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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 consentfrom a child's mother. When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.
The patientwas 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 nurseit "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 nursesthen 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 consentto 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 consentform 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 hospitalin 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 hospitaland 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 consentof a parent sufficient to proceed with harvesting of a child's organs.
2. Were the nursesnegligent 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 informedher 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 documentationthat 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 consentonly 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 consenthad 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 courtwas 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 consentform. 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 hospitalmay 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.consent.medical.legal.htm
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...
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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 Wednesday, December 28, 2011
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