders, monitoring the incision site for bleeding and unusual swelling, pain control, oxygen and continuous pulse ox monitoring, IV steroids and anti-rejection medication, blood pressure, and lab values i.e. BUN, creatinine, H&H, and potassium level. The RN also has the important role of teaching the patient about the transplant medications they will be taking for the rest of their lives, possible side effects of these medications, as well as the signs/symptoms of rejection. 2)this post is from Paula: Collapse Total views: 33 (Your views: 3). There are ethical considerations when talking about organ transplantation. Because the process for determining death seems to be getting more rather less complex, it is not surprising that the number of living donors has begun to outpace the number of cadaver donors. Living donors may also have increased in number simply because the transplant community has become accustomed to using both living donors' whole, paired organs, such as the kidneys, and lving donors' regenerative organs such as parts of livers. Although all types of living donors are increasing in number, living kidney donors remain the most numerous among living donors. In 2003, over 40% of the kidney transplaned in the United States came from living donors (Tong, 2007). As might be expected , when one family member receives an organ from another family member, the organ recipient may feel he or she can never repay the gift they have been given. Perhaps the most poignant problems associated with living related donors occur when parents want to donate organs to their children (Tong, 2007). Organ trafficking is another area to consider as far as being unethical. This is where people are selling their organs from overseas and selling them for profit. People who are poor are desperate and will sell their organs for money. This is unethical and is illegal in the United States. It is important for the health care community to develop policies that separate clinicians' duties to organ donors on the one hand from transplant teams' duties to organ recipients on the other. No one should be a party to a situation in which, for example, family members feel that their loved one's dying process is being expedited in order to secure their organs for transplant purposes. Patients choose kidney transplantation for various reasons, such as the desire to avoid dialysis or to improve their sense of well-being and the wish to lead a more normal life. The cost of maintaining a successful transplantation is one-third the cost of dialysis treatment (Smeltzer, Bare, Hinkle, & Cheever 2010). According to several polls, more than 70% of American adults say they want to donate their organs after their death, yet relatively few actually sign donor cards. Other factors that may hinder transplantation is culture and religion. The main reasons people do not sign donor cards include not liking the idea of being cut up, lingering fears that health care professionals may hasten their death in order to secure their organs, and a general reluctance to confront matters related to death (Tong, 2007). These are a few of the disadvantages of legal mandate. Because families do not always honor their loved one's organ-donation wishes, and because health care professionals are very reluctant to processd without the family's consent, organ donors' wishes to give the gift of life are sometimes defied in death. In an effort to take the family out of the organ-donation consent process as much as possible, some experts have proposed that everyone, or at least the majority of the adult population, be required to identify themselves as either organ donors or organ nondonors when they apply for a driver's license or are admitted to a hospital or other health care facility. After identifying themselves as organ donors/organ nondonors, individuals would be assured that their organ-donations wishes would be honored irrespective of their family preference. Presumed consent policies rely on the assumption that unless individuals have taken "proactive, explicit, and legally sanctioned measures to register their refusal," it is safe to assume they would want to be organ donors. The reasoning behind this assumption is inspired by the thought that the bulk of the population is willing to give the "gift of life" to someone when they no longer need them for their own use, and that only a few persons would want to take every piece of their body to the grave. Given the fact many U.S. citizens do not fully trust health care professionals' motives when it comes to securing organs for transplant purposes, a presumed consent law may cause large numbers of them to document an unwillingness to serve as organ donors (Tong, 2007). The organization United Network for Organ Sharing (UNOS), a private nonprofit organization, determines the criteria for organ allocation in the U.S. UNOS's system may seem ideal, but it is not. Some people may live in a geographic area where the number of organ donors is high, but the number of patients waiting for organs is low. Other people may live in a geographic area where the number of organ donors is low, but the number of patients waiting for organs is high. UNOS may alter its system to become more national in focus (Tong, 2007). Even if we solve the organ-supply problem, we cannot solve the organ-transplant operations and follow-up care. In the future, one of the best ways to solve the organ-demand problem might be by not meeting it in all cases, but only in some. Rationing may prove to be the court of last resort in the world of transplantation (Tong, 2007) The RN plays a huge role in organ transplantation. The RN can educate the family on what to expect before and after the procedure. The nurse will be assessing the patient's stress and coping and offer emotional support . The nurse will be the one working with the patient and family to make sure that they are coping and seeing that the patient is adhering to the medication regimen. When applying post-op care, the RN will observe for any distress and assess for any complications that could arise after surgery. Such things as breathing exercises, early ambulation, and care of the surgical site are important to add to the post-op care. The RN should also explain the adverse affects that could happen. The patient should be instructed to inform any other health care providers about the transplantation and about the immunosuppressive meds that they are on (Smeltzer, Bare, Hinkle, & Cheever, 2010). The RN is the one who can work closely with the patient and family by educating them on any and all complications, things to expect, and things that need to be reported, should they arise. 3) this post is from Amy: Advantages to kidney transplant are, it enhances the quality of life. The patient can be free from dialysis and free from AV fistula. Dialysis is an expensive long term treatment for kidney disease. Dialysis can be omitted with a new Kidney. Kidney transplant can be more cost effective (Smeltzer, S., Bare, B., et al. (2010). The demand for kidneys is presently far greater than the supply. The source of a kidney for transplantation may be from a living or deceased donor. Often, a living donor is family or a loved one. Are there ethical considerations associated with living donors? Explain. The doctor has taken an oath to do no harm. Kidney transplant from a living donor becomes an ethical issue. This is an ethical issue because it involves the removal of a healthy organ from one person for implantation into another person. Dialysis is an option for patients with end-stage renal disease. Surgery on a healthy patient may be difficult to justify, despite the dialysis patient's diminished quality of life. What are the advantages or disadvantages of a legal mandate to declare organ donation choice on driver's licenses? End-of-life decisions are difficult, mainly because it has to do with the person's death. A decision is made to be an organ donor or not to be an organ donor. Organ donation can save lives and improve the quality of life for other people in need. Having this decision on the person's driver license is the person's choice and not the family. A disadvantage to having it on your license is there needs to be more information on what will happen. When I renewed my license the form just says do you want to be an organ donor yes or no. People caring a license need education to make an informed decision. In NH, you can get your license at 16 years old. If the deceased person did not state their wishes in advanced directives or on their driver license the family is asked if they would be willing to donate their relatives' organs. What leads to the discrepancy between the number of people who require kidney transplants and available organs? Kidneys are the most commonly transplanted organs. For most people who need a transplant, the first step in receiving a transplant is to get on the national transplant waiting list for a transplant from a deceased donor (The National Kidney Foundation, Inc.). There are insufficient organs for transport, therefore a person can wait a very long time to receive a kidney or not at all. Factors that contribute to weather the person will receive an organ are, blood type, medical urgency, distance from the organ, patients health, mental status, social support, and persons size compared to the donor (The National Kidney Foundation, Inc) . What is the professional nurse's role in organ donation? The nurse needs to offer support, education, and references to the patient, donor if applicable, and the family. Organ donation can be a long process, the patient needs guidance on the process. After the transplant, the patient has a long road to recovery. After surgery, the patient faces a possibility of rejection. Rejection is the process where the body fights off the newly implanted organ. Every person is unique and no plan of care is the same. The RN needs to develop a therapeutic relationship and develop good communication with the patient. All parts of the health care team need to work together to provide quality care. Areas that need to be assessed in developing a plan of care should include physical, psychospiritual, environmental and social aspects