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Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Index

A

ABTC. See American Board for Transplant Certification

Acceptable appeals, for organ donation, 3, 79, 8485

Access.

See also Preferential access to donated organs

to immunosuppressive medications following transplantation, 95

Accreditation, 99

American Board for Transplant Certification, 99

Association of Organ Procurement Organizations, 99

Centers for Medicare & Medicaid Services, 99

Joint Commission on Accreditation of Healthcare Organizations, 99

Organ Procurement and Transplantation Network, 99

ACOT. See Advisory Committee on Transplantation

Actions needed to increase rates of DCDD, 14, 156160, 282

clarification of regulatory and statutory requirements, 158

developing regional infrastructures, 159

ensuring the opportunity for donation, 158

mentoring and evaluation, 158

proposed by the National Conference on Donation after Cardiac Death, 136137

providing excellent emergency and resuscitative care, 157

providing professional education, 157158

providing public education, 157

Actual donors, 25

Ad Council, 188

Adjusted patient survival rate, 59

Advance directives, 23, 115

Advanced cardiac life-support efforts, criteria for termination of, 132

Adverse biopsy results, 47, 50

Adverse selection problem, 256257

Advisory Committee on Transplantation (ACOT), 136, 264, 272

Advocates

for donors, independent, 13, 275, 307

family, 308309

African Americans, 54, 6465, 67, 195196, 198, 301

Agency relationships, 237, 246

AHA. See American Heart Association

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Allocating and distributing organs, 95

access to immunosuppressive medications following transplantation, 95

equitable access to transplantation, 95

Allosensitization, 59

Altruism, cultural norms and models of willingness to donate, 7071

AMA. See American Medical Association

American Board for Transplant Certification (ABTC), 99

American Heart Association (AHA), 153154, 156

American Medical Association (AMA), 197, 214, 225, 250, 257

American Nurses Association, 197

American Society of Transplant Physicians (ASTP), 133

American Society of Transplant Surgeons (ASTS), 33, 188, 249, 252

American Society of Transplantation (AST), 33, 188

AOPO. See Association of Organ Procurement Organizations

Appeals. See Acceptable appeals

Arguments for and against preferred-access approaches, 254258

the adverse selection problem, 256257

the information problem, 256

the unfair allocation problem, 257258

Arizona, 186, 302

Arkansas, 194

Asian Americans, 65, 196

Asian-Pacific Islanders, 195

Assessment of DCDD strategies in the United States, 141143

DCDD cases reported by OPOs, 143

deceased donors, 142

organs recovered from DCDD donors in the U.S., 143

Assessment of presumed-consent policies, 212224

autonomy-based arguments, 218219

chances of a presumed-consent policy being adopted in the U.S., 222224

cost-effectiveness, 216

effectiveness in increasing the number of transplantable organs, 212216

individual generosity, societal generosity, and mutual self-interest, 221222

justice and fairness, 219221

possible benefits of and barriers to presumed-consent policies, 223

reducing the burden of familial decision making, 216218

Association of Organ Procurement Organizations (AOPO), 5, 21, 33, 97, 99, 119, 136

AST. See American Society of Transplantation

ASTP. See American Society of Transplant Physicians

ASTS. See American Society of Transplant Surgeons

Austria, 27

Autonomy-based arguments, 218219

B

Barriers, to a futures market, 234235

Behavioral interventions, 300301

Belgium, 27, 217

Brain function, controversy over, 146

Breakthrough collaborative model, 103.

See also Organ Donation Breakthrough Collaboratives;

Organ Transplantation Breakthrough Collaborative;

Transplantation breakthrough collaboratives

British Medical Association, 222n

Buying and selling of organs, 239242

advantages of the gift model, 240241

claims of a liberty right to sell organs, 241242

C

California Transplant Donor Network, 109

Candidates on the transplant waiting list, growth in numbers of, 2, 16

Cannulation, 133, 310.

Cardiac arrests, 138, 286287, 308

Cardiac life-support efforts, criteria for termination of advanced, 132

CDC. See Centers for Disease Control and Prevention

CDD. See Circulatory determination of death

Centers for Disease Control and Prevention (CDC), 8, 198199

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Centers for Medicare & Medicaid Services (CMS), 32, 97, 99, 101, 119

Christianity, and deceased organ donation, 66, 193

Circulatory determination of death (CDD), 31, 83, 128.

See also Donation after circulatory determination of death

Clarification

of criteria for determination of death, 1819

of regulatory and statutory requirements, 158

relevant legislation, 19

of terminology, 4

Clinical Interventions grants program, 300301

CMS. See Centers for Medicare & Medicaid Services

Coalition on Donation, 33, 188189, 193

Cold preservation techniques, 153

Collaborators and consultants.

