Ethics In Donation Of Organs Of Older Patients

Ethics in donation of organs of older patients

Introduction

The world lack of organs for transplants and the continuous improvement of the strategies for the preservation of the organs have led to a renewed interest in techniques for organ preservation. The real evidence in the fall of organ procedures in brain or cardiopulmonary death has had the need to assess other options such as donation in asistolia as an alternative resource.

For elderly, the donation of certain organs is possible with treatments during the Premortem, which helps preserve and condition the organs for this practice, in the same way this leads to an ethical deontological reflection by people in the branch of Medicine, as well as relatives near the patient.

Developing.

In the procedure of donating organs, it leads to being in situations where the patient and medical have to decide to form ethically correct, but this would be carried out to demonstrate that the decision made was the best for individuals better. On the other hand, decisions not only depend on whether it results in a saved life but if the donor’s life was worthy before the donation, if the patient had what was necessary in care and without any pain that may cause necessary treatment for the donation.

This article talks about aspects that must be taken into account and studying so that the decision made is correct, these aspects are mainly focused on a Marxist ethic where all individuals involved have a benefit evenly.

Origin and history of organ donations

In the branch of medicine there were procedures where it offers the possibility of transplanting organs or tissues these being of the same subject or of a different one with the therapeutic purposes, has faced the doctor to a unique way of exercising medicine; Only 50 years have passed since it was shown that this way of solving some medical problems was technically feasible.

This procedure is now accepted as the treatment of choice for organic insufficiency in the terminal stage. Although tremendous progress has contributed to the success of this therapy, there are several challenges for the transplantation to be widely available with minimal risks and optimal results.

The need to create a branch called "Bioethics" as a consequence of the revolution and advanced advance in the medical and biological sciences from the fifties. Technical advances allowed to do new things that were, at least, problems such as transplantation from a patient with an advanced age. There are currently many patients who are possible donors being elderly or with terminal disease, but reject the option of being for a wrong criterion of having deteriorated organs and who do not fulfill their function correctly.

Effective organ conservation after death.

The main objective is for each patient Of Lora. This article addresses ethical issues related to controlled NHBD and not controlled. He argues that certain preparatory measures, such as giving anticoagulants, should be acceptable before patients are dead, but when a point in which an additional healing treatment is useless, they are in the process of dying and are unconscious. 

The study by Salih et al. He mentions that the supply of donor organs (specifically kidneys) could be increased by altering the treatment of 50-69-year-old patients who die of severe cerebrovascular disease in general medical rooms, particularly increasing the ventilated proportion. After this treatment the different organs are optimal for their transplant, in addition that said organ will have a normal and lasting performance for the person who is benefited, without forgetting that it has no secondary effect for the organ.

LAUPACIS et al. Through their article they conclude that renal transplantation was more effective and less expensive than dialysis in all subgroups of patients examined, which were 168 patients preferably the elderly examined in 3 US hospitals. This means that in renal transplants it is effective from elderly patients and helps with the shortage of people willing to donate this organ.

This preservation of the organs for donation must meet certain conditions, the patient must be out of viral or bacterial conditions this mentions Shah et al. In his article focused on donation in Covid 19 Pandemia, this is not sure for having a high degree of contamination in the organs.

Life expectancy with organ transplantation

The ethical foundations of transplant medicine and organ donation, mainly made in elderly in brain death, were examined. Having consolidated today as a universally accepted therapy that benefits many people, organ transplantation rests in a solid ethical base, mainly in the principles of autonomy, beneficence and non-medium efficiency.

For organs that come from people with an advanced age Kuo et al. Mention what age alone it should not be an exclusion criterion for renal organ donation. When the major renal donor is considered, creatinine clearance should be included within the decision algorithm.

In the study by Domínguez et al. They confirm that although the donation process is optimized in Spain, there are opportunities for the improvement in the detection of possible donors in controlled asistolia in deceased patients after limitation of life support treatment this with an efficacy of 64 % of 695 patients of brain death patients.

