Tissue and Organ Donation

About this course

The number of people who are waiting for an organ transplant far exceeds the number of donor organs available. While there are multiple ways to consent to organ donation, it is estimated that less than 40% of potential donors become actual organ donors, likely resulting from misconceptions regarding tissue and organ donation. Healthcare professionals must have the knowledge to address these misconceptions, and better educate the public on organ and tissue donation.

Learning objectives

• Describe the various tissues and organs used in donation and transplantation
• Summarize brain death and various ways brain death is determined
• Understand the functions of the organ procurement coordinator
• Outline the steps for tissue and organ donation

Course outline

10 sections · finish in any order across devices

1. 1

   Introduction

   In the United States, it is estimated that a new person is added to the transplant list every ten minutes, and every day, twenty people on the transplant list will die while waiting for a transplant. An organ transplant is performed in people with end-stage organ failure and can increase life expect

   4 min

2. 2

   Organ Transplantation

   Organ transplantation is the removal of an organ from one person (the donor), and placement into another (the recipient). ⁸˒⁹ Organs that may be recovered from the donor and transplanted into the recipient include the heart, intestine, kidney, liver, lung, heart, and pancreas. Tissues that may be re

   4 min

3. 3

   Living Donors

   A living donor is someone who donates an organ while they are still living. The most common organs (or partial organs) donated by a living donor are the kidney and liver. Relatives, loved ones, and friends are most likely to donate. To become a living donor, one must be 18 or older, healthy, and ant

   4 min

4. 4

   Dead Donor Rule

   The “Dead Donor Rule” (DDR) lies at the heart of current organ procurement policy. It is not a legal statute; rather, it is an ethical norm that reflects the widely held belief that it is wrong to kill one person to save the life of another. ⁵ Because of this ideology, an organ donor must already be

   4 min

5. 5

   Brain Death

   To make a diagnosis of brain death, an individual must be in an irreversible coma with a known cause (ex. anoxia, brain tumors, cerebrovascular accidents, or traumatic brain injuries) and completely unresponsive to stimuli. ¹ All reversible causes of a coma must be excluded, and all central nervous

   4 min

6. 6

   Circulatory Death

   Circulatory death is defined as the irreversible loss of cardiopulmonary function. The typical donation after cardiovascular death (DCD) donor is one who has suffered a neurologic injury but does not fit the criteria for brain death. ³ There are two defined forms of DCD, controlled circulatory death

   4 min

7. 7

   Preparing for Procurement

   Local organ procurement organizations assist with the coordination of organ and tissue donation, including the evaluation of potential donors, obtaining consent for organ and tissue donation, organ and tissue allocation, and the procurement process. ⁶ The organ procurement coordinator (who is often

   4 min

8. 8

   Medical Ethics

   Medical ethics, a set of values used to navigate complicated situations, are founded in the concepts of patient autonomy, beneficence, non-maleficence, and justice. These concepts are relevant in organ donation and transplantation. Much of the ethical framework surrounding organ and tissue donation

   4 min

9. 9

   Working within the Team

   The healthcare professional's responsibilities in tissue and organ donation varies with their role. Some providers work with the families of donors, while others work with the families of recipients. Some may be responsible for performing procurement, while others are responsible for managing the pa

   4 min

10. 10

    Conclusion

    Tissue and organ donation is of tremendous benefit to people in need of a transplant. One donor’s tissue and organ donation can improve several lives. While most of the public is in favor of organ donation, people often fail to include this decision in their living wills or discuss their desires reg