See also Organ Donation Breakthrough Collaboratives

at the Washington Hospital Center, 314

Committee’s charge, 7778

Commodification, 233234, 248249, 255

Community coalitions, 89, 199200

Community education, at the Washington Hospital Center, 154, 313314

Community grassroots efforts, and minority populations, 195198

Community Oversight Committee, 137, 308

Community recognition, 229, 253

Competence trustworthiness, 111112

Confidentiality, of donor registrations, 183

Conflicts of interest, 148149

Confucianism, and deceased organ donation, 67

Consensus Conference on the Asystolic Trauma Donor, 305

Consensus Conference on Trauma Victims and Organ Donation, 308, 314

Consent.

See also First-person consent status;

Informed consent;

Presumed consent;

Voluntary consent

varieties of, 175, 209210

at the Washington Hospital Center, 309310

Controlled DCDD in the U.S., 128

conflicts of interest, 148149

controversy over brain function, 146

controversy over irreversibility, 145146

controversy over premortem interventions, 146147

end-of-life care, 147

family interests and consent, 149150

myths and misperceptions about, 151

withdrawal of treatment, 147148

Controlled death, defining, 129131

Conversion rates, among member hospitals, 105

Cost-effectiveness issues, 35, 90, 165, 216

Council on Ethical and Judicial Affairs, 214215, 225

CPR (cardiopulmonary resuscitation), 152, 154156

Cultural issues, 2829, 71

D

DCD. See National Conference on Donation after Cardiac Death

DCDD. See Donation after circulatory determination of death

Dead bodies, commodification of, 233234, 248249

Dead donor rule, 112

Death, defining controlled, 129131

Deceased organ donation, 2225

incentives for, 229262

process of organ donation, 24

religion and, 6667

Deceased organ donors, 51, 142

eligible, actual, and additional, 25

increase in number of, 105

numbers of, 28

Decedents’ wishes, respect for, 87

“Decision: Donation” packet, 194

Decision making

surrogate, 116

training in, 117119

Decisions to donate. See Facilitation of individual and family decisions to donate

Demand side of an organ market, 236239

Demographics, 6263

in family decision making, 63

in individual decision making, 6263

Demonstration projects, 118, 160, 168

Denmark, 27, 29

Departments of motor vehicles, 9, 184, 185

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Determination of death, 128131

defining controlled and uncontrolled death, 129131

Maastricht categories, 129

DHHS. See U.S. Department of Health and Human Services

Dispositional authority, 211

Distribution of organs. See Allocating and distributing organs

Division of Transplantation (DoT), 20, 3132, 189, 304

DNDD. See Donation after neurologic determination of death

Documention of decisions to donate, 183187

additional opportunities to document donation decisions, 187

donor cards, 184185

donor registries, 185187

driver’s license registration, 184

Donate Life Organization, 188189

Donation after circulatory determination of death (DCDD), 67, 31, 100, 127161, 165168, 281282

cases reported by OPOs, 143

Donation after neurologic determination of death (DNDD), 31, 128, 141142

Donation rates, 27, 100, 249252.

See also Expansion of the population of potential donors

comparing, 27

increasing, 288

Donation service areas (DSAs), 97

Donor advocates, independent, 275, 307

Donor cards, 184185

Donor choice issues, 182183

communicating decisions to family, 182

confidentiality of donor registrations, 183

honoring donor consent, 182183

informed choice, 182

Donor hospitals, 6, 168

Donor registries, 185187

confidentiality of, 183

Donor Sabbath, 187

Donor service areas, 21

Donors.

See also Actual donors;

Additional donors;

Deceased organ donors;

Eligible donors;

Living donors;

Organ donors;

Potential donors

altruism, cultural norms, and models of willingness to donate, 7071

demographics, 6263

ethnicity, 6465

family discussions regarding organ donation, 6869

financial costs to, 270

individual and family decisions, 6271

quality of health care and trust in the healthcare system, 6970

spirituality, 6568

Donor’s loss, 232

DoT. See Division of Transplantation

Driver’s license registration, 184, 194

DSAs. See Donation service areas

Durable powers of attorney, 116

E

Economic considerations, 159160, 286

Economic value of increasing the organ supply, 3335

Education. See Public education;

