Abstracts from the 12th Congress of the International

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Nov 21, 2013 - Janaina Lenzi1, Andreia Assis1, Márcia Ponte1, Priscila Paura2, ... Isaac Azevedo Silva, Rafael Simas, Laura Menegat,. Cristiano de Jesus ...
Abstracts from the 12th Congress of the International Society for Organ Donation and Procurement November 21–24, 2013 / Sydney, Australia 130

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Conscience-based refusal to participate in donation after cardiac death (DCD)

Legalizing HIV-positive organ donation to HIV-positive recipients: One giant leap toward addressing organ donation waiting list burden

Mark Wicclair1,2 West Virginia University, Morgantown, WV, United States; Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, United States.

1Philosophy, 2

While conscientious objection has its historical roots in objections to military service, a growing number of health professionals have refused to provide a broad range of goods and services that violate their ethical beliefs. Such actions, clearly, can have a major impact on organ donation. Some ICU clinicians, for instance, have objected to participating in donation after cardiac death (DCD) because it is against their conscience. In this presentation, two extreme approaches to managing conscience-based objections to participating in DCD are identified and rejected and a more nuanced middle-ground is proposed. One extreme is “conscience absolutism,” the view that clinicians should be exempted from performing any action, including participating in DCD, that is contrary to their conscience. The second extreme is the “incompatibility thesis,” the view that practitioners have an obligation to provide any good or service, including participating in DCD, that is legal, professionally accepted, and within the scope of their professional competence. Neither of these extreme approaches is defensible. Conscience absolutism is indefensible because it fails to consider that clinicians have obligations to patients and their families, other professionals, institutions, and society. The incompatibility thesis is untenable because it fails to acknowledge the value of moral integrity, and it presupposes an indefensible conception of clinicians’ professional obligations. An alternative to both extreme approaches is presented. It features the following guidelines: a) Clinicians should provide advance notification of a conscience-based objection to participating in DCD; b) accommodation should not result in a failure to inform surrogates of the DCD option in a timely manner; c) accommodation should not impede or unduly delay DCD; d) accommodation should not impose excessive burdens on other clinicians, administrators, or institutions.

Leslie Wolf, Rachel Hulkower College of Law, Georgia State University, Atlanta, GA, United States. In the United States today, over 115,000 patients are waiting for organ transplantation, but, in 2012, only 28,051 organs were transplanted from living and deceased donors. The gap between the supply and demand continues to grow, while thousands of patients die annually awaiting organ transplantation. US laws that ban transplantation of organs from donors who are HIVinfected, even when the recipient is HIV-infected, exacerbate this gap. Such limits may have been necessary early in the HIV/AIDS epidemic, when there were no effective treatments and patients typically died within a year or two of an AIDS diagnosis. Today, however, with access to effective antiretroviral therapies, people living with HIV have life expectancies similar to those without HIV and now also add to the number of patients awaiting organ transplantation. Eliminating legal barriers to transplantation of organs from HIV-infected donors could alleviate the shortage of organs for both HIV-infected and non-infected transplantation candidates. This would occur by increasing the pool of organs available to HIV-infected transplantation candidates, moving them off the transplant list, and allocating remaining organs to those remaining on the list. This presentation will describe the laws and policies prohibiting organ donation by those who are HIV-infected, the need for and evidence supporting a policy change, and recommend ways to accomplish that policy change.

Supplement to Transplantation November 27, 2013, Volume 96 Number 10S

Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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November 27, 2013

132 Changing pattern of death cause and future source of organs in Korea Won H Cho1,2, Ui J Park1, Jin S Yu2, Hyeung T Kim1,2 of Surgery, Division of Transplantation, Keimyung University School of Medicine, Daegu, Korea; 2Vitallink Korea, Seoul, Korea.

use all of the potential donor that developed at hospital right now, we easily expect the donor from deceased donor will be soon flat or decreasing. To solve this problem, we actively change our policy to use non-heart beating donor and aggressively use expanded criteria donor which were discarded previously. National consensus about changing the law for removing the life supporting system is also seriously considered.

1Department

Required reporting system included in newly revised transplantation law increase deceased donor about 20% in recent 2 years. However, nobody can believe this amount of growth in the next year because we already sense a slowing of growth this year. In order to have a prospective possibility of organ donation from deceased donor, national statistics about changing pattern of death cause were reviewed. The Korea Network of Organ Sharing(KONOS) reported that number of living donor transplantation is decreasing from 53.3% in 2008 to 50.9% in 2012. Instead, proportion of deceased donor is increased from 35.3% to 45.7%.

FIGURE 1. Among these deceased donor, two most frequent cause of brain death were cerebrovascular disease and head trauma by traffic or other accident, which comprised 81.0%. But real problem in recent year is the changing pattern of death cause which reported by the Statistics Korea(national statistics). The death rate of cerebrovascular disease and head trauma are decreasing definitely and their reducing rate in 2012 are 31.2% and 39.6% compare to 2001. Even we don’t

FIGURE 2. S166

Supplement to Transplantation November 27, 2013, Volume 96 Number 10S

Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

November 27, 2013

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An exploration of consent issues in Victorian potential donors after brain death (DBD) and cardiac death (DCD) Hugh Stephens1, David Pilcher2, Helen Opdam3, Gregory Snell4, Jeffrey Rosenfeld5 1 MBBS/PhD Candidate, Monash University / The Alfred Hospital, Melbourne, Australia; 2Department of Intensive Care, Alfred Hospital, Melbourne, Australia; 3DonateLife Victoria, Melbourne, Australia; 4 AIRmed Lung Transplant Service, Alfred Hospital, Melbourne, Australia; 5Department of Surgery, Alfred Hospital, Melbourne, Australia. Background & Aim: Consent remains one of the greatest barriers to increasing the donor pool [1]. International centres have found family consent rates to be associated with brain death status, age, and ethnicity [2]. Methods: From a database of 18,949 deaths occurring in 22 Victorian hospitals between 1 January 2010 and 30 June 2012, we selected cases where organ donation was discussed with the family or guardian. Examination of patient and family wishes; donor type and whether donation was successful was completed using univariate analysis. Results: A total of 623 family discussions occurred. Of these, 115 were unsuitable for donation due to a medical contraindication, were considered unsupportable to facilitate donation or were not ventilated in the 6 hours prior to death. There were a total of 175 successful donations (130 DBD donations and 41 DCD donations (n=4 unknown), from 508 potential donors, 34%), and one patient survived to discharge (n=4 data missing). Donation was raised by staff in 73% (n=372) of cases and family in 24% of cases (n=123). The patient was recorded as a consent on the organ donation registry in 54 cases out of 256 checks (remainder not listed). In one of these cases, the family subsequently declined donation. Of those not listed on the registry, 45% of families subsequently consented to donation (n=201), with n=242 refusals and n=5 not asked. Family consent was more likely in patients with confirmed or probable brain death (50% vs 40%, p=0.03), whether the patient died of non-neurological causes (69% vs 50%, p=0.04) and whether families initially raised donation (76% vs 42%, p