Ethical approach in organ donation

In many cases, organ donation is made under the donor’s decision, but this maintains an intimate perspective in the decision, since this decision is made together with the family and specifically with the doctor who attends it. Baumann et al. It offers an ethical evaluation that uses the four principles of medical ethics of Beauchamp and Childress by applying them in their broader sense to include patients and their families, their caregivers, other possible intensive care receptors, and in fact the society as a whole as a whole.

A broader perspective should be seen and considering future people who will benefit from the donation, this decision would involve taking into account the time that a certain organ is optimal to use it, in another case what would be the end of the donation if it is in the end It could not be done and which the patient undoubtedly had to perform difficult treatments before his death.

This aspect has a Marxist ethical approach and specifically the common good in the individuals involved. Méndez and Rodríguez describe the characteristics of the donation focus on a dignified death and a joint decision of the patient and family for the withdrawal or not of support measures in controlled assistolia type III of Maastricht. 

Having a negative response, the nurse has an important role in the implementation of a palliative care plan that must participate doctors, nurses and patient/family, and whose focus should be the dignity and well -being of the patient, considering their physical needs, psychological and spiritual.

Distribution ethics

Although body donation can expand the availability of organs for transplant or for exhausted options .

So how should these resources be distributed?, While all patients have the need to obtain an urgent transplant, not everyone can count on one, they lead us to an even more difficult questioning How to select patients who will give that preference?,. This is what medicine is known as triage. The need to have a “correct” response must have as an ethical basis of autonomy, beneficence and non-medium efficiency and in which it implies a common benefit in all the people involved.

Having to decide who would have the benefit of this treatment is only the doctor who is in charge in the area of ​​donations, in medical aspects and internal standards of hospitals, the severity of operation, age of the benefited patient and in general their health is considered, then without considering the position that this is on the waiting list.

The doctor who must make this decision must be done deontologically well, his decision must be strictly following his knowledge in this branch, he must ensure that the person who is chosen has the best probability of being a safe and long -term procedure, his guides, his guides For the decision they are exclusively with their experience, knowledge and the previous study of each case.

Trueba mentions that there are two main purposes where the decision of organ transplant.

Analysis

The important aspects involved in a decision to be a donor or being an advanced person with a terminal disease must be focused on having as its objective the common good of the donor as well as the person who is benefited from this procedure.

Ethically speaking this decision must be joint between the elderly and her doctor, and taking as a starting point the well -being of it; The doctor must examine in depth the most effective procedures for each case, deontologically the doctor is obliged to fulfill his work efficiently and with all the necessary studies to give a correct opinion.

Deontology in doctors if you practice it with some conditions, respect the common good for all those involved in these decisions, carry out the corresponding studies in an efficient way to have a correct panorama and choose the best decision and take into account that your work will have short and long term impact.

The ethics involved in organ donation will certainly be correct if this decision does not affect the health and well -being of people who are involved, starting with the patient mainly, family, doctors and finally to the person who will benefit from this donation.In addition, patient care in their last stage of life should be dignified, this has responsibility in nurses, doctors and family, the health and comfort of the patient has to be the best possible and in context of procedures that must follow for certain organs maintain your optimal efficiency.

5. Conclusions

The main principles where the decision of those who obtains this donation benefit are of autonomy, beneficence and non-medium efficiency, the choosing of several patients who need it is focused on giving as a priority the survival in the short term and long-term so that whoever whoever Dono has a purpose of which he had to carry out.

Doctors when exercising their profession must be professionally and ethically prepared for difficult decisions that will be presented to them throughout their medical activity, this implies having enough technical knowledge that it implies and in the same way to have knowledge in human psychology that will help guide patients and relatives to choose a decision that is attached to the needs of the situation.

The ethics involved in organ donation is focused by creating a benefit to the patient who decides to carry out this activity, but certainly this decision is more difficult if the patient has a committed health and with an advanced age then the benefits of this process do not be concentrated physical, but also in the spiritual.

Patients who have these conditions should take into account that the procedure leads to some discomfort by the procedures prior to donation, but these discomforts must have a beneficial purpose that considers that it is worth going through these procedures.Organ donation in elderly patients and palliative care has a complexity greater than in patients with better health conditions, however, in these conditions it is no less effective and safe, so it would be ethically correct.

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