Training

Effectiveness

of the healthcare system, 94

in increasing the number of transplantable organs, 212216

Efficiency, of the healthcare system, 94

Eligible donors, 25

Emergency medical services (EMS), 154155, 159160

End-of-life care, 23, 87, 115117, 147

communication and decision making in, 117119

End-of-life communication, training in, 117119

End-stage renal disease (ESRD), 53, 98

End-Stage Renal Disease program, 220n, 246

Equipment. See Facilities and equipment

Equitability

of access to transplantation, 95

of the healthcare system, 94

ESRD. See End-stage renal disease

Ethical considerations, 2829, 143154

for expanded-criteria organ donation, 165

Ethical considerations in living donation, 1213, 263279

background, 264268

donations, not sales, 273274

independent donor advocates, 13, 275, 307

informed consent, 270272

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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living donor follow-up, 276

next steps, 274276

other ethical considerations, 270274

recommendation concerning facilitating living donor follow-up, 13, 277

recommendation concerning protecting living donors, 13, 276277

relationships between living donors and recipients, 265266

risk-benefit ratios, 268270

voluntary consent, 272273

Ethical issues pertinent to controlled DCDD

myths and misperceptions about, 151

in the U.S., 145150

Ethical issues pertinent to uncontrolled DCDD, 150154

informed consent, 153154

myths and misperceptions about, 152

resuscitation, 150153

Ethnicity, 6465.

See also individual racial and ethnic groups

donors, transplants, and waiting list by, 50

family decision making, 65

individual decision making, 6465

Europe, 138140, 305

European Resuscitation Council, 153

Eurotransplant International Foundation, 27

Evaluation, 158

of HRSA’s extramural research grants, 303304

of proposed changes, criteria for, 9091

Evolution of the request process, 106110

formulation of the request, 107

requesters, 108110

timing of requests, 107108

Excellence, in emergency and resuscitative care, 157

Expanded criteria for organ donation, 160167

ethical considerations for expanded-criteria organ donation, 165

next steps for expanded criteria, 166167

organ quality, 166

organ screening, 167

targeted research needs, 166167

UNOS definition of expanded-criteria kidney donors, 162

Expansion of the population of potential donors, 67, 39, 127173

actions needed to increase rates of DCDD, 157159

assessment of DCDD strategies in the United States, 141143

background and issues, 128140

common criteria for termination of advanced cardiac life-support efforts, 132

demonstration projects, 160

determination of death, 128131

economic considerations, 159160

encouraging and funding DCDD demonstration projects, 7, 168

expanded criteria for organ donation, 160167

general considerations, 131133

general ethical considerations, 143154

implementing initiatives to increase rates of donation after circulatory determination of death, 67, 168

increasing research on organ quality and enhanced organ viability, 7, 168

learning from past experience and international models, 136140

next steps for DCDD, 156160

prior reports and recommendations, 133136

recommendation concerning maintaining opportunities for organ donation, 67, 167168

reexamination of uncontrolled DCDD, 154156

Expected donations, 107, 111, 216

Explicit consent, 28

Extramural research program, 299304

clinical interventions, 301

grant summary, 301303

media-based interventions, 301

overview of HRSA’s extramural research program, 299303

social and behavioral interventions, 300301

F

Facilitation of individual and family decisions to donate, 79, 39, 175203

additional opportunities to document donation decisions, 187

donor cards, 184185

donor registries, 9, 185187, 200

driver’s license registration, 184

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
×

framework for informed choice, 176177

mandated choice, 177181

opportunities for people to record their decision to donate, 9, 181187, 200

public education, 187199

public understanding of and support for organ donation, 89, 199

recommendations, 199200

voluntary choice, 181187

Fairness, 3, 79, 8990, 219221

Faith-based organizations, 8, 199

False-negative and -positive responses, 218219

Familial decision making, 63, 65

discussions regarding organ donation, 6869

family interests and consent, 149150

reducing the burden of, 216218

Families, respect for, 8889

Family advocates, 308309

Financial costs, to donors, 270

Financial incentives within a donation framework, 149, 247252

the commodification issue, 248249

impact on donation rates, 249252

payments to families for funeral expenses, 249250

payments to register, 250251

pilot studies, 251252

Finland, 27

First-person consent status, and organ donor registry participation, 289292

First steps, 113119, 274276.

See also Actions needed to increase rates of DCDD

enhancing training in end-of-life communication and decision making, 117119

for expanded criteria, 166167

facilitating and documenting decisions to donate, 183187

integrating organ donation and end-of-life care, 114117

for public education, 198199

regarding mandated choice, 180181

sustaining continuous quality improvement, 113114

Florida, 206

Florida v. Powell, 206207

Formulation of requests, 107

Framework

for informed choice, 176177

of trust, 110113

France, 26

Free market in organs

demand side of an organ market, 236239

problems with, 231239

supply side of an organ market, 232236

G

Gender disparities, 273

Georgia, 207, 251

Germany, 27, 29

Gift model, 12

advantages of, 240241

Gift of Life initiatives, 32, 69

Grant summary, 301303

Grassroots efforts, and minority populations, 195198

Green screen, 95, 237

Greenwall Foundation, The, 3, 17

Growth

in numbers of transplants and in numbers of candidates on the transplant waiting list, 2, 16

of the transplantation field, 2022

H

Haddon matrix, 36

Health Care Financing Administration (HCFA), 101

Health Resources and Services Administration (HRSA), 39, 13, 17, 102103, 120, 141, 176, 189, 198200, 236, 264, 299304

evaluating HRSA’s extramural research grants, 303304

extramural research program, 299304

Healthcare professionals.

