Getting the Word Out: Organ and Tissue Donation - Essay Example

Getting the Word Out: Organ and Tissue Donation Getting the Word Out: Organ and Tissue Donation "While a record 2,867 life-giving transplants took place last year, tragically 443 people died while waiting due to the critical shortage of donors." (Launch of UK, 2004, n.p.) That sentence alone answers any doubt as to why it is vital to successfully launch an effective promotion plan to raise awareness about organ and tissue donation. Since April of this year alone 1,486 people have received a transplant here in UK thanks to the generous gifts of 511 donors. Unfortunately there are still 6,545 people waiting for a transplant. Currently there are 12,881,354 people registered with the National Health Services (NHS) to donate tissue and organs upon their death. That figure represents approximately 21% of the total population of the UK. (UK Transplant, 2005, n.p.) "We know that nine out ten people support organ donation in principle but that only two out of ten have got around to recording their wishes on the Register."(Launch of UK, 2004, n.p.) Getting the word out about Organ and Tissue donation will give the 6,545 people waiting now and countless others who will need a transplant at some point in the future a new lease on life. Educating health care professionals about the importance of this is imperative to ensuring success of such an initiative. More important, however, than just education is action - doing what we all know we should do - now, not before it's too late. Dare to Share. Although most people think of death as the time when organ donation occurs, this is not always the case. Living Donations also occur or can occur as well. "Living donor transplants are a viable alternative for patients in need of new organs. Many different types of organs can be delivered by living donors, including: Kidney, the most frequent type of living organ donation; liver; lung; pancreas; intestine; and heart (A domino transplant makes some heart-lung recipients living heart donors. When a patient receives a heart-lung "bloc" from a deceased donor, his or her healthy heart may be given to an individual waiting for a heart transplant. This procedure is used when physicians determine that the deceased donor lungs will function best if they are used in conjunction with the deceased donor heart." (Living Transplants, 2005, n.p.) There are three important aspects regarding Living Donations that need to be considered. These three areas include: Living donation eliminates the recipient's need for placement on the national waiting list. Transplant surgery can be scheduled at a mutually-agreed upon time rather than performed as an emergency operation. Because the operation can be scheduled in advance, the recipient may begin taking immunosuppressant drugs two days before the operation. This decreases the risk of organ rejection. Transplants from living donors are often more successful, because there is a better tissue match between the living donor and the recipient. This higher rate of compatibility also decreases the risk of organ rejection. Perhaps the most important aspect of living donation is the psychological benefit. The recipient can experience positive feelings knowing that the gift came from a loved one or a caring stranger. The donor experiences the satisfaction of knowing that he or she has contributed to the improved health of the recipient. (Positive Aspects, 2005, n.p.) Other organ transplants however can only occur at the death of the donor. It is at this most stressful time that the need to be registered for organ donation prior to death is seen. Almost as important, the donor must make his wishes known to family members so there is no confusion when the need to make that decision arises. There is a very limited time between the death of the donor and the transplant of the needed organ into the recipient. Unfortunately, as is too often the case, time runs out and life saving organs are not made available. With nine out of ten people in favor of transplantation, there is no reason why people die waiting for an available organ or suffer through years of medical procedures to prolong their lives until a donor can be found. Yet, it still continues to happen: In the UK alone an adult waits an average of 729 days for a kidney transplant while a child waits 139 days; an adult waits 137 days for a heart transplant while a child waits 105 days; an adult waits 394 days for a lung transplant; and an adult waits 73 days for a liver transplant while a child waits 63 days. (Average wait, 2005, n.p.) While this may seem promising these dates don't account for those who have died waiting for that life saving transplant. Another important aspect of organ donation that needs to be portrayed is its success rate and how much we have advanced in the field of organ transplantation. It may seem that organ transplants have been happening forever, but in actuality they have only been successfully done for just over 50 years. For instance: the first Cornea transplant occurred in 1905; The first blood transfusion was in 1918; The first successful kidney transplant was in 1954; In 1960, the first living donor kidney transplant was done in the UK; The first liver transplant was performed in 1963; In 1965, the first kidney transplant in UK from a deceased donor was done; and in 1967, Dr. Christian Bernard performed the first heart transplantation followed by the first heart transplant in the UK the following year. (Transplant Milestones, 2005, n.p.) Since that first transplant remarkable strides have been made in the field of transplantation, but we still have far to go. When really considered, a transplant is truly a remarkable advancement in modern medicine. As stated earlier, during the just over fifty years that organ transplants have become a reality their success has truly been a modern medical miracle. Recent results of transplant success within the UK reveal that after upon re-evaluation a year after transplant surgery: 93% of kidneys in living donor transplants are still functioning well 88% of kidneys from people who have died are still functioning well 87% of liver transplants are still functioning well while 85% of heart transplants are still