Course # 38552 • Organ and Tissue Donation and Recovery: The New Jersey Requirement


Study Points

  1. Outline trends in organ donation and transplant needs.
  2. Describe the organ/tissue donation process, including donor selection and preservation of tissues.
  3. Utilize knowledge of the clinical aspects of organ/tissue donation to create comprehensive strategies that target critical barriers to donation and recovery.

    1 . What percentage of Americans report a positive opinion of organ donation?
    A) 25%
    B) 45%
    C) 65%
    D) 95%

    IMPACT OF ORGAN AND TISSUE DONATION

    When rightly conducted, organ and tissue donation is of enormous benefit to the health and well-being of the community. It is estimated that one individual can save 8 lives through organ donation and enhance up to 50 lives through tissue donation [1]. Despite strong public sentiment in favor of donation (95%), the majority of licensed drivers are not registered organ donors [3,17]. This is a problem on a national level, but the problem is even greater in New Jersey. While organ donation in the state increased 35% between 2012 and 2018, only about 40% of New Jersey drivers are registered organ donors, compared to about 58% nationwide [3,16,17,18]. There are currently nearly 4,000 individuals in the state of New Jersey waiting for a life-saving transplant [16]. Every day, three New Jersey residents are added to the transplant waiting list, and every three days, one person in New Jersey dies waiting for a transplant organ [16]. In one 10-year period, nearly 2,500 New Jersey residents (and almost 75,000 nationwide) died because a transplant organ was not available [1].

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    2 . What percentage of New Jersey licensed drivers are organ donors?
    A) 1%
    B) 13%
    C) 40%
    D) 61%

    IMPACT OF ORGAN AND TISSUE DONATION

    When rightly conducted, organ and tissue donation is of enormous benefit to the health and well-being of the community. It is estimated that one individual can save 8 lives through organ donation and enhance up to 50 lives through tissue donation [1]. Despite strong public sentiment in favor of donation (95%), the majority of licensed drivers are not registered organ donors [3,17]. This is a problem on a national level, but the problem is even greater in New Jersey. While organ donation in the state increased 35% between 2012 and 2018, only about 40% of New Jersey drivers are registered organ donors, compared to about 58% nationwide [3,16,17,18]. There are currently nearly 4,000 individuals in the state of New Jersey waiting for a life-saving transplant [16]. Every day, three New Jersey residents are added to the transplant waiting list, and every three days, one person in New Jersey dies waiting for a transplant organ [16]. In one 10-year period, nearly 2,500 New Jersey residents (and almost 75,000 nationwide) died because a transplant organ was not available [1].

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    3 . How many people died in New Jersey waiting for a transplant in one 10-year period?
    A) 250
    B) 2,500
    C) 25,000
    D) 250,000

    IMPACT OF ORGAN AND TISSUE DONATION

    When rightly conducted, organ and tissue donation is of enormous benefit to the health and well-being of the community. It is estimated that one individual can save 8 lives through organ donation and enhance up to 50 lives through tissue donation [1]. Despite strong public sentiment in favor of donation (95%), the majority of licensed drivers are not registered organ donors [3,17]. This is a problem on a national level, but the problem is even greater in New Jersey. While organ donation in the state increased 35% between 2012 and 2018, only about 40% of New Jersey drivers are registered organ donors, compared to about 58% nationwide [3,16,17,18]. There are currently nearly 4,000 individuals in the state of New Jersey waiting for a life-saving transplant [16]. Every day, three New Jersey residents are added to the transplant waiting list, and every three days, one person in New Jersey dies waiting for a transplant organ [16]. In one 10-year period, nearly 2,500 New Jersey residents (and almost 75,000 nationwide) died because a transplant organ was not available [1].

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    4 . It is recommended that nurses interested in becoming more involved in organ donation do all of the following, EXCEPT:
    A) Become familiar with the local organ procurement program and encourage colleagues to do the same.
    B) Study only the cultural, religious, and social issues surrounding the donation of organs and tissues that fit their particular belief system.
    C) Take part in educational programs and activities regarding organ donation recruitment, including staff development and public awareness campaigns.
    D) Serve as a resource to colleagues, patients, and families for the distribution of accurate information regarding organ donation.

