Showing posts with label tissue donations. Show all posts
Showing posts with label tissue donations. Show all posts

Wednesday, April 6, 2011

Organ Donation Informed Consent, Is A Single Parent's Sufficient? Nursing Malpractice Cases

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Summary:  Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.

The patient was an 11-year-old child that had died soon after an Asthma attack.

"By condition (excluding pregnancy), the five leading causes of hospitalization among children are: bronchitis/asthma, digestive disease, pneumonia and respiratory infection, otitis media and mental disorders."1

The parents were approached for the purpose of donating the child's corneas under the Uniform Anatomical Gift Act.

"What is a Corneal Transplant?

The cornea is a dime-sized clear tissue covering the front of the eye. Light rays pass through the cornea and then through the lens. The lens forms an image on the retina in the back of the eye where the optic nerve is located. Sight is controlled by the optic nerve, the only nerve of vision. This nerve activates the retina to pick up the image in view."2

The mother alone was present at this time when it was first discussed.

"The child's mother maintains that she told the nurse it "did not matter" to her."3

"The Uniform Anatomical Gift Act (UAGA) of 1968 provided for the first time that an individual could donate his or her organs at death to another for medical purposes. It was adopted in all 50 states and the District of Columbia, and was a major step toward solving the organ donation problem. But new medical technologies have now made many transplant operations commonplace, and a shortage of donor organs remains."4

With this, the harvesting center was contacted and the patient's information left.  A consent form was faxed over to the hospital.  Two nurses then spoke to the mother by telephone and signed off on the form that consent had been obtained.

Individual state laws may vary in procedure for who can consent to an anatomical gift.  In Alaska for instance:

"(a) A competent person who is 18 or more years of age may make a gift to take effect upon death of all or a part of the person's body for a purpose specified in AS 13.50.020.

(b) When persons in prior classes are not available at the time of death, and in the absence of actual notice of contrary indications by the decedent or actual notice of opposition by a member of the same or a prior class, any of the following persons, in order of priority listed, may give all or a part of the decedent's body for a purpose specified in AS 13.50.020:

(1) the spouse;
(2) an adult son or daughter;
(3) either parent;
(4) an adult brother or sister;
(5) a guardian of the decedent at the time of death;
(6) any other person authorized or under obligation to dispose of the body.
(c) The persons authorized by (b) of this section may make the gift after or immediately before death."5

The agent for the organ center came and harvested the child's corneas and returned to the center.  He had looked over the consent form obtained, initialed it to verify it had been obtained by phone and was satisfied.

"When the cornea, a thin tissue that covers the front of the eye, becomes cloudy or damaged due to disease, injury or hereditary conditions, the result is vision loss or even blindness.

To clear this window, the damaged cornea is removed surgically and replaced with healthy, transplanted eye tissue-a donated cornea. This transplant operation is successful in more than 90 percent of cases in the US. After a successful transplant, patients have renewed vision or see for the first time."6

Each individual facility must generate protocols on organ procurement and obtaining informed consent:

"Each hospital in the state shall develop procedures for identifying potential donors of gifts, requesting gifts, notifying and coordinating with eye banks, tissue banks, and organ procurement agencies, and assisting in the procurement, removal, storage, and transportation of gifts."7
 

The child's father would arrive on the scene soon after.  When approached and informed of the harvesting, he was perturbed.  He would not sign the consent after the fact and chose to take legal action against the hospital and the donor center.

In court, summary judgement was entered for the defense:

The parent's appealed.

Questions to be answered:

1. Under the Uniform Anatomical Gift Act (UAGA), is the consent of a parent sufficient to proceed with harvesting of a child's organs.

2. Were the nurses negligent in their explanation of the procedure or in not waiting till the father was available?

The applicable laws stated that as long as a consent from a legally "responsible" and informed party is obtained, no liability or negligence can be assigned.  It was clear from the testimony of the nurses that they spoke to the mother and informed her of what was to happen.

In obtaining organs, time is typically of the essence.  The longer an organ or tissues remains in a body, the less likely it will be useful for the purposes of transplantation.

There was no evidence that the mother was either "coerced" or "rushed" into making a decision.  There was no documentation that she "wished to speak to her husband" before making the decision.  If more time had been needed or another family member needed to be consulted, the mother could have clearly stated this.

On the part of the nurses, a single adult guardian consent only was needed and obtained.

When the agent of the eye bank looked over the informed consent, he as satisfied that it was legitimate.  In harvesting the child's corneas, he acted in good faith and had no reason to believe a proper consent had not been obtained.