functioning well. 80% of lung transplants are functioning well. 70% of heat/lung transplants are functioning well. (Success Rates, 2005, n.p.) Another misconception that needs to be erradicated to encourage more people to register for organ donation is how the organ allocation process works. Unfortunately, there are more people in need of transplants than there are suitable organs available. Due to this, the Allocation System was established to ensure that available organs are distributed in a fair, non biased, ethical manner. People who need organs are registered and information regarding theirdegree of need and also medical matching information is entered in to the national database administer by the National Health Service (NHS). Based on the information mentioned plus additional factors such as age, health are also entered into the computer database. As organs become available, the computer will match the donor information to the awaiting recipient who will be a best match. The closer the match between the donor and the receipient the higher the likelihood that the transplant will be successful. Transplants are monitored closely by the National Health Service to ensure that the selection of transplant remains unbiased and fair. (Organ Allocation, 2005, n.p.) The final area that needs to be discussed is the common myths that people have concerning donation. Distributing information on these and disspelling these will assist people in making informed decisions about becoming an organ donor. Common, misleading misconceptions include: Myth: Doctors will not try to save my life if they know I want to be a donor. Fact: The medical staff trying to save lives is completely separate from the transplant team. Donation takes place and transplant surgeons are called in only after all efforts to save a life have been exhausted and death is imminent or has been declared. Myth: People can recover from brain death. Fact: People can recover from comas, but not brain death. Coma and brain death are not the same. Brain death is final. Myth: Minorities should refuse to donate because organ distribution discriminates by race. Fact: Organs are matched by factors, including blood and tissue typing, which can vary by race. Patients are more likely to find matches among donors of their same race or ethnicity. Myth: The rich and famous on the waiting list for organs get preferential treatment. Fact: The computerized matching system does not select recipients based on fame or wealth. Organs are matched by blood and tissue typing, organ size, medical urgency, waiting time, and geographic location. Myth: I am too old to donate organs and tissues. Fact: People of all ages may be organ and tissue donors. Physical condition, not age, is important. Please sign a donor card; physicians will decide whether your organs and tissues can be transplanted. Myth: My family will be charged for donating my organs. Fact: Donation costs are not the responsibility of the donor's family or estate. Myth: Donation will disfigure my body. Fact: Organs and tissues are removed in procedures similar to surgery, and all incisions are closed at the conclusion of the surgery. An open casket funeral is possible after donation. Myth: Organs are sold, with enormous profits going to the medical community. Fact: Federal law prohibits buying and selling organs in the U.S. Violators are punishable by prison sentences and fines. (This also holds true in the UK.) Myth: Marrow donation is painful. Fact: Marrow donors do not feel pain when the marrow is removed because anesthesia is used. Soreness and/or stiffness may be felt for a week or so post-donation. (Myths & Facts, 2005, n.p.) In 2001 a study was completed in the United States to determine how family members make the decision to permit donation of a loved one's organs if the deceased was not a registered donor. Although this study was not conducted in the UK, the results and human behavior behind them know no geographical boundary. The survey found the a lack of understanding of the donation process and not possessing all the information need to make the decision to donate a loved one's organs severely hampers organ donations. In response to the findings the US Health and Human Services Secretary Tommy Thompson stated "The need for donated organs continues to grow faster than the supply of available organs, this study clearly indicates that we need to further intensify our public awareness and education efforts to increase the number of organ donors. It also is a reminder that organ donors need to share their decisions to donate with their loved ones."(Press Release, n.p.) The study conducted over a period of 5 years, from January 1994 to December of 1999 as published in the Journal of the American Medical Association yielded the following results. Families who knew about the patient wishes were seven times more likely to donate organs. Families who were kept updated about their loved ones' condition and got timely and detailed information on organ donation were five times more likely to donate. Families who met with organ donation professionals about the donation process were more than three times as likely to donate in spite of other negating factors such as sociodemographics or preconceived attitudes. Families who first met with the health care provider and then with an organ donation professional were almost three times as likely to consent to donate organs. (Press Release, 2001, n.p.) Not only do these result dispel any doubt as to the importance of educating health care professionals as to the important role they fulfill in the transplant process, it reveals the ongoing need for each health care professional to educate their patients as well. The information I have discussed to date is a brief overview of the educational information that needs to be included in an awareness initiative. Now that we know what needs to be communicated and why, the question becomes how. Determining the best method to ensure success requires looking at benchmark transplant facilities and evaluating how they have become successful. In researching this, it was noted that there is no 'one best' plan to follow. Rather each organization is unique and has differing needs and demands placed upon it. However, there did emerge some 'guiding principles' that were woven into each successful donation facility. These include: 1. Orient organizational mission and goals toward increasing organ donation. 