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Friday, May 20, 2005

Should we be dying to donate?

Bio Ethicists are at it again. This time the discussion is "should patients be able to decide to donate while they are still alive?"

In September, the prestigious and influential Kennedy Institute Journal of Ethics devoted an entire issue to such topics.

One ethicist even stated, "A patient, while still competent, may choose to have organs removed prior to death, through an advance directive".

Some of the ethicists cited an Ohio poll showing widespread public confusion over whether terms like "brain death", "vegetative state" and "coma" described a living or dead person as an opportunity to change the rules about organ donation.

Last October, Colorado coroner and paramedic Mark Young sent shockwaves through the organ transplant community when he ruled that a 31-year-old man's death was a homicide as the result of his organs being removed, rather than the result of a self-inflicted gunshot wound to the head.
Mr. Young contended that the standard of brain death was not adequately met.

In December 2004 25-year-old K. Venkatesh, a young man with muscular dystrophy who developed respiratory failure requested his ventilator be removed and his organs removed before actual death. His family supporte his decision.

Nancy Valko sat in at a meeting of Drs. and was surprised to hear one suggest they remove the EEg test on hospital's policy on brain death tests required for organ donation. Reason? Some people after a stroke who are near death maintain brain activity. She was accused of favoring the near-death altho still alive patients over those who are in need of organs, when she objected!

Some strategies propose changing organ donation rules from consent for donation to "presumed consent." Which means Unless you "OPT OUT" it is presumed you will consent to organ harvesting!

HHS has recommended that hospitals be required to notify organ procurement organizations prior to the withdrawal of life support so that such patients can be evaluated as "potential organ donors."

"When organ donors are not referred and organs are buried, patients die and deaths in a hospital are a sentinel event,"said Howard M. Nathan, president of the Gift of Life Donor Program, based in Philadelphia.
Nathan admitted the measure sounds "a little severe," but said it was a necessary step to "force hospitals to take this seriously."

The Assn. of Organ Procurement Organizations first advanced this idea in a May 6, 2002, letter to U.S. Dept. of Health and Human Services Secretary Tommy Thompson. The group pointed out how failure to identify a potential donor meets the National Quality Forum's definition of a "serious reportable event."

So Now Hospitals get into trouble for NOT harvesting organs?

"It shouldn't rely on an individual physician or nurse to make a decision to make a phone call to an organ procurement organization," he said. "It should be a routine event."

Like every other organisation who wants to change the world they are heading for the children!
Educational programs for promoting organ donation are entering many school systems and especially aimed at new teen drivers.

The most outrageous proposal of all is performing outright euthanasia to obtain organs.

Drs. Robert D. Troug and Walter M. Robinson said

"We propose that individuals who desire to donate their organs and who are
either neurologically devastated or imminently dying should be allowed to donate
their organs, without first being declared dead."

So Serious are these people they have contact HHS and President Bush has signed a bill Public Law 108-216 which authorizes $25 million in new resources for efforts to increase donation, including providing
(1) grants for reimbursement of travel and subsistence expenses and incidental non-medical expenses incurred by individuals toward making living organ donations;
(2) peer reviewed grants for studies and demonstration projects to increase organ donation and recovery rates;
(3) grants to states for organ donor awareness, public education and outreach activities, and programs designed to increase the number of organ donors within the state; and
(4) matching grants to qualified organ procurement organizations and hospitals to establish programs coordinating organ donation activities to increase the rate of organ donations for such hospitals.

The law also directs the Secretary, acting through the Director of the Agency for Healthcare Research and Quality, to:
(1) develop scientific evidence supporting increased donation and improved recovery, preservation, and transportation of donated organs; and
(2) support research and dissemination of findings to develop a uniform clinical vocabulary, (THAT'S CHANGING THE LANGUAGE!) apply technology to support organ procurement organizations, enhance the skills of the organ procurement workforce, and assess specific organ recovery, preservation, and transportation technologies.

U.S. Department of Health and Human Services
Advisory Committee on Organ Transplantation
Summary Recommendations to the Secretary
1: That the following ethical principles and informed consent standards be implemented for all living donors.....(I did Not List)
2: That each institution that performs living donor transplantation provide an independent donor advocate
3: That a database of health outcomes for all live donors be established and funded through and under the auspices of the U.S. Department of Health and Human Services
4: That serious consideration be given to the establishment of a separate resource center for living donors and their families.
5: That the present preference in OPTN allocation policy -- given to prior living organ donors who subsequently need a kidney -- be extended so that any living organ donor would be given preference as a candidate for any organ transplant, should one become needed. ( THEY ARE COMING FOR YOU!)
9: That research be conducted into the causes of existing disparities in organ transplant rates and outcomes, with the goal of eliminating those disparities, ( Find out why they aren't donating, then change their minds!)
10: That legislative strategies be adopted that will encourage medical examiners and coroners not to withhold life-saving organs and tissues from qualified organ procurement organizations.(Just Take what you need)
11: That the secretary of HHS, in concert with the Secretary of Education, should recommend to states that organ and tissue donation be included in core curriculum standards for public education as well as in the curricula of professional schools, including schools of education,..etc (BRAIN WASH THE KIDS!)
12: That in order to ensure best practices, organ procurement organizations and the OPTN be encouraged to develop, evaluate, and support the implementation of improved management protocols of potential donors(Start screening and keeping better records)
14:Each hospital should establish, in conjunction with its OPO, policies and procedures to manage and maximize organ retrieval from donors without a heartbeat(Take it if you need, especially if it aint moving)
15: That the following measure be added to the CMS conditions of participation: Hospitals shall notify organ procurement organizations prior to the withdrawal of life support to a patient, so as to determine that patient's potential for organ donation. If it is determined that the patient is a potential donor, the OPO shall reimburse the hospital for appropriate costs related to maintaining that patient as a potential donor.(Watching you in the Hospital, If you are a potential match they will hover over you, until they get what they want!)
17: That all hospitals, particularly those with more than one hundred beds, be strongly encouraged by CMS and AHRQ to implement policies such that the failure to identify a potential organ donor and/or refer such a potential donor to the organ procurement organization in a timely manner be considered a serious medical error. Such events should be investigated and reviewed by hospitals in a manner similar to that for other major adverse healthcare events. (It is NOW against the law to NOT harvest)
22: That the use of split livers be encouraged as a matter of national policy
28:That HHS support legislation providing for elimination of the current requirement that recipients must have been Medicare eligible when they underwent organ transplantation, in a Medicare approved facility, to later receive the immunosuppressive drug benefit when they become Medicare eligible through age or disability.(OOPS! There goes the Tax Bill, Medicare will pick up the tab!)
29: HHS should fund necessary research initiatives (MORE TAX DOLLARS!)
31:transplant centers should be encouraged to establish and implement back to work programs for transplant recipients and living organ donors (Got Kidney? Now get a JOB!)
33: So as to identify more kidneys, and more appropriate kidneys, that can be used for transplantation, HHS should fund a clinical multi-center trial to determine whether, and under what circumstances, pre-transplant kidney biopsies are a predictor of post-transplant kidney function. (they are stocking up and hoarding)
35: HHS should conduct an evaluation of materials presently used by various centers and organizations across the nation to educate potential transplant recipients; the purpose of this review would be to develop improved patient information and education as part of the informed consent process( They will swarm your hospital bed to pressure you!)