The court dismissed the plaintiff's argument that the "good faith" actions of the hospital or eyebank were "subject to interpretation."  The court was satisfied that under the conditions, the actions of the employees were reasonable and within the boundaries of existing law.

This case does point out the need for judgement and clear documentation when a consent for organ donation is obtained.  The nurses were wise to obtain not one but two witness signatures on the consent form.  The agent of the eye bank was wise to make sure the notation was made of a "telephone" consent.

Regardless of these precautions, the nurses, hospital and eyebank were still sued.  Had this lawsuit been initiated after either of the employees involved had left, the hospital may or may not have covered or defended them.

Related Link Sections:

Clinical Charting and Documentation, Nurses Notes
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Informed Consent
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm

Organ Donation:
http://www.nursefriendly.com/nursing/directpatientcare/organ.tissue.donation.htm
 

Sources:

1. National Association of Children's Hospitals and Related Institutions.  No date given. About Childrens Hospitals - Facts on Children's Health - Illness and Injury.  Retrieved June 20, 1999 from the World Wide Web: http://www.nachri.org/abouth/facts/hlth_illness.html

2. Old Dominion Eyebank.  No date given.  Corneal Transplant. Retrieved June 20, 1999 from the World Wide Web: http://www.odeb.org/html/cornealtransplant.htm

3. RRNL 39 May 12 (1999)

4. National Conference of Commissioners on Uniform State Laws.  No date given.  Why All States Should Adopt The Revised Uniform Anatomical Gift Act (1987). Retrieved June 20, 1999 from the World Wide Web: http://www.nccusl.org/whystate/uagawhy.html

5. The Alaska Legal Resource Center. No date given.  Persons Who May Execute An Anatomical Gift.  Retrieved June 20, 1999 from the World Wide Web:  http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section010...

6. Medical Eye Bank of Florida.  No date given.  Anatomy of the Eye. Retrieved June 20, 1999 from the World Wide Web: http://www.castlegate.net/mebfl/anatomy.htm

7. The Alaska Legal Resource Center. No date given. Requests By Hospitals For Anatomical Gifts. Retrieved June 20, 1999 from the World Wide Web: http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section014...
 

The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Send comments and mail to Andrew Lopez, RN

Created on Saturday May 23, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Friday, December 3, 2010

Donate Life America

Organ and tissue transplants offer patients a new chance at healthy, productive, normal lives and return them to their families, friends and communities. You have the power to change someone's world by being a donor. It's about living. It's about Life.

Donate Life America board member joins transplant docs climbing Mt Rainier to promote the importance of registering to be an organ, eye and tissue donor! Follow them on twitter @DonateLife2day. A portion of their experience will be web streamed "live" at 5:00 PM (PDT) on WEDNESDAY, SEPTEMBER 1.
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The third annual National Donor Designation Report Card prepared by Donate Life America shows 86.3 million people were enrolled in state donor registries at the end of 2009. This represents an increase of 24.4 percent since 2007 and bringing us a step closer to the goal of 100 million designated donors. Click here to view the April 2010 Donor Designation Report Card.

Donate Life America:"Donate Life America, formerly the Coalition on Donation, was founded by the transplant community in 1992 to educate the public about organ, eye and tissue donation and avoid duplication of effort. Donate Life America assists in mobilizing the transplant community to educate the American public on the need for organ, eye and tissue donation and motivating the public to make an actionable donor designation. The organization publishes brochures, program kits and other materials; provides technical assistance and referral services; coordinates the national campaign for organ, eye and tissue donation; identifies measurable best practices and leads the Donor Designation Collaborative."
Donate Life America
700 N. Fourth Street
Richmond, Virginia 23219
phone: 804-782-4920
fax: 804-782-4643
http://donatelife.net

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Andrew Lopez, RN
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Thursday, December 2, 2010

Musculoskeletal Transplant Foundation

The Musculoskeletal Transplant
Foundation, the nation’s largest
tissue bank, changes lives by connecting donors with surgeons and transplant recipients. As a non-profit service organization, MTF is dedicated to providing quality tissue through a commitment to excellence in education, research, recovery and care for recipients, donors and their families. Since our inception in 1987, MTF has recovered more than 60,000 donors and has distributed more than 3 million grafts for transplantation.

