Mandatory Organ Donation: Ethical or Unethical

The American Transplant Foundation reports that every 12 minutes, there is an additional member who joins 123,000 national organ transplant donors. Even though many people are aware of the advantages that come with organ donation, they may not comprehend all the benefits that come with organ donation, especially to the donor (Santivasi, Strand, Mueller & Beckman, 2017). The subject of organ donation is important because it improves the quality of life for the recipient of the organ transplant. For instance, individuals who have an eye problem and who receive eye transplants will have the advantage of being freed from the pain associated with the defective organ.

It means that when one participated in organ donation, they are offering others a chance to live a more fulfilling life. It is particularly important to note that the subject of organ donation is essential to nursing and nurses because it allows them to exercise leadership roles when engaging in the process of organ donation education and care for those individuals. The case of clinical nurse educators is of significances because the nurse leaders can serve various functions such as overseeing the orientation of a new worker and engaging in continuous quality improvement as it pertains to the organ donation process (Saidi & Hejazii Kenari, 2014). The leadership position such as acting as the organ procurement coordinator allow the medical personnel to attend to the quality improvement need so that other employees can gain access to the best evidence-based practice that will ensure that the most viable organs are transplanted. The subject of organ transplantation should be made a mandatory exercise because it improves lives and enables nurses to learn and implement quality practices.

Even though it is understood that organ donation is a critical aspect to the health care system and those in need of an organ, many people still feel challenged to engage in it. It is quite surprising that there is a lack of awareness on the subject. Many people are unaware of the benefits it offers, how the process works, and the possible life-saving and life changing implications that donorship plays. By definition, organ donation refers to the process where the organ (s) are removed from one person by a medical professional in a surgical manner and when it is compatible, placed on another person (Bortz, Ashkenazi & Melnikov, 2015). A broad range of organs has been successfully transplanted to organ recipients, organs such as lung, kidney, heart, pancreases, liver, bone/bone marrow, skin, and cornea. People of all ages can be potential organ donors, and when a person dies, the suitability of their organ (s) can be determined as it pertains to their medical history and age. In the US, the suitability factor is determined by the Organ Procurement Agency that assess the appropriateness of a potential donor (Saidi & Hejazii Kenari, 2014). Opt-in for organ donation involves two options; that is when a patient gives a health consent by signing a document indicating that they are willing to participate in the organ donation. On the contrary, organ opt-out is where there is an existing assumption that the patients are part og the mandatory process unless they express in writing that they are unwilling to participate. In opting out, the patients are considered as participants unless they indicate they are not engaging in it (Bortz et al., 2015). The opt-out may have many participants because the patients need to do nothing for them to be included in the participation. Therefore, the opt-out does not represent the most valid informed consent because the patients are not thoroghly educated on what the exercise may involve. Although some education in included in the opt-out, a patient may not understand the information about the organ donation process, unless they take the time to learn about it.

The greatest challenge that has been perceived is the growing shortage of organ transplantation. The problem has since necessitated the need to address the issue by various means including national efforts to increase the chances of deceased donor donation. Other measures have involved paired donor exchange initiatives, the use of expanded criteria donors and live donation programs. Improved standards through increasing the awareness among the public, the utility of transplantation options and the consideration of standardized donor management have also been implemented to enhance the process of organ procurements and transplantation efforts. The most preferred and successful techniques have been the use of live donation, and donation following brain death even though they have not addressed the change fully (Eurotransplant, 2013). The problem has arisen from the fact that, many blood donors who have experienced severe brain damage have done so to the extent where they are no longer candidates and/or meet the criteria. In this case, the family member and physician determine that there is limited chance for the subject to recover in order to lead a meaningful life, the life support could then be discontinued, and the circulatory arrest induced and allow the person to donate their organs. It is worth noting that despite the implementation of all the stated options, the challenge of organ donation still faces adverse organ shortage challenges that necessitate the need for alternative approaches (Saidi & Hejazii Kenari, 2014). Upon this basis, it should be a mandatory initiative for everyone to be classed as an organ donor unless they have been opted-out because of an underlying medical condition or related illness that affects their qualification criteria.

The need for the use of mandatory organ donation plans is prompted by the shocking statistics that reveal why many people need body organs. Reports indicate that in 2009 - 50,463 patients were included on the ever-growing organ donation waiting list and even though 28,463 received the organs, 6683 died while they were waiting (Santivasi et al., 2017). The U.S. Department of Health and Human Services has been a critical voice in addressing the problem with the idea of the use of mandatory plans being in line with the initiative that has already been in place. In 2003, the institution facilitated a program that was intended to increase access to the transplantable organs by the use of donation after circulatory death (DCD) and expanded criteria donors (ECDs). Everyone could be enrolled in the program because unless they have opt-out, they would enable the growing list of patients to benefit directly. In 2006, a major challenge was perceived following the decreased number of potential donors in 2006, in either case (Saidi & Hejazii Kenari, 2014). It is very encouraging that the number of deceased organ donors has been rising consistently in the past few years, thanks to the idea of DCD. Research into the area has further been inspired by the need to determine the eligibility of those who undergo irreversible brain damages, yet they do not meet the criteria for brain death but are still potential donors. The rise in the number of donors opting for DCD option has been on the rise, and it is consistent with the objectives initiated by the Health Resources and Services Administration for DCD development.