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Bernat, J. L. (2017). Brain death and the definition of death. Oxford Scholarship Online.
• Childress, J. F. (2017). The failure to give: Reducing barriers to organ donation. Organ and Tissue Transplantation, 203-218.
• Donation after cardiac death. (2015). Encyclopedia of Trauma Care, 490-490.
• Friedman, L., & Thistlethwaite, Jr, J. R. (2021). Expanding living donor liver transplantation. The Living Organ Donor as Patient, 214-240.
• McKenna, B. (n.d.). The ‘dead donor rule’ and organ donation. Foundations of Healthcare Ethics, 246-262.
• Price, D. (n.d.). Consent to donation. Human Tissue in Transplantation and Research, 99-121.
• Price, D. (n.d.). Living donation. Human Tissue in Transplantation and Research, 196-229.
• Roh, Y. (2018). Organ donation. Organ Donation and Transplantation - Current Status and Future Challenges.
• Roh, Y. (2018). Organ donation. Organ Donation and Transplantation - Current Status and Future Challenges.
• Tissue and Organ Donation Posttest
• The “Dead Donor Rule” is an ethical norm that reflects the widely held belief that it is wrong to kill one person to save the life of another.
• The Uniform Declaration of Death Act (UDDA) assures patients, families, and healthcare professionals that a patient who is brain dead is in fact dead.
• Donation after cardiac death (DCD) allows donation by patients who are near death and are ventilator-dependent but will not progress to brain death.
• In the process of donation after cardiac death, if circulation does not stop within _____minutes, the organs are deemed to be too damaged for transplant.
• In determining brain death, spinal reflexes can remain in up to 75% of people and therefore, their presence should not stop a diagnosis of brain death.
• An apnea test can also assess respiratory drive.
• The electroencephalography (EEG) is a common method to assess for brain electrical activity, however it can be heavily influenced by sedation, hypothermia, and metabolic disorders limiting its usefulness.
• Controlled DCD happens when an anticipated cardiac arrest occurs.
• Uncontrolled DCD is most frequently seen in individuals who are dead on arrival to the hospital.
• A healthcare professional can preclude themselves from the donation and transfer of tissue and organs.
• Tissue and Organ Donation Posttest Answers
• The “Dead Donor Rule” is an ethical norm that reflects the widely held belief that it is wrong to kill one person to save the life of another.
• The “Dead Donor Rule” (DDR) lies at the heart of current organ procurement policy. It is not a legal statute; rather, it is an ethical norm that reflects the widely held belief that it is wrong to kill one person to save the life of another.
• The Uniform Declaration of Death Act (UDDA) assures patients, families, and healthcare professionals that a patient who is brain dead is in fact dead.
• The Uniform Declaration of Death Act (UDDA) assures patients, families, and healthcare professionals that a patient who is brain dead is in fact dead, and in combination with the dead donor rule, the removal of organs for life-saving transplantation legally and ethically acceptable.
• Donation after cardiac death (DCD) allows donation by patients who are near death and are ventilator-dependent but will not progress to brain death.
• Donation after cardiac death (DCD) - This type of organ donation allows donation by patients who are near death and are ventilator-dependent but will not progress to brain death. After a valid decision is made to discontinue life support, the option of organ donation may be offered. If the patient expressed a wish to be a donor or if the family agrees to donation, donation after cardiac death may be conducted.
• In the process of donation after cardiac death, if circulation does not stop within _____minutes, the organs are deemed to be too damaged for transplant.
• If circulation does not stop within 60 minutes, the organs are deemed to be too damaged for transplant because of the ischemia that develops because of diminished circulation, and the patient dies without donating organs.
• In determining brain death, spinal reflexes can remain in up to 75% of people and therefore, their presence should not stop a diagnosis of brain death.
• The brainstem reflexes: corneal, cough and gag, pupillary, oculocephalic, and vestibular should be assessed, however spinal reflexes can remain in up to 75% of people and therefore, their presence should not stop a diagnosis of brain death.
• An apnea test can also assess respiratory drive.
• An apnea test can also assess respiratory drive. The apnea test is performed by disconnecting an individual from the ventilator for 10 minutes and observing for no respiratory effort and increasing PaCO2. If cardiac arrhythmia hypoxemia or hypotension occurs during the test, the ventilator must be reconnected. A false-positive apnea test can occur when sedation is administered or a high cervical injury impairing diaphragmatic function is present.
• The electroencephalography (EEG) is a common method to assess for brain electrical activity, however it can be heavily influenced by sedation, hypothermia, and metabolic disorders limiting its usefulness.
• Assessing the cerebral blood flow through cerebral angiography, transcranial doppler ultrasound, and cerebral scintigraphy are useful tests to confirm brain death because they are not influenced by central nervous system depression, hypothermia, or metabolic disorders. The electroencephalography (EEG) is also a common method to assess for brain electrical activity, however it can be heavily influenced by sedation, hypothermia, and metabolic disorders limiting its usefulness.
• Controlled DCD happens when an anticipated cardiac arrest occurs.
• Controlled DCD happens when an anticipated cardiac arrest occurs. In these cases, the decision to withdraw care is made before the decision to donate. Most often, the declaration of death occurs in the operating room. Life-sustaining measures are withdrawn, and the donor is monitored until there is a loss of cardiopulmonary function.
• Uncontrolled DCD is most frequently seen in individuals who are dead on arrival to the hospital.
• Uncontrolled DCD is most frequently seen in the Emergency Department. These cases are often individuals who are dead on arrival to the hospital. Unexpected cardiac arrests in patients admitted to the hospital are also described as uncontrolled. Because these deaths are unexpected, organ donation in this group is more complicated because end-organ ischemia has likely already begun. Steps must be taken to stop the progression of ischemia while preparation and consenting for organ procurement occurs.
• A healthcare professional can preclude themselves from the donation and transfer of tissue and organs.
• A healthcare professional can preclude themselves from the donation and transfer of tissue and organs, but they cannot prevent such acts from occurring because the patient's desires should be respected as a personal choice.

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