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Summary: Organ donors are in high demand. Frequently intended
recipients can wait a lifetime for the critical matching organ. In
this case, two nurses obtained a consent from a child's mother. When
the father later expressed his disagreement, the child's corneas had been
harvested and it was too late.
The patient was an 11-year-old child that had died soon after an Asthma
attack.
"By condition (excluding pregnancy), the five leading causes of hospitalization
among children are: bronchitis/asthma, digestive disease, pneumonia and
respiratory infection, otitis media and mental disorders."1
The parents were approached for the purpose of donating the child's
corneas under the Uniform Anatomical Gift Act.
"What is a Corneal Transplant?
The cornea is a dime-sized clear tissue covering the front of the eye.
Light rays pass through the cornea and then through the lens. The lens
forms an image on the retina in the back of the eye where the optic nerve
is located. Sight is controlled by the optic nerve, the only nerve of vision.
This nerve activates the retina to pick up the image in view."2
The mother alone was present at this time when it was first discussed.
"The child's mother maintains that she told the nurse
it "did not matter" to her."3
"The Uniform Anatomical Gift Act (UAGA) of 1968 provided for the first
time that an individual could donate his or her organs at death to another
for medical purposes. It was adopted in all 50 states and the District
of Columbia, and was a major step toward solving the organ donation problem.
But new medical technologies have now made many transplant operations commonplace,
and a shortage of donor organs remains."4
With this, the harvesting center was contacted and the patient's information
left. A consent
form was faxed over to the hospital. Two nurses
then spoke to the mother by telephone and signed off on the form that consent
had been obtained.
Individual state laws may vary in procedure for who can consent
to an anatomical gift. In Alaska for instance:
"(a) A competent person who is 18 or more years of age may make a gift
to take effect upon death of all or a part of the person's body for a purpose
specified in AS 13.50.020.
(b) When persons in prior classes are not available at the time of death,
and in the absence of actual notice of contrary indications by the decedent
or actual notice of opposition by a member of the same or a prior class,
any of the following persons, in order of priority listed, may give all
or a part of the decedent's body for a purpose specified in AS 13.50.020:
(1) the spouse;
(2) an adult son or daughter;
(3) either parent;
(4) an adult brother or sister;
(5) a guardian of the decedent at the time of death;
(6) any other person authorized or under obligation to dispose of the
body.
(c) The persons authorized by (b) of this section may make the gift
after or immediately before death."5
The agent for the organ center came and harvested the child's corneas
and returned to the center. He had looked over the consent
form obtained, initialed it to verify it had been obtained by phone and
was satisfied.
"When the cornea, a thin tissue that covers the front of the eye, becomes
cloudy or damaged due to disease, injury or hereditary conditions, the
result is vision loss or even blindness.
To clear this window, the damaged cornea is removed surgically and replaced
with healthy, transplanted eye tissue-a donated cornea. This transplant
operation is successful in more than 90 percent of cases in the US. After
a successful transplant, patients have renewed vision or see for the first
time."6
Each individual facility must generate protocols on organ procurement
and obtaining informed
consent:
"Each
hospital in the state shall develop procedures for identifying
potential donors of gifts, requesting gifts, notifying and coordinating
with eye banks, tissue banks, and organ procurement agencies, and assisting
in the procurement, removal, storage, and transportation of gifts."7
The child's father would arrive on the scene soon after. When
approached and informed of the harvesting, he was perturbed. He would
not sign the consent
after the fact and chose to take legal action against the
hospital and
the donor center.
In court, summary judgement was entered for the defense:
The parent's appealed.
Questions to be answered:
1. Under the Uniform Anatomical Gift Act (UAGA), is the consent
of a parent sufficient to proceed with harvesting of a child's organs.
2. Were the nurses
negligent in their explanation of the procedure or in not waiting till
the father was available?
The applicable laws stated that as long as a consent
from a legally "responsible" and informed party is obtained, no liability
or negligence can be assigned. It was clear from the testimony of
the nurses that
they spoke to the mother and informed her of what was to happen.
In obtaining organs, time is typically of the essence. The longer
an organ or tissues remains in a body, the less likely it will be useful
for the purposes of transplantation.
There was no evidence that the mother was either "coerced" or "rushed"
into making a decision. There was no documentation
that she "wished to speak to her husband" before making the decision.
If more time had been needed or another family member needed to be consulted,
the mother could have clearly stated this.
On the part of the nurses,
a single adult guardian consent
only was needed and obtained.
When the agent of the eye bank looked over the informed
consent, he as satisfied that it was legitimate. In harvesting
the child's corneas, he acted in good faith and had no reason to believe
a proper consent had not been obtained.
The court dismissed the plaintiff's argument that the "good faith" actions
of the
hospital or eyebank were "subject to interpretation." The
court was satisfied that under the conditions, the actions of the employees
were reasonable and within the boundaries of existing law.
This case does point out the need for judgement and clear documentation
when a consent for organ donation is obtained. The nurses
were wise to obtain not one but two witness signatures on the consent form.
The agent of the eye bank was wise to make sure the notation was made of
a "telephone" consent.
Regardless of these precautions, the nurses,
hospital and eyebank were still sued. Had this lawsuit been initiated
after either of the employees involved had left, the
hospital may or may
not have covered or defended them.
Related Link Sections:
Clinical
Charting and Documentation, Nurses Notes
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm
Informed
Consent
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.consent.medical.legal.htm
Medical Legal Consulting
Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm
Organ
Donation:
http://www.nursefriendly.com/nursing/directpatientcare/organ.tissue.donation.htm
Sources:
1. National Association of Children's Hospitals and Related Institutions.
No date given. About
Childrens Hospitals - Facts on Children's Health - Illness and Injury.
Retrieved June 20, 1999 from the World Wide Web: http://www.nachri.org/abouth/facts/hlth_illness.html
2. Old Dominion Eyebank. No date given. Corneal
Transplant. Retrieved June 20, 1999 from the World Wide Web: http://www.odeb.org/html/cornealtransplant.htm
3. RRNL 39 May 12 (1999)
4. National Conference of Commissioners on Uniform State Laws.
No date given. Why
All States Should Adopt The Revised Uniform Anatomical Gift Act (1987).
Retrieved June 20, 1999 from the World Wide Web: http://www.nccusl.org/whystate/uagawhy.html
5. The Alaska Legal Resource Center. No date given. Persons
Who May Execute An Anatomical Gift. Retrieved June 20, 1999 from
the World Wide Web: http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section010.htm
6. Medical Eye Bank of Florida. No date given. Anatomy
of the Eye. Retrieved June 20, 1999 from the World Wide Web: http://www.castlegate.net/mebfl/anatomy.htm
7. The Alaska Legal Resource Center. No date given. Requests
By Hospitals For Anatomical Gifts. Retrieved June 20, 1999 from the
World Wide Web: http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section014.htm
The Uniform Resource Locator (URL) or Internet Street Address
of this page is
http://www.nursefriendly.com/nursing/clinical.cases/062099.htm
Send comments and mail to Andrew Lopez, RN
Created on Saturday May 23, 1999
Last updated by Andrew
Lopez, RN on Thursday, February 14, 2008 |