See also Professional societies

enhancing training for, 6, 120

Heart and heart-lung, 5759

adjusted patient survival rate, 59

Hemodialysis, 53

Hinduism, and deceased organ donation, 67

Hispanics, 64, 195, 197, 301

History

clarifying criteria for determination of death, 1819

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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and context, 230231

of the current U.S. system, 18, 230, 293

deceased organ donation, 2225

growth and organization of the transplantation field, 2022

illicit markets for bodies in, 233

transplant recipients, 2526

HLA. See Human leukocyte antigen matching

Hollywood, Health & Society, 189

Honoring donor consent, 182183

Hospital Clinico San Carlos (Madrid), 138140

Hospitals, 104, 109, 160, 198199, 304.

See also Donor hospitals

HRSA. See Health Resources and Services Administration

Human dignity, respect for, 86

Human leukocyte antigen (HLA) matching, 5455, 59

Human remains, respect for, 88

I

Iceland, 27

ICUs. See Intensive care units

IHI. See Institute for Healthcare Improvement

Illicit markets for bodies, 233

Immunosuppressive therapies, 51

Improvement aims for the healthcare system, 9394

effectiveness, 94

efficiency, 94

equitability, 94

patient centeredness, 94

safety, 93

timeliness, 94

Incentives for deceased donation, 1012, 39, 229262, 285

financial incentives within a donation framework, 247252, 286

history and context, 230231

nonfinancial incentives, 253258

payments as a token of gratitude, 252253

preferential access to donated organs, 253258

recommendation concerning financial incentives, 12, 259

recommendation concerning preferential access, 12, 259

recommendations, 258259

regulated commerce in organs, 239247

why a free market in organs is problematic, 231239

Independent donor advocates, 13, 275, 307

Individual autonomy, 179180

Individual decision making, 6265, 286

Individual generosity, 221222

Information problem, 256

Informed choice, 182

Informed consent, 153154, 270272

robust, 271

Innovative system changes, increasing research on, 5, 120

Institute for Healthcare Improvement (IHI), 103

Institute of Medicine (IOM), 3, 17, 9395, 115, 127, 143, 289

Integrated approaches, 115

Integration of organ donation and end-of-life care, 114117

emphasis on patient and family relationships, 116117

use of interdisciplinary healthcare teams, 117

Intensive care units (ICUs), 100

donor protocol (controlled donors) in, 307308

Interdisciplinary healthcare teams, 112, 117

Interdisciplinary training, 118

Intermountain Donor Services, 69

International models, learning from, 136140

International perspective, 2629, 285

comparing rates of organ donation, 27

ethical, social, and cultural issues, 2829

numbers of deceased donors, 28

Intestine, 6162

IOM. See Institute of Medicine

Iowa, 194

Ireland, 27

Irreversibility, controversy over, 145146

Islam, and deceased organ donation, 66

J

Japan, 29

JCAHO. See Joint Commission on Accreditation of Healthcare Organizations

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 5, 33, 97, 99, 119

Judaism, and deceased organ donation, 6667

Justice, 212, 219221

K

Kentucky, 188

Kidney transplants, 16, 46, 130

Kidneys, 5255

living kidney donors, 264, 266

obtained as a result of DCDD, 140

L

Latinos, 64, 195196

Learning from other public health efforts, 189192

correcting myths and misperceptions, 190191

public health intervention strategies, 192

Learning from past experience and international models, 136140

Europe, 138140

kidneys obtained as a result of DCDD, 140

Modified Madrid Criteria, 139

Washington, D.C., 137138

Legislation on criteria for determination of death, 19

National Organ Transplant Act, 19

Omnibus Budget Reconciliation Act, 19

Organ Donation and Recovery Improvement Act, 19

Uniform Anatomical Gift Act, 19

Uniform Determination of Death Act, 19

Libertarian argument, 241

Liberty right, to sell organs, claims of, 241242

Life Gift, 109

Life Point, 109

Life-support efforts, 30, 148

criteria for termination of advanced cardiac, 132

LifeNet, 69

LifeSharers program, 253254

Line placement techniques, 310311

Linking organ recovery and distribution, 80

Liver, 5557, 365

Living donations, 287

ethical considerations in, 263279

Living donors, 5152, 269

following-up with, 276

Local governments, 9

Louisiana, 194

Lung, 5960

Luxembourg, 27

M

Maastricht categories, 129, 141, 155

Madrid Criteria. See Modified Madrid Criteria

Maine, 194

Mandated choice, 177181

individual autonomy, 179180

next steps regarding, 180181

timing and family involvement, 180

Markets.