There are various outcomes to the health sector whenever the subject of organ donation is mentioned. It is especially significant because there are both advantages and disadvantages of participating in it, especially when perceived in the context of making it a mandatory act. The most significant positive role of organ donation is that it is a life-saving act. There are many people globally who are in need of organ transplantation services including those who need kidneys, heart and liver transplants. When one participates in the practice, they are giving such patients a chance to have a better life as the new organ extends life. Another significant benefit is that it will allow for the medical research process and related opportunities to expand. The relevance of organs for research purposes often happens when the organs donated are not helpful to the patient in some manner, either because of incompatibility or other issues (Saidi & Hejazii Kenari, 2014). The idea of automatic organ donation for those who consent to the concept further offers the benefit of ensuring that medical personnel does not engage in abuses especially in situations where they do not have the license to proceed with the act.

In my opinion, I feel that the approach should be focused on making it mandatory because the automatic opt-out initiative allows those who object, to be granted their choice. It is quite encouraging that the idea has already been implemented in England, the deceased organs can only be removed once it has been confirmed that an individual has been documented under the Organ Donor Register (ODR). It is also reported that out of 170 organ donations that was performed in the month of January 2008 in the UK, there was a subsequent positive outcome of 400 life-saving transplants, even though it is reported that the number was still considerably low (Saidi & Hejazii, 2014). Considering the success that has been witnessed in the UK, the same approach could be considered in the US as it would have massive positive effects on the growing list of those who are waiting for appropriate organs to enable them to lead a sustainable life.

It is important to understand the possible challenge of family refusal to adhere to the needs and instead pose a problem that could hamper the efforts adversely. It has been identified to be one of the greatest challenges to organ donation, it is estimated that around 91% of families agree for the organ donation to be undertaken once they confirm that the deceased was recorded on the ODR (Saidi & Hejazii Kenari, 2014). However, when it is determined that the deceased individual was not on the register, there was almost a 50% chance that the family would object to the idea of removing the body organs from the departed (Saidi & Hejazii Kenari, 2014). It is a significant challenge especially when it is recognized that the Black, Asian and minority ethnic (BME) groups are the most affected, yet their families are the most adamant to comply to the organ donation initiative. Reports indicate that a quarter of the population that is on the current waiting list are from these communities and they fall under the background that are less likely to be selected for the donation. However, there are a significant number of those that have had the organ donation blocked or declined by their relatives. Patient education is critical to the success of either mandatory organ donation or opting-out. Making the choice to opt-out should entail essential training to ensure that the individual makes an informed consent based on enough knowledge regarding the donation process. There is an existing assumption that the client is part of the donation exercise unless they express their unwillingness to take part (Saidi & Hejazii Kenari, 2014). Due to the benefits associated with the opt-out, there are other benefits such as improving the accuracy and inclusiveness of medical records and the quality of the patient's healthcare outcome. I also feel that implementing a successful mandatory organ donation initiative involves the cooperation of the provider as well as the patient. The doctor has to understand the cultural, ethical and ethnic background of the individual before engaging them in choosing whether they should be opt-out (Saidi & Hejazii Kenari, 2014). Therefore, providing an adequate education for the patient during opt-out may be beneficial to the medical professionals in ensuring the safety and accuracy of medical reports.

In summary, educating the patient in opt-out when implementing the mandatory organ donor initiative is critical to ensure the effectiveness of the process. The need for compulsory programs has been necessitated by the increasing number of people who need an organ transplantation service. The use of ODR has been effective in the UK and allowed people to notify the health institutions of their willingness to participate. There is a need for awareness though because it will bring convenience, due to the reduction of the mortality rate for those who need the organs and will ensure high-quality care. Eliminating the assumption that a patient is part of the organ donation is necessary for every healthcare provider and that they should provide education to the patient so that they may understand the procedures and make informed consent. It is recommended that the doctor explain to them all of the medical procedures they are to undergo. It is then that the patient can choose wisely if the internal body organs should be removed once they experience brain death. The subject is relevant in the present-day health situation where the number of patients on the waiting list is rising consistently, yet the organs available for transplantation are decreasing due to lack of awareness in the role the everyone plays.

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