2. Do not be satisfied with the status quo; innovate and experiment continuously. 3. Strive to recruit and retain highly motivated and skilled staff. 4. Be there: integrate Organ Donation staff into the fabric of high potential hospitals. 5. Identify and support organ donation champions at various hospital levels; include leaders who are willing to be called upon to overcome barriers to organ donation in real time. 6. All aboard: secure and maintain buy-in at all levels of hospital staff and across departments/functions that affect organ donation. 7. Educate constantly; tailor and accommodate to staff needs, requests, and constraints. 8. Design, implement, and monitor public education and outreach efforts to achieve informed consent and other donation goals. 9. Use data to drive decision-making. 10. Follow up in a timely and systematic manner. Don't let any issues fester. (Best Practice, 2003, n.p.) Of these guiding principles listed above, consideration of each and integration into a donor awareness initiative program is necessary to ensure success of the program. Any program will not be successful without the support of those responsible for the direction of the hospital. If organ donation is a priority of the administrative leaders it becomes a priority of the hospital itself. Therefore, the first necessary step is achieving that 'buy-in' by the organizational leaders. Once that is obtained, each and every member of the hospital team needs to see the need for promoting the organ donation program. This can best be achieved through training, training, training and more training. The importance of organ and tissue donation and the commitment to drive the program to success needs to become an interwoven part of the hospital fabric itself, not merely a once a year training session. The National Health Service has a very active Organ and Tissue Donation Awareness Program. There is no need to 'reinvent' the wheel by trying to set up an exclusive campaign to raise awareness. As a Transplant Coordinator within a Healthcare setting I would first and foremost take advantage of the expertise available through this government agency and create an active working relationship between the hospital and the NHS. They offer ongoing training programs and Awareness Campaigns. Additionally, advertising these campaigns and actively promoting them makes good sense. Through using their services printed information including posters and pamphlets are widely available for passing on to not only health care staff, but also patients. This, of course, is the ultimate goal of such an initiative - to educate the public and encourage more participation in the registration process. It would be imperative to proactively participate in these campaigns and make it a hospital wide endeavor not merely a Transplant Coordinator initiative. Visibility is another key area for success of such a program. The Transplant Coordinator needs to be actively involved within the hospital setting, not just at the time when a donation decision needs to be made, but all the time. Hospital staff needs to know who the Transplant Coordinator is and that they are truly committed to the position. Every interaction with both staff and the public is an opportunity to educate and any opportunity to promote organ donation. The importance of building a positive working relationship can not be over-emphasized. Mutual respect and understanding go far in achieving a 'buy in' to any awareness program. Upon deciding to launch a hospital wide awareness program, one of the first things that would need to be accomplished is to determine where the organization is at present. This needs to be achieved on several different levels - a people level and an organizational level. Both of these are necessary steps to ensure success. First, on the people level, I would: gather data concerning employee perceptions about organ and tissue donation; determine their educational needs based on their personal self-evaluation; and, lastly, determine through the survey any stumbling blocks or other road blocks staff would identify and any possible solution they may offer. In doing this not only do I gain baseline information, but staff feels that their concerns and opinions matter leading to a greater acceptance of any awareness program instituted. The second set of data to be collect would be, as stated previously, information on an organizational level. In order to measure any progress made by an organ and tissue donation program there needs to be a thorough understanding of where the program is now. The type of data that needs to be collected and how to collect it is dependent on what the desired outcome is. A staff education/training plan could be designed with required training identified. Through review of training records or through survey of staff a baseline of percentage of compliance with the required training could be gathered to evaluate measuring the same data at intervals throughout the program duration. For instance, if 15% of the staff has fulfilled all the required training at the onset, a goal of 30% could be the target at a three month period, 60% at nine months and 100% at 12 months. Depending on the outcomes desired more detailed information could be gathered such as number of patients who are registered with NHS as organ donors. This could easily be achieved at the admissions phase and would not require much time or expenditure of additional manpower to accomplish, nor would it be a burden for the patient. This initial contact could, in and of itself, begin to get people thinking about registering as donors. Gathering this data over a period of time could show the effectiveness of the awareness program and its affect on health care professionals promoting organ and tissue donation to patients. Also, if transplants are performed at the facility, data could be gathered regarding number of transplants performed and number of transplants that could have been performed had the compatible match been found. This last measurement although interesting, would not necessarily