See also Free market in organs;

Organ markets

for bodies, illicit, 233

Maryland, 184, 187

Massachusetts, 194, 264

Media, 192193

print, 246

Media-Based Interventions program, 300301

Medicaid coverage, 9798

Medicare coverage, 20, 53, 9798, 158, 220n, 246

Medlantic Healthcare Group, 306

Medlantic Research Institute (MRI), 305, 313315

MedSTAR, 305309, 311, 314

MELD. See Model for End-Stage Liver Disease

Mental capacity issues, 219

Mentoring, 158

Minnesota, 194

Minority populations, 2

community grassroots efforts and, 195198

Misperceptions. See Myths and misperceptions

Missouri, 186

Mistaken removals and nonremovals, 219

Model for End-Stage Liver Disease (MELD), 57

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Modified Madrid Criteria, 139, 155156, 167

Mortality

confronting one’s own, 189

postoperative, 35

Motor vehicles departments, 9, 184, 185

MOTTEP

See National Minority Organ and Tissue Transplant Education Program

MRI. See Medlantic Research Institute

Multi-organ transplant, 61

Multistakeholder consensus conferences, 145

Mutual self-interest, 221222

Myths and misperceptions

about controlled DCDD, 151

about uncontrolled DCDD, 152

correcting, 189191

N

Nanotechnology, 37

NATCO. See Organization for Transplant Professionals

National Association of Hispanic Nurses, 197

National Black Nurses Association, 197

National Bone Marrow Donor Registry, 299

National Center on Minority Health and Health Disparities, 5, 32, 120, 195n, 197

National Committee for Quality Assurance (NCQA), 5, 119

National Conference on Donation after Cardiac Death (DCD), 136, 146, 150

actions proposed by, 136137

National Consensus Project Steering Committee, 117

National Donor Family Council, 30

National Hispanic Medical Association, 197

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), 32, 195n

National Institutes of Health (NIH), 58, 32, 120, 168, 195, 198199

National Kidney Foundation (NKF), 33, 245, 250

National Medical Association, 197

National Minority Organ and Tissue Transplant Education Program (MOTTEP), 32, 189, 195197

National Organ Transplant Act (NOTA), 1920, 153, 231, 239, 265, 273

National Survey of Organ Donation, 181182, 215, 224, 244

Native Americans, 195

NCQA. See National Committee for Quality Assurance

NDD. See Neurologic determination of death

Nebraska Health System, 117

Nephrectomy, 312

Netherlands, The, 154, 194

Neurologic determination of death (NDD), 29, 31, 7071, 131, 193.

See also Donation after neurologic determination of death

Neutral-choice policy, 214

New Jersey, 193, 302

New Mexico, 185, 194

Newman v. Sathyavaglswaran, 88

NHBDs. See Non-heart-beating organ donations

NIDDK. See National Institute of Diabetes & Digestive & Kidney Diseases

NIH. See National Institutes of Health

NKF. See National Kidney Foundation

Non-heart-beating organ donations (NHBDs), 152, 305, 313

Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement, 133134

Non-Heart-Beating Organ Transplantation: Practice and Protocols, 134

Nonfinancial incentives, 253258

arguments against preferential access, 255258

arguments for preferred-access approaches, 254255

Nonprofit organizations, 9, 200

Normative trustworthiness, 112113

North Carolina, 184

Norway, 27

NOTA. See National Organ Transplant Act

O

ODA. See Office of Decedent Affairs

Office of Community Affairs, 306

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Office of Decedent Affairs (ODA), 306307, 309, 313

Office of Minority Health Research, 195n

Ohio, 194

Omnibus Budget Reconciliation Act, 19

Opinions of healthcare professionals, 245

OPOs. See Organ procurement organizations

Opportunities for action, 1314, 281282

to document donation decisions, 187

to ensure donations, 158

to increase organ donations, 14, 282

Opt-in approach, 154, 214215, 280

Opt-out approach, 28, 210, 214

OPTN. See Organ Procurement and Transplantation Network

OPTN/UNOS policy, 136137, 161164

waiting list under, 47

Organ brokers, 238

Organ Donation and Recovery Improvement Act, 19, 270

Organ Donation Breakthrough Collaboratives, 5, 32, 102, 110, 118119, 158, 181, 199, 236, 243, 258259, 288, 301302

