The intent of this Position Statement is to confirm the role of registered professional nurses in the identification and care of organ and tissue donors and their families, as well as their role in public education and awareness.
Brain Death: Occurs when a person’s brain activity stops permanently. It is impossible to return to life after brain death (http://organdonor.gov/terms.htm).
Cardiac Death: Occurs when a person's heart stops and cannot be resuscitated. Just like brain death, there is no recovery from cardiac death (http://organdonor.gov/terms.htm).
Deceased Donor: A person who has been declared dead and whose organs and/or tissue have been donated to a transplant recipient (http://organdonor.gov/terms.htm).
First Person Consent Legislation: Legislation that allows donor designation to be indicated on a driver's license or an official signed donor document, which gives hospitals legal authority to proceed with organ procurement without consent from the family (http://www.unos.org/resources/glossary).
Informed Consent: The process of reaching an agreement based on a full disclosure and full understanding of what will take place. Informed consent has components of disclosure, comprehension, competence and voluntary response. Informed consent often refers to the process by which one makes decisions regarding medical procedures, including the decision to donate the organs of a loved one (http://organdonor.gov/terms.htm).
Living Donor: A person (unrelated or related to the transplant recipient) who donates a kidney or part of a lung or liver while they are still alive (http://organdonor.gov/terms.htm)
Transplantation: The transfer of cells (e.g. stem cells), tissue, or organs from one person to another or from one area of the body to another (http://organdonor.gov/terms.htm).
Waiting List (sometimes called a “wait list”): A national list that exists for all patients who are waiting for a transplant. It lists the total number of patients and the numbers of patients waiting for specific organs. It is used to locate the best recipient for a particular donated organ (http://organdonor.gov/terms.htm).
The New York State Nurses Association believes the registered professional nurse assumes an integral and valuable role in overcoming the shortage of suitable, viable organs and tissue for transplantation. Inherent in the role of clinician, educator and counselor, the registered nurse provides emotional support to the patient and significant others while facilitating the process of organ donation. In this role the registered professional nurse should:
Transplantation of living human organs and tissue has become an increasingly significant life-altering and life-saving therapy for thousands of people in the last several decades. The supply and demand for organs and tissues continues to be disproportionate and the equitable distribution of this scarce resource remains an ethical issue. Yearly, there are more than 90,000 of candidates waiting for donors and transplantation on the national waiting list and a significant number are from New York (www.optn.org, 2010). Every day, individuals receive an organ transplant; however hundreds will die waiting because there are not enough organs available (www.organdonor.gov, 2010). Many patients wait years for a suitable organ. There are complex reasons for the shortage of organs which include barriers to organ donation. Barriers that continue to be examined and addressed though research, healthcare continuing education, public awareness and education programs include but are not limited to:
At the NYSNA Convention of 2000, the voting body forwarded a Resolution on Organ and Tissue Donation to the American Nurses Association (ANA) House of Delegates (2000 Voting Body Actions). Subsequently, an ANA House of Delegates (HOD) Action in 2001 recommended that these barriers be addressed with organ donation and transplantation organizations. The ANA HOD agreed that ANA should advocate for and promote a more collaborative relationship between professional nurses and organ procurement teams (ANA House of Delegates, 2001).
In 2006, a series of seven bills to encourage increase organ, eye and tissue donation were signed into law which included creation of the New York State Organ and Tissue Donor Registry (Registry) to record an individual’s own legal consent to organ, eye and tissue donation upon their death (New York Organ Donor Network, 2010).
The Registry, managed through the New York State Department of Health, organizes and maintains the confidential listing of individuals who have enrolled. In 2008 the registry was fully implemented. In 2009, changes to law were made regarding the order of individuals who can make donation decisions. The health care agent becomes the highest authority unless language contained within the health care proxy states otherwise. The remaining hierarchy of adult child, parents, adult siblings, guardian and any other person authorized or under the obligation to dispose of the body remain unchanged (New York State Public Health Law, § 4301).
As research continues to examine additional barriers to organ donation, registered nurses must continue to advance their role as advocate and facilitate the coping of patients and their families and significant others as they approach the final stage of life. Ultimately, transplants enrich, prolong and save lives (www.alliancefordonation.org, 2010).
Registered professional nurses, in fulfillment of their roles, are intimately involved in all aspects of donation. As one who may be the first to recognize a potential donor, registered nurses must be knowledgeable regarding their facility policy on contacting the local Organ Procurement Organization (OPO). Recognition of the family’s right in opting for tissue or organ donation and advocating that this is offered, remain the two essential elements in improving the availability of organs (Norris & House as cited in NYSNA, 2010). More information on the registered nurses role in Organ Donation may be obtained from NYSNA’s eLeaRN course: Think, Care, Act: The Role of the Nurse in Organ and Tissue Donation at www.elearnonline.net
The registered professional nurse who is involved in the process of organ and tissue donation should:
Approved by the Board of Directors on September 18, 1996; September 15, 2004; September 15, 2010. Reviewed/revised by the Councils on Ethical Practice and Human Rights on August 27, 2004.
Reviewed/Revised by the Council on Ethics and Human Rights on June 10, 2010.
Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Washington, DC: Author.
American Nurses Association. (2001). Professional nursing practice: End-of-life care and organ donation. In Summary of proceedings, American Nurses Association, 2001 House of Delegates (pp. 47-52). Washington, DC: Author.
American Nurses Association. (2001). Report of the New York State Nurses Association. 31 (10), 14.
DuBois, J., & Anderson, E. (2006). Attitudes toward death criteria and organ donation among healthcare personnel and the general public. Progress in Transplantation, 16(1), 65-73.
Molzahn, A., Starzomski, R., & McCormick, J. (2003). The supply of organs for transplantation: Issues and challenges. Nephrology Nursing Journal, 30(1), 17-28.
New York Organ Donor Network (2010) New & Events- New Releases. Who can consent to organ, eye and tissue donation in New York State? Retrieved from http://www.donatelifeny.org/news/20091123_01.html
N.Y. Public Health Law § 4301 (2010).
New York State Nurses Association. (2011). Think, Care, Act: The role of the nurse in organ and tissue donation. Retrieved from http://www.elearnonline.net/coursedesc.aspx?ClassID=190&s=66
U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation. (2002). In Guidelines for donor registry development conference final report (pp. i-ix). Washington, DC: Author.
U.S. Department of Health and Human Services. The organ donation breakthrough collaborative: Best practices final report. (2003). In Executive Summary (pp. ii-xi). ftp://ftp.hrsa.gov/osp: Author.
(2010). www.alliancefordonation.org: The New York Alliance for Donation, Inc.
(2010). www.optn.org/latestdata: United Network for Organ Sharing (UNOS).
(2010). www.organdonor.gov: U.S. Department of Health and Human Services.
Zink, S. & Werlieb, S. (2006) A study of the presumptive approach to a consent for organ donation. Critical Care Nurse, 26(2), 129-136.
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.