    ROLE OF THE CLINICAL CARE PROVIDER

    For those who do wish to become more involved in donation efforts (either directly or indirectly), there are several steps that can be taken, including improving donor awareness and increasing enrollment in donor registries. It is recommended that interested nurses [4]:

    • Become familiar with the local organ procurement program and encourage colleagues to do the same.

    • Study the ethical, cultural, religious, and social issues surrounding the donation of organs and tissues.

    • Take part in educational programs and activities regarding organ donation recruitment, including staff development and public awareness campaigns.

    • Serve as a resource to colleagues, patients, and families for the distribution of accurate information regarding organ donation.

    • Acquire the knowledge and skills required to work with members of the healthcare team, the OPO and/or tissue bank, and the facility in the identification and recovery of viable organs and tissue for transplantation.

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    5 . In the state of New Jersey, cardiac death is a satisfactory prerequisite for organ donation if all the following conditions are met, EXCEPT:
    A) Consent is obtained for a do not resuscitate order and donation.
    B) Suitability for donation as determined by NJ Sharing Network.
    C) The organ procurement organization's coordinator is present when life support is withdrawn to pronounce the death.
    D) The family or patient, via an advance directive or discussion with physician, has decided to withdraw life support.

    CLINICAL ASPECTS OF ORGAN DONATION

    In certain cases, cardiac death is a satisfactory prerequisite for organ donation. This includes cases in which the following conditions are met [9]:

    • The family or patient, via an advance directive or discussion with physician, has decided to withdraw life support.

    • The suitability for donation has been determined by the New Jersey Organ and Tissue Sharing Network (NJ Sharing Network).

    • Consent is obtained for a do not resuscitate (DNR) order and donation.

    • The attending physician or designee not affiliated with the transplant or organ recovery team will be present when life support is withdrawn to pronounce the death.

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    6 . In the absence of a potential donor's personal consent, who should approach the family of the deceased to initiate a request for consent?
    A) Nurse
    B) Nurse and physician
    C) Nurse, physician, and hospital administrator
    D) Hospital staff in collaboration with the NJ Sharing Network designated requestor

    CLINICAL ASPECTS OF ORGAN DONATION

    If the medical evaluation of the patient does not rule out donation, the OPO coordinator should discuss the next steps for donor management, plan of care, and approach for consent (including additional tests and notification of clergy, social work, or bereavement, if not already initiated) with the attending physician (or designee). The state donor registry is searched to determine if the patient has given prior consent by enrolling in the registry (i.e., has a donor card) or if intent to donate is indicated on the patient's driver's license. When these forms of consent are absent, the OPO will contact the next of kin to obtain consent according to state policy in the following order: spouse or certified domestic partner, adult child, parent, adult sibling, legal guardian, another person authorized or under an obligation to dispose of the body (e.g., hospital administrator, designated healthcare representative, holder of a durable medical power of attorney, person named in the decedent's will) [9]. There should also be an attempt to access a living will or advance directive. Hospital staff should only approach the family in collaboration with the NJ Sharing Network designated requestor. During this time, the donor is maintained on artificial support and monitored by medical staff.

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    7 . Who is responsible for contacting the Organ Procurement and Transplantation Network (OPTN) to initiate a search for matching recipients in the national database of all patients waiting for a transplant?
    A) Nurse
    B) The OPO
    C) Attending physician
    D) All of the above

    CLINICAL ASPECTS OF ORGAN DONATION

    The OPO is responsible for contacting the medical examiner and the Organ Procurement and Transplantation Network (OPTN) to initiate a search for matching recipients in the national database (operated by the United Network for Organ Sharing, under contract to the U.S. Department of Health and Human Services) [6]. Donor organs are matched with recipients based on various characteristics (e.g., blood type, tissue type, height, weight) and other considerations (e.g., patients' waiting time, severity of the patients' illness, distance between hospitals). As noted, gender, income, race, and social status are not referenced. Information about patients awaiting transplants is stored in the OPTN system, and when the donor information is entered into the system, a matching recipient list (by organ/tissue type) is generated. The first match for each organ/tissue becomes the prime transplant candidate; however, the transplant surgeon makes the final decision based on various considerations (e.g., recipient health status, suitability of each organ/tissue, availability of the recipient) [6]. Local patients are typically offered most organs (75%), while the remainder is shared with recipients in other regions of the country.