Organ donation systems, 26, 93125

context of the current U.S. organ donation system, 95101

conversion rates among member hospitals, 105

framework of trust, 110113

improvement aims for the healthcare system, 9394

increase in number of deceased organ donors, 105

initiatives in, 4

issues in allocating and distributing organs, 95

next steps, 113119

ongoing evolution of the request process, 106110

organ donation and transplantation breakthrough collaboratives, 101106

quality improvement in health care, 102

recommendations, 119120

Organ donations

acceptable appeals for, 3, 79, 8485

decision-making policies, 211

process of, 24, 236, 310313

and quality end-of-life care practices, 6, 120

statistics and trends, 4562

Organ Donor Leave Act, 270

Organ donors, 1, 4652

deceased donors, 51

by donor type, 48

by ethnicity, 50

living donors, 5152

OPTN/UNOS waiting list, 47

transplants, 4950

waiting list, 4950

waiting list additions, 48

Organ exchange organizations, 26

Organ markets

buying and selling in, 239242

demand side of, 236239

problems with a free market in, 231239

supply side of, 232236

Organ Procurement and Transplantation Network (OPTN), 1n, 6, 13, 1516, 20, 31, 46, 53, 5761, 99, 136, 168, 238, 265266, 299

Organ procurement organizations (OPOs), 49, 20, 69, 93, 96100, 141, 160, 168, 198200, 217, 245, 288, 301, 304

donation rates, 100

Organ recovery

from DCDD donors in the U.S., 143

at the Washington Hospital Center, 311313

Organ Transplantation Breakthrough Collaborative, 106

Organization for Transplant Professionals (NATCO), 33, 188, 250

Organization of the transplantation field, 2022

donor service areas, 21

Organs, 5262.

See also Organ donation systems

heart and heart-lung, 5759

intestine, 6162

kidneys, 5255

liver, 5557

lung, 5960

pancreas, 6061

quality of, 166

screening, 167

types of, 5262

Out-of-pocket costs, 272

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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P

Pacific Islanders, 195

Palliative care, 114, 120

Pancreas, 6061

Past experience, learning from, 136140

Patient and family relationships, emphasis on, 116117

Patient centeredness, of the healthcare system, 94

Patient survival rate, adjusted, 59

“Paying for Organs,” 249

Payments

to families for funeral expenses, 249250

to register, 250251

as a token of gratitude, 252253

Pediatric End-Stage Liver Disease (PELD), 57

PELD. See Pediatric End-Stage Liver Disease

Pennsylvania, 249, 303

Perceptions. See Myths and misperceptions

Perfusion catheter, line placement by, 310311

Peritoneal lavage, line placement by, 310

Persons, respect for, 3

Peter Brent Brigham Hospital (Boston), 264

PHASE. See Pre-Hospital Arrest Survival Evaluation data set

Physician’s Orders for Life-Sustaining Treatment, 187

Poor people, risk of exploiting, 255

Potential donors, 308

estimation of, 155156

expanding the population of, 127173

issues in expanding the population of, 128140

Powers of attorney, durable, 116

Pre-Hospital Arrest Survival Evaluation (PHASE) data set, 155

Precedent autonomy, 87

Preferential access to donated organs, 229, 253258

arguments against, 255258

arguments for, 254255

Premortem interventions, 144

controversy over, 146147

Preservation, 308.

See also Cold preservation techniques;

Kidney preservation

Presumed consent, 910, 28, 107, 205228, 303

recommendations concerning, 226227

routine removal, 206208

varieties of consent, 209210

weak and strong, 210212

Presumed-consent policies

assessment of, 212224

autonomy-based arguments, 218219

chances of its being adopted in the U.S., 222224

cost-effectiveness, 216

effectiveness in increasing the number of transplantable organs, 212216

individual generosity, societal generosity, and mutual self-interest, 221222

justice and fairness, 219221

organ donation decision-making, 211

possible benefits of and barriers to, 223

reducing the burden of familial decision making, 216218

Prevention

emphasis on, 3637

organ transplantation prevention matrix, 37

Primum non nocere (above all do no harm), 12, 263

Principles, 3, 7792

acceptable appeals for organ donation, 3, 79, 8485

the committee’s charge, 7778

common stake in a trustworthy system, 3, 7984

criteria for evaluating proposed changes, 9091

fairness, 3, 79, 8990

respect for persons, 3, 79, 8589

Print media campaigns, 246

Prior reports and recommendations, 133136

actions proposed by the National Conference on Donation after Cardiac Death, 136137

