Organ Donation Ethics q

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Kobebucsfan

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A previously healthy 32 yr old man is brought to the emergency department after being found unconscious on the floor at his workplace. On arrival, he is obtunded. He is intubated and mechanical ventilation is begun. Examination shows flaccid paralysis on the right. A CT scan of the head shows a large evolving cerebral infarction on the left. Carotid duplex ultrasonography shows dissection of the left carotid artery. After receiving intensive medical care for 6 hours, the patient develops decerebrate posturing and becomes hemodynamically unstable. Vasopressor therapy is begun. A second CT scan of the head shows a massive left hemispheric cerebral infarction with severe edema and herniation. The physician determines that surgical intervention is not indicated because of the patient's poor prognosis. The patient's driver's license indicates that
he wishes to be an organ donor. The physician meets with the patient's family and informs them about the patient's prognosis,and they are devastated.
During the meeting, they say that they were unaware of his willingness to be an organ donor and
agree that he should not receive cardiopulmonary resuscitation. Which of the following is the most appropriate next step with
respect to organ donation?
(A)Arrange for the regional organ procurement organization to address the issue with the patient's family
(B)Delay further consideration of the issue until after 24 hours of aggressive care
(C)Delay further consideration of the issue until the family seems ready
(D)Initiate organ donation at this time

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Two reasons:
1) there's a finite period of time where the organs are viable, need to get the ball rolling if patient indicated he is an organ donor. So you don't want to really "delay" this.
2) Physicians should not themselves initiate the organ donation because of percieved bias and lack of objectivity. Furthermore, the family may perceive that the physician is not doing "all that he/she can" for the patient which could jeopardize any chance at organ donation. It should always be initiated by the regional transplant team.
 
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