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Organ & Tissue Donation, Direct Patient Care Links

ShareThis Buzz up!2 votes
See also: Caregivers, Chronic Care Nurses, Disability Services Nurses, Geriatrics Nurses, Home Health Nurses, Long Term Care Nurses Physical Rehabilitation Nurses

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New! Musculoskeletal Transplant Foundation:"The Musculoskeletal Transplant Foundation, the nation’s largest tissue bank, changes lives by connecting donors with surgeons and transplant recipients. As a non-profit service organization, MTF is dedicated to providing quality tissue through a commitment to excellence in education, research, recovery and care for recipients, donors and their families. Since our inception in 1987, MTF has recovered more than 60,000 donors and has distributed more than 3 million grafts for transplantation."
Musculoskeletal Transplant Foundation
125 May Street
Edison, NJ 08837
Telephone: 732-661-0202
Fax: 732-661-2298
Customer Service Telephone: 1-800-433-6576
Customer Service Hours: Monday - Friday, 8:15 a.m. - 6:30 p.m. (EST)
E-mail Addresses: General information and questions may be directed to: Information@mtf.org
http://www.mtf.org/

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Donate Life America:"Donate Life America, formerly the Coalition on Donation, was founded by the transplant community in 1992 to educate the public about organ, eye and tissue donation and avoid duplication of effort. Donate Life America assists in mobilizing the transplant community to educate the American public on the need for organ, eye and tissue donation and motivating the public to make an actionable donor designation. The organization publishes brochures, program kits and other materials; provides technical assistance and referral services; coordinates the national campaign for organ, eye and tissue donation; identifies measurable best practices and leads the Donor Designation Collaborative."
Donate Life America
700 N. Fourth Street
Richmond, Virginia 23219
phone: 804-782-4920
fax: 804-782-4643
http://donatelife.net

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American Cord Blood Program:"While you are pregnant, your baby’s umbilical cord is a lifeline between the two of you. After your baby is born, umbilical cord blood can be a lifeline for someone else a child or adult with leukemia or another life-threatening illness. By donating umbilical cord blood, your baby can become a hero to a patient in need.
http://www.americancordblood.com/home.html

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Anatomic Gift Foundation (AGF), Maryland:"The Anatomic Gift Foundation (AGF) is an independent Maryland non-profit, 501 (c) (3), organization and is governed by a Board of Directors comprised of community professionals."
http://www.anatomicgift.com/

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BMT InfoNet Homepage...
Blood & Marrow Transplant Information Network is a not-for-profit organization dedicated exclusively to serving the needs of persons facing a bone marrow, blood stem cell or umbilical cord blood trans...
http://www.http://www.bmtinfonet.org

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Duke Transplant Center - Lung Transplant Home...
Transplant Center at Duke University Medical Center ...
http://lungtransplant.mc.duke.edu

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Harvard Brain Tissue Resource Center:"The Harvard Brain Tissue Resource Center has been established at McLean Hospital as a centralized resource for the collection and distribution of human brain specimens for brain research. Research over the past decade has shown that the study of human brain tissue is essential to increasing our understanding of how the nervous system functions. Most recently, postmortem human brain research has played a significant role in the development of a genetic test for Huntington's disease as well as a treatment for Parkinson's disease. Similarly, neurochemical and anatomical studies focusing on the biological nature of the severe mental illnesses are now emerging and bringing forth new hope for understanding the underlying brain mechanisms responsible for psychosis and other symptoms associated with these debilitating brain disorders. In order to perform research into the neurological or psychiatric disorders, it is vital to collect normal control tissue as well."
Harvard Brain Tissue Resource Center
McLean Hospital
115 Mill Street
Belmont, MA 02478
1-800-BRAIN BANK, (1-800-272-4622)
http://www.brainbank.mclean.org/

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International Institute for the Advancement of Medicine (IIAM):"a non-profit organization whose purpose is to facilitate the placement of non-transplantable human organs and tissues for biomedical research and education."
http://www.iiam.org/geninfo/backgrnd.htm

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Living Bank Uniform Anatomical Gift Act Donor Form:"For more information about organ/tissue donation, contact The Living Bank at 1-800-528-2971. The organ and tissue shortage is a crisis, but it is a crisis with a cure. Remember, the only way your family will know your decision is if you tell them."
http://www.actec.org/pubInfoArk/livingbank.html

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Organ Donation, Frequently Asked Questions:
http://www.organdonor.gov/faq.html

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Second Wind Lung Transplant Association, Inc....
Second Wind Lung Transplantation Association...
http://www.2ndWind.org

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Uniform Anatomical Gift Act (Alaska):
http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50.htm

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Nursing Malpractice Case Studies:

June 20, 1999: Organ Donation Informed Consent, Is A Single Parent's Sufficient?
Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.
Andrews v. Alabama Eye Bank, 727 S. 2d 62 –AL (1999)
http://www.nursefriendly.com/nursing/clinical.cases/062099.htm

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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