recommendations of Non-Heart-Beating Organ Transplantation, 134135

Process, of organ donation, 24, 236, 310313

Professional education, 157158

Professional societies, 6, 168

Proposed changes, criteria for evaluating, 9091

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
×

Protocol for the Rapid Organ Recovery Program, 150

Public education, 135, 157, 179, 187199

Coalition on Donation, 188

community grassroots efforts and minority populations, 195198

driver’s license registration, 194

learning from other public health efforts, 189192

media, 192193

next steps for public education, 198199

workplace efforts, 193

youth, 194195

Public health

intervention strategies, 192

learning from previous efforts, 189192

Public opinion, 243245

Q

Quality improvement

in health care, 102

sustaining continuous, 5, 113114, 119

and trust in the healthcare system, 6970

Quantifying self-interest in organ donation, 293297

assumptions, 294296

notation, 294

risk of being placed on a waiting list, 297

Question of whether payments would actually increase the organ supply, 242245

opinions of healthcare professionals, 245

public opinion, 243245

religious group opinion, 245

Question of whether payments would be a cost-effective policy, 245247

R

Race. See Ethnicity;

individual racial and ethnic groups

Rapid Organ Recovery Program, 306, 313

protocol for, 150

Rapid organ recovery program transplantation services

consent, 309310

design and methods for, 306313

donor criteria, 306307

fatal trauma victim protocol (uncontrolled donors) in, 308

kidney preservation, 313

line placement technique, 310311

Rates. See Donation rates;

Expansion of the population of potential donors

Reciprocity model, 12, 8081, 254255, 257

Recommendations, 119120, 199200, 226227, 258259, 276277

encouraging and funding DCDD demonstration projects, 7, 168

enhancing donor registries, 9, 200

enhancing training for healthcare professionals, 6, 120

facilitating living donor follow-up, 13, 277

financial incentives, 12, 259

implementing initiatives to increase rates of donation after circulatory determination of death, 67, 168

increasing opportunities for people to record their decision to donate, 9, 200

increasing public understanding of and support for organ donation, 89, 199

increasing research on innovative system changes, 5, 120

increasing research on organ quality and enhanced organ viability, 7, 168

maintaining opportunities for organ donation, 7, 168

from Non-Heart-Beating Organ Transplantation, 134135

preferential access, 12, 259

protecting living donors, 13, 277

strengthening and integrating organ donation and quality end-of-life care practices, 6, 120

sustaining continuous quality improvement initiatives, 5, 119

systems approach, 46

terms, 4

Referrals, required, 101

Regional infrastructures, 159

Regulated commerce in organs, 99, 239247

allowing buying and selling of organs, 239242

American Board for Transplant Certification, 99

Association of Organ Procurement Organizations, 99

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
×

Centers for Medicare & Medicaid Services, 99

Joint Commission on Accreditation of Healthcare Organizations, 99

Organ Procurement and Transplantation Network, 99

question of whether payments would actually increase the organ supply, 242245

question of whether payments would be a cost-effective policy, 245247

Relationships between living donors and recipients, 265266

Religion and deceased organ donation, 6667, 257

Christianity, 66, 193

Confucianism, 67

group opinion in, 245

Hinduism, 67

Islam, 66

Judaism, 6667

Taoism, 67

Requests and requesters, 108110

formulation of, 107

required, 101

Respect for persons, 3, 79, 8589

for decedents’ wishes, 87

for families, 8889

for human dignity, 86

for human remains, 88

Resuscitation, 150153

Risk-benefit ratios, 268270

Risk of being placed on a waiting list for an organ transplant, by cause of death, 297

Robust informed consent, 271

Routine-removal policies, 205208

S

Safety, of the healthcare system, 93

Scandiatransplant, 27

SCCM. See Society of Critical Care Medicine

Scientific Registry of Transplant Recipients (SRTR), 31, 98, 299

“Second Chance” Volunteers, 188

Self-interest, mutual, 221222

Self-interest in organ donation, quantifying, 293297

Selling. See Buying and selling of organs

Sensitivity analysis, 295296

Social and Behavioral Interventions grants program, 190191, 299301

Social issues, 2829

Societal generosity, 221222

Society of Critical Care Medicine (SCCM), 146

Spain, 2627, 217

Spirituality, 6568

religion and deceased organ donation, 6667

SRTR. See Scientific Registry of Transplant Recipients

State governments, 9, 84.

See also individual states

Strong presumed consent, 210212

organ donation decision-making policies, 211

Supply side of an organ market, 232236

barriers to a futures market, 234235

commodification of dead bodies, 233234

other complexities, 235236

Surrogate decision making, 116

Survival. See Patient survival rate

Sweden, 27

Systems

changing, 286

trustworthiness of, 3

Systems approach recommendations, 46.

