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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, twonursesobtained aconsentfrom a

child's mother. When the father later expressed his disagreement, the child's corneas had

been harvested and it was too late.

Thepatientwas 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 passthrough 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 thenurseit "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 solvingthe 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.

Aconsentform was faxed over to the hospital. Twonursesthen 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 canconsentto 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 upondeath 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:

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(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 theconsentform 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

obtaininginformed consent:

"Eachhospitalin 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, andtransportation of gifts."7

The child's father would arrive on the scene soon after. When approached andinformedof

the harvesting, he was perturbed. He would not sign theconsentafter the fact and chose to

take legal action against thehospitaland 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 theconsentof a parent sufficient to

proceed with harvesting of a child's organs.

2. Were thenursesnegligent in their explanation of the procedure or in not waiting till the

father was available?

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The applicable laws stated that as long as aconsentfrom a legally "responsible" and informed

party is obtained, no liability or negligence can be assigned. It was clear from the testimony of

thenursesthat they spoke to the mother andinformedher 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 nodocumentationthat she "wished to speak to her husband" before making thedecision. 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 thenurses, a single adult guardianconsentonly was needed and obtained.

When the agent of the eye bank looked over theinformed consent, he as satisfied that it waslegitimate. In harvesting the child's corneas, he acted in good faith and had no reason to believe

a properconsenthad not been obtained.

Thecourtdismissed the plaintiff's argument that the "good faith" actions of thehospitalor

eyebank were "subject to interpretation." Thecourtwas 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 cleardocumentationwhen aconsentfororgan donation is obtained. Thenurseswere wise to obtain not one but two witness signatures

on theconsentform. The agent of the eye bank was wise to make sure the notation was made of

a "telephone" consent.

Regardless of these precautions, thenurses,hospitaland eyebank were still sued. Had thislawsuit been initiated after either of the employees involved had left, thehospitalmay or may not

have covered or defended them.

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