show success of this particular awareness program as proper matches may not be exclusive between the donor and recipient being at the same facility; however, number of donor organs being offered could be measured for effectiveness. Another area to consider when designing an awareness program would be to encompass a recognition program within the initiative itself. Promoting a positive reward system for participation in the program would greatly increase its success. When I speak of reward, I am not referring to monetary remuneration, rather positive reinforcement for support of the program. By human nature we all like to be told thank you and rewarded when our hard work and dedication is recognized and appreciated. It could be as simple as a thank you note or email or as intricate as awards. It would be interesting to allow employees to devise possible a possible reward program. Again this would allow the transplant coordinator to see what type of motivational suggestions staff feel will work while also fostering a team approach which will lead to employee 'buy in' to the program. Creativity is the key to any successful program. Don't be afraid to try something a little different to promote the program. Although organ donation is a very important and necessary program that has the potential of saving thousands of more lives a year, the awareness program itself does not have to be totally somber and uninteresting. Make it exciting. Make people want to participate. Listen to healthcare employees and their suggestions. Those who are in the field and deal with patients on a daily basis may offer valuable suggestions. Listen - you may be surprised what you hear. The last area I would like to comment on is the need for relying on data driven information. Earlier I discussed the need for baseline information and devising a measurement system to evaluate program success. This evaluation and re-evaluation needs to be done on a continual basis to ensure process improvement. If we are not moving forward, we are falling behind as there is no middle ground. In reviewing the literature I did uncover an interesting study published in the Oxford Journals in 2003 which was conducted to research the variation of organ donor rates geographically within the UK. Data from 1999 and 2000 was used to evaluate why there is such a disparity of organ donation rates within specific geographical regions inside the UK. Although no definite causal effective could be positively identified, the conclusions led to the following statement: "Clearly, there is a need to gain a better understanding of the variations in the pathway between hospital admission, ICU and organ donation, which will most probably come from qualitative studies. To be most fruitful, these would have to include detailed interviews of the personnel involved in the different steps in the pathway, covering, for example, how possible donors are treated, how medical contra-indications are evaluated and how donation is discussed with relatives. In this way, light may be thrown on the decisions which lead to the observed variation in donation rates, and the much lower donation rates in certain areas. " (Wight et al, pg. 968) In closing I would like to emphasize again the importance of this awareness program. Although the Transplant Coordinator will take the lead role in ensuring the success of the program, it is not a battle to be fought by one individual. Everyone must become involved. I'll leave you with a quote I found will researching this paper. The spirit of hope and positive thinking still exists. "It's my belief that not every single organ that becomes potentially available need be used, if there are no surgeons available to carry out a transplant because they are all busy transplanting other organs then fair enough." (Archer, 2004, n.p.) With us all working together, we can make this a reality. Works Cited Archer, R. 24 Jun. 2004. "UK Parliament Vote on Oran Donation Opt Out Scheme." Talk About website. Retrieved December 1, 2005 from: http://www.talkaboutsupport.com/group/alt.support.kidney-failure/messages/22639.html "Average Waiting Time for a Transplant in Days" April 2005. UK Transplant Organization. Retrieved December 1, 2005 from http://www.uktransplant.org.uk/ukt/about_transplants/waiting_time_to_transplant/ waiting_time_to_transplant.jsp "Best Practice". Sept. 2003. Donate Life. Department of Health and Human Services, United States Government. Retrieved December 1, 2005 from http://www.organdonor.gov/bestpractice.htm "Launch of UK challenge to increase organ donation". 6 Oct. 2004. Medical News Today. Retrieved December 2, 2005 from http://www.medicalnewstoday.com/medicalnews.phpnewsid=14539&nfid=rssfeeds "Living Transplants" Aug. 2005. The Organ Procurement and Transplantation Network. Retrieved December 1, 2005 from http://www.optn.org/ "Myths & Facts About Organ and Tissue Donation" Donate for Life. Department of Health and Human Services, United States Government. Retrieved December 1, 2005 from http://www.organdonor.gov/myths_and_facts.htm "Organ Allocation" 1 Apr. 2005. UK Transplant Organization. Retrieved December 2, 2005 from http://www.uktransplant.org.uk/ukt/about_transplants/organ_allocation/organ_allocation.jsp "Positive Aspects of Living Donation" Aug. 2005. The Organ Procurement and Transplantation Network. Retrieved December 1, 2005 from http://www.optn.org/ "Press Release: Study Results" 4 Jul. 2001. Journal of the American Medical Association. U. S. Agency of Healthcare Research and Quality (AHRQ). Retrieved December 1, 2005 From http://www.ahrq.gov/news/press/pr2001/organpr.htm "Success Rates" 1 Apr. 2005. UK Transplant Organization. Retrieved December 1, 2005 from http://www.uktransplant.org.uk/ukt/about_transplants/success_rates/success_rates.jsp "Transplantation Milestones." 1 Apr. 2005. UK Transplant Organization. Retrieved December 2, 2005 from http://www.uktransplant.org.uk "UK Transplant Statistics". 1 Apr. 2005. UK Transplant Organization. Retrieved December 1, 2005 from http://www.uktransplant.org.uk/ukt/default.jsp Wight, J., Jakubovi, M., Walters, S., Maheswaran, R., White, P. & Lennon, V. 22 Oct. 2003. "Variation in cadaveric organ donor rate in the UK." Oxford Journals, 19:4, pgs. 963 -968. Read More