See also Organ donation systems

enhancing training for healthcare professionals, 6, 120

increasing research on innovative system changes, 5, 120

strengthening and integrating organ donation and quality end-of-life care practices, 6, 120

sustaining continuous quality improvement initiatives, 5, 119

Systems of care, an organizational perspective, 96101

OPO donation rates, 100

regulation and accreditation, 99

T

Taoism, and deceased organ donation, 67

Targeted research needs, 166167

Task Force on Organ Transplantation, 81, 220

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
×

Tax incentives, 247

Termination of advanced cardiac life-support efforts, criteria for, 132

Terminology, 3031

recommendations concerning, 4

Timeliness, of the healthcare system, 94

Timing

and family involvement, 180

of requests, 107108

Training

in end-of-life communication and decision making, 117119

for health professionals, 157158

interdisciplinary, 118

Transparency, 84

Transplant centers, 6, 21, 26, 166, 168, 264265

Transplant recipients, 2526

Transplant waiting lists, 12, 16, 54

additions, 48

growth in numbers of candidates on, 2, 16

risk of being placed on, by cause of death, 297

Transplantation breakthrough collaboratives, 101106

conversion rates among member hospitals, 105

increase in number of deceased organ donors, 105

quality improvement in health care, 102

Transplantation services

growth and organization of, 2022

Washington Hospital Center’s rapid organ recovery program, 305315

Transplants, growth in numbers of, 2, 16

Trends, 4575

organ donation statistics and trends, 4562

who donates—individual and family decisions, 6271

Trustworthiness of a system, 3, 29, 7984

common stake in, 3

competence, 111112

link between organ recovery and distribution, 80

normative, 112113

reciprocity, 8081

transparency, 84

U

UAGA. See Uniform Anatomical Gift Act

UDDA. See Uniform Determination of Death Act

UK Transplant, 27

Uncontrolled DCDD, 128

estimation of potential donors, 155156

myths and misperceptions about, 152

reexamination of, 154156

Uncontrolled death, defining, 129131

Unfair allocation problem, 257258

Uniform Anatomical Gift Act (UAGA), 19, 2223, 84, 138, 175, 177, 209, 230

Uniform Determination of Death Act (UDDA), 1819, 144146

United Kingdom, 2627, 193, 217

United Network for Organ Sharing (UNOS), 8, 20, 5355, 104, 136, 199, 238, 245, 253, 257258, 267, 313

definition of expanded-criteria kidney donors, 162

United States (U.S.), 290292.

See also State governments;

individual states

University of Pennsylvania, 303

University of Wisconsin, 132, 303

UNOS. See United Network for Organ Sharing

U.S. Department of Health and Human Services, 7, 20, 100, 133, 136, 168, 264, 272

U.S. efforts to increase organ donation, 3133

funding the HRSA Division of Transplantation, 32

U.S. organ donation system

context of the current, 95101

required request and required referral, 101

systems of care—an organizational perspective, 96101

U.S. Renal Data System, 53

U.S. Supreme Court, 148

V

Vacco v. Quill, 148

Voluntary choice

ensuring, 276277

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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expanding opportunities to document donation decisions, 181187

facilitating and documenting decisions to donate, 183187

key issues for donor choice, 182183

Voluntary consent, 272273

Voluntary health organizations, 8, 199

W

Waiting lists. See Transplant waiting lists

Washington Hospital Center (WHC), 137138

community education, 313314

protocol for the rapid organ recovery program, 305315

transplantation services, 305315

Washington Regional Transplant Consortium (WRTC), 311

Weak presumed consent, 210212, 217

WHC. See Washington Hospital Center

Wisconsin, 194

Withdrawal of treatment, 147148

Workplace efforts, 193

Workplace Partnership for Life, 193

Workshop meetings, 285288

WRTC. See Washington Regional Transplant Consortium

X

Xenotransplantation, 38

Y

Youth, 194195

Suggested Citation:"Index." Institute of Medicine. 2006. Organ Donation: Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/11643.
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Rates of organ donation lag far behind the increasing need. At the start of 2006, more than 90,000 people were waiting to receive a solid organ (kidney, liver, lung, pancreas, heart, or intestine). Organ Donation examines a wide range of proposals to increase organ donation, including policies that presume consent for donation as well as the use of financial incentives such as direct payments, coverage of funeral expenses, and charitable contributions. This book urges federal agencies, nonprofit groups, and others to boost opportunities for people to record their decisions to donate, strengthen efforts to educate the public about the benefits of organ donation, and continue to improve donation systems. Organ Donation also supports initiatives to increase donations from people whose deaths are the result of irreversible cardiac failure. This book emphasizes that all members of society have a stake in an adequate supply of organs for patients in need, because each individual is a potential recipient as well as a potential donor.

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