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    8 . Living donors most often donate a
    A) kidney.
    B) liver segment.
    C) lung segment.
    D) pancreas segment.

    LIVING DONORS

    Living donation has the potential to greatly reduce wait times for individuals in need of a transplant. The kidney is the most commonly donated organ from a living donor, followed by liver segment donation (usually to a family member). In rare instances, lung, intestine, or pancreas segments may be transplanted [10]. There are two types of living donation: directed donation, when a donor names a specific patient to receive their organ, and non-directed (altruistic) donation, when an organ is given to an unknown recipient. To become a living donor, individuals should contact the transplant program where the intended recipient is listed or, in the case of non-directed donation, a transplant center of their choosing. A list of transplant centers is available online at https://optn.transplant.hrsa.gov.

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    9 . Which of the following statements about organ donation is TRUE?
    A) An individual/family must cover the costs for the donation of an organ or tissue.
    B) If a patient is sick or injured and admitted to a hospital, the number one priority is to harvest the patient's organs.
    C) All major religions in the United States support donation as an unselfish act of charity that will save or improve someone's life.
    D) When matching donor organs to recipients, a computerized matching system primarily considers issues such as race and social status.

    OVERCOMING BARRIERS TO DONATION

    COMMON MISCONCEPTIONS ABOUT ORGAN DONATION

    MythFact
    If emergency department physicians know the patient is an organ donor, they will not work as hard to save him/her.Saving the patient's life is the highest priority of all emergency department staff. It is a basic fundamental of medical ethics. Furthermore, the emergency department team is not involved with the recovery/transplant process.
    An individual is too old to be a donor.There is no set age limit on donation. Organs have been recovered from donors older than 90 years of age.
    Cannot donate organs/tissue because religion prohibits donation.All major religions in the United States acknowledge donation as a selfless act of kindness and compassion.
    The cost of organ donation will be passed to family members.There is no cost to donors' families.
    The body is mutilated during recovery, and an open casket will not be possible.Care is taken to respect the body. The same techniques used during live surgery are employed, including sterile tools and environment. An open-casket funeral is possible.
    A medical condition precludes organ donation.The health status of the donor is determined at the time of death. Many medical conditions do not affect the viability of organs and tissues.
    Organs are sold to the highest bidder.Recipients are matched by a computer database based on factors that do not include socioeconomic status. Also, selling organs in the United States is prohibited by federal law and can be punished with prison sentences and fines.
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    10 . What is the age limit for organ donation?
    A) 50 years
    B) 60 years
    C) 90 years
    D) There is no age limit for donation.

    OVERCOMING BARRIERS TO DONATION

    COMMON MISCONCEPTIONS ABOUT ORGAN DONATION

    MythFact
    If emergency department physicians know the patient is an organ donor, they will not work as hard to save him/her.Saving the patient's life is the highest priority of all emergency department staff. It is a basic fundamental of medical ethics. Furthermore, the emergency department team is not involved with the recovery/transplant process.
    An individual is too old to be a donor.There is no set age limit on donation. Organs have been recovered from donors older than 90 years of age.
    Cannot donate organs/tissue because religion prohibits donation.All major religions in the United States acknowledge donation as a selfless act of kindness and compassion.
    The cost of organ donation will be passed to family members.There is no cost to donors' families.
    The body is mutilated during recovery, and an open casket will not be possible.Care is taken to respect the body. The same techniques used during live surgery are employed, including sterile tools and environment. An open-casket funeral is possible.
    A medical condition precludes organ donation.The health status of the donor is determined at the time of death. Many medical conditions do not affect the viability of organs and tissues.
    Organs are sold to the highest bidder.Recipients are matched by a computer database based on factors that do not include socioeconomic status. Also, selling organs in the United States is prohibited by federal law and can be punished with prison sentences and fines.
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