Turning Loss Into Legacy: Opportunities for Tissue and Eye Donation in Community Hospice/Palliative Care.

Organ, tissue, and eye donations provide opportunities to leave a legacy by saving and/or enhancing the quality of life of others. There has been little published related to tissue or eye donation in hospice/palliative care and few initiatives to facilitate donation among hospice patients/families. Donation myths, gaps in knowledge, and, most significantly, lack of donation referral processes result in missed opportunities for patient/families to consider donation. One donor has the potential to impact 75 lives or more through tissue donation and 2 lives through eye donation. Hospice/palliative care providers can play key roles related to education, advocacy, and collaboration. The support of hospice/palliative care organizations and the local Organ Procurement Organization/Tissue and Eye Recovery Agency are essential for facilitating donation opportunities. This article summarizes current literature, examines legislation and regulations related to donation, presents a case that illustrates an opportunity for hospice community based donation, and shares practices that support donation in hospice/palliative care organizations together with the local Organ Procurement Organization/Tissue and Eye Recovery Agency. This article will hopefully provide the impetus for further study and the development of practices to optimize donation in hospice/palliative care, thus providing more patients and families the opportunity to turn loss into legacy.

Addressing Religious or Cultural Opposition to Brain Death Diagnosis.

In 1968, the neurologic or "brain death" standard for declaration was introduced as an accepted standard for declaration of death in hospitals where heartbeat and breathing are being sustained by technology, but functions of the brain, including the brain stem, have ceased. For many people, this accepted ethical, legal, and medical definition of death by neurologic standards can seem to blur the line between life and death as the heart is still beating, the lungs are still moving air albeit by mechanical ventilation, and the body is still warm. As experts in end-of-life care, hospice and palliative care nurses must be knowledgeable about declaration of death by neurologic criteria, understand beliefs that do not support the concept, and collaborate with the health care team in providing compassionate end-of-life care. This article will use a case study to describe the legal and ethical challenges that ensue when religious and/or cultural beliefs result in rejection of the concept of brain death and propose ethically sound strategies to navigate these challenges within a framework of culturally congruent care that includes a 4-step process to progressively appreciate, accommodate, negotiate, and/or explicate the differences.