Introduction:

Although scientists and physicians had experimented with organ transplant as early as the mid 18th century it was not until 1954 that the first successful kidney transplant was performed by Dr. Joseph Murray at the Brigham and Women’s Hospital in Boston Massachusetts.  The past 50 years have seen a remarkable rise in the practice or transplant to the point where it is an ordinary and important part of the practice of medicine. While other medical innovations have seen similar advances, transplant is unique because the key element making transplant possible is a supply of donor organs. Much of the ethics surrounding transplant surgery has to do with the ways in which donor organs are procured or harvested. All physicians need to be acquainted with these issues because there are a number of ways in which the topic of donation can arise in the practice of medicine. Emergency department physicians and others who deal with critically ill patients will often fine themselves on the forefront of organ procurement but almost all physicians will find themselves asked for advice about donation or the care of critically ill family members.

In this unit we will explore a number of these ethical issues. We begin with donors and their qualifications, examine the ethical issues surrounding directed donation, and finally look at the global health issues surrounding various types of organ donor networks.

Objectives:

At the conclusion of this unit you should be able to:

• Describe how an organ donation network operates.
• Explain the criteria for becoming an organ donor and for eligibility as a recipient.
• Discuss the impact of public solicitation of donor organs on the health care system.

Preparation

• Read the articles assigned on the resources page.
• Explore the UNOS web site for the latest statistics on donation, policies on donor acceptance, and operation of the transplant network in our state.
• Explore the New York State Donor Network web site for local policies and practices.
• Suggestions for Written Assignment:
• The cases for this week and cases found on the web are apt topics for a position paper.
• Any topical issue in donation such as public solicitation, fairness in procurement, legal and economic issues, etc. are all excellent venues for a position paper.
• You may review one of the articles or even one of the web sites.
• Choose a controversial case and write a letter to the editor.

Process

• We begin in Lecture today with David Bekofsky, Transplant Coordinator for University Hospital.
• In Section continue to discuss Mr. Bekofsky’s lecture and the cases for the week.

Study Guide:

• Explain the difference between Deceased Donor, Living Donor, Deceased Donor after Cardiac Death, Extended Criteria Donor.
• What is directed donation and under what circumstances is it legal and ethical.
• Explain the difference between graft survival and donor survival and why this distinction is important in recipient selection.