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来自 University of Cape Town 的课程

Organ Donation: From Death to Life

82 个评分

University of Cape Town

Organ Donation: From Death to Life

82 个评分

Considering someone for organ and tissue donation at the end of life is complicated. The boundary between life and death is more complex than ever before and it falls to medical professionals to help clarify a situation at an often confusing and emotionally stressful time. In this course you will learn about the science behind death determination and when it is possible for deceased organ donation take place. The lectures will cover medical standards at the end of life - from brain death testing, to requesting informed consent from a grieving family. By improving knowledge of good ethical practices, cultural and religious considerations and the logistics of the organ donation process this course will empower the interactions and discussions of medical professionals and the general public at an often confusing time. This course will help you to ensure that the option of organ donation is compassionately explored in all appropriate situations at the end of life in the best way possible. Watch the course trailer here https://www.youtube.com/watch?v=Ak-kVtmZGRs The course is certified for continuing professional development (CPD) points in South Africa. Send your completion certificate to organdonation@uct.ac.za together with your HPCSA number for 25 general and 5 ethics points. For another interesting course on organ donation and transplantation, see Clinical Kidney, Pancreas and Islet Transplantation from Leiden University https://www.coursera.org/learn/clinical-kidney-transplantation

从本节课中

Brain Death and Consent

Welcome to the first week of Organ Donation - From Death to Life. In our first lesson we cover the two absolute prerequisites for deceased organ donation: That the donor must be dead and that there must be consent. Our second lesson takes a look at the history of, and the actual mechanism of brain death as well as the story behind the first heart donor. While our third lesson reviews in detail the scientific determination of brain death, from the preconditions that must be met before testing, to the actual tests themselves, including the role of ancillary tests. Our final lesson will look at the consent process, how to communicate effectively with a grieving family and what is the best way to make the organ donor request.

Introduction to Week 11:29

Dead Donor Rule4:55

与讲师见面

David Thomson
Dr
Critical Care Specialist and Transplant Surgeon

Consent is the second absolute rule for organ donation.

Without it, organ donation is not ethically or legally permissible.

To be valid, the consent must be informed,

voluntary, and given by the appropriate person.

Ideally, the wishes of the deceased should be known

prior to their death so that their wishes can be honored.

Organ donor registries function to do this.

In South Africa, we have the organ donor foundation

and similar organizations exist across the world.

However they have a major limitation,

in that unless legislation exists to support them,

they are merely expressions of intent.

When this is the case, or when the individual's

wishes in respect to organ donation are unknown,

the family is approached to act as

a surrogate decision maker to best represent the wishes of the patient.

Even in countries where consent is presumed already valid,

the family will be routinely sought out and approached.

In South Africa in 2017,

we have just over 200,000 people on the organ donor foundation registry,

out of a population of 53 million.

In the United States,

ninety 95% of people are in favor of

organ donation and yet only 48% are registered as organ donors,

and only half of these have discussed organ donation with their family.

I cannot stress enough how important it is to

have these discussions with your family about organ donation,

wherever you are in the world.

Your family will always be asked for consent.

In a time of severe distress,

the default response is No.

But if you have primed your family about your wishes,

when they hear the question,

"What would you have wanted in this situation?",

the answer is much more likely to be a Yes.

Informed consent in medicine explains

the risks and benefits of a particular intervention to the patient.

Only once you understand these risks and have freely agreed to them,

is it considered informed consent.

If I needed a cardiac bypass operation,

I need to know the chance of death both with and without the operation.

I also need to know the risk of a major disability,

how long I will be in hospital,

and what quality of life I can expect.

An organ donation request is unique because when a patient is dead,

there are no inherent risks to the patient.

There is however always a family coming to terms with death and the consent process

must supply them with adequate information about

organ donation so they can make an informed decision.

How we treat the patient and their family at the end of

their life has an impact on what their decision will be.

It is essential to be compassionate and understanding.

At the heart of all consent is trust.

For organ donation this is trust in the determination of death,

trust that all required information is given and correct,

trust that the donor will be treated with respect and

trust that the gift of organ donation will be allocated equitably,

fairly and that no one will profit financially.

There is no cultural religion in the world that does not champion helping

our fellow human beings and yet consent rates for

deceased donation vary markedly between countries,

and even within communities within countries.

Some will say this is cultural or religious.

Some will say it's related to socioeconomic factors or education levels,

that we need to improve public awareness.

I firmly believe it is up to doctors and nurses

interacting with patients and their families at the end of

a person's life to help change practices

by being informed about organ donation and the processes involved.

These interactions are where we can make a meaningful impact.

How we treat patients and their families at the end of

life has a huge impact not only for

them at that moment but also for potential transplant recipients.

Ultimately, organ donation always comes down

to someone asking for and someone giving consent.

We must make sure that we ask in the best possible way,

at the best possible moment.

Without consent, there can be no organ donation.

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