EMS and End-of-Life Care

National Organ Transplant Act (NOTA)

Before 1984, the US lacked legal frameworks governing the organ transplants. This affected the process of regulating the medical industry and the procedures involved in EMS, especially in organ transplants (Michael & Jesus, 2012). The absence of effective framework led to the development of an uncontrolled market where human organs could be sold secretly. In fact, there were no well-defined jurisdictions on the rights of a human corpse. However, through the quasi-right the relatives of the deceased person would have absolute privileges in possession of the corpse and the choice of disposal and burying. Besides, the market became controlled after the (NOTA) National Organ Transplant Act of 1984 was passed (Michael & Jesus, 2012). However, the law has been amended twice, in 1988 and 1990, to fit better in the ever-dynamic market and health care frameworks. The essence of the law was to regulate the selling and buying of human organs, which happened beyond the hospital settings. Therefore, the NOTA framework has been used ever since to prohibit the processes of buying or selling of human organs, even for emergency medical services (Michael & Jesus, 2012). As such, the efforts to increase financial incentives in the processes of cadaveric donations have received an equal measure of resistance from the Senate through the development of legal frameworks. The law considers it illegal for anyone to acquire, transfer, or even possess human organs for business transacting in the United States.

Ways of Organ Donor Directive in the United State

In spite of the government effort to regulate the processes of organ donation and transplants in the United States, the need for the organ transplants keeps rising (Michael & Jesus, 2012). Through the National Organ Transplant Act, the government controls the market from liberalizing the operations and increasing the security threat due to the high demand for human organs (Michael & Jesus, 2012). However, the United States holds with regard an individual’s preference when given through writing and in a sober mind (Michael & Jesus, 2012). For instance, the US law is quite clear on the application of the living wills, advance health care directives, and Healthcare proxies. Therefore, through the instruments of donor directives such as the living wills and health care proxies, the US law allows an individual to make a directive on how his/her organs could be used in an emergency or even in death (Michael & Jesus, 2012). Through such written directives, the individuals can decide to have the organs donated for use in emergency care, or even prohibit the use of organs for such purposes. Therefore, the law is well defined on the application of the donor directives. In this aspect, one can become a donor during death or in emergency cases as against having the organs transplanted and sold for profit.

Uniform Anatomical Gift Act

The UAGA is an equal legal framework embraced in the United States and through which organ donations are governed for transplantation purposes (Hanto, 2007). Moreover, the law allows an individual to decide on the use of their own cadaver that is not limited to offering it for the purpose of dissection and use in medical studies. Therefore, through the law, the US stipulates how such gifts could be given, which include a written will, the offer of a spouse, or other specific relatives to the deceased (Hanto, 2007). Through the law, the healthcare professional who would otherwise decide to give out the cadaver for the study purposes is restricted from the same (Hanto, 2007). Besides, the law plays a critical role in controlling the illegal trade in human organs, even from the donations made by the individuals or even the family. The UAGA was enacted in 2007 after years of public debate on the efficiency of the existing legal frameworks in regulating the procedures of organ transplant and organ donations in the country (Hanto, 2007). However, the formulation of the act was informed by the need to balance the patient rights and the responsibilities of the physicians.

Frequently Asked Questions About Organ Donation

While the debate on rights for the civilian participation in organ donations and transplantation continues in the United States, many people lack the elaborate information concerning the health care, the law, and the processes of organ donation. Therefore, people ask some disturbing questions concerning organ donations. These questions are illustrated below.

  1. Whom does the law allow to be a donor?
  2. Could anyone be too sick or too old to donate an organ in the US?
  3. Must an individual be a registered donor to qualify for organ donations?
  4. According to the law, how can a person decide to become an organ donor?
  5. What healthcare directives are available for the US citizens regarding choices on organ donation and EMS?

Grief and Grieving

By definition, grief is a deep mental suffering or, better still, distress that occurs to all people after suffering affliction and loss (Shear, 2015). The psychological condition can also be understood from the perspective of anguish, sadness, melancholy, or even heartache over a loss suffered. Often, people experience grief whenever a loved one passes on or when one loses something of great value, which has a strong bond and affection (Shear, 2015). As such, grieving is a natural process that occurs to everybody in response to a loss. It is worth noting that although grief is an internal feeling, many people have different ways of exhibiting it. Often, individuals exhibit grief through such natural processes as crying or sobbing, although there are other common illustrations of grief (Shear, 2015).

The process of grief takes different stages, as illustrated in the discussion below. It is to be appreciated that the steps involved in grieving are natural and occur for all people regardless of their background. In the event of a bereavement, people spend considerable time mourning the loss, and every step shows different levels of intensity (Shear, 2015). Through the process and the steps of grieving, every person strives to reach the final stage of peacefully accepting the loss (Shear, 2015). Although the stages outlined below do not occur in the sequence in all humans, they are basic stages that all persons must undergo through as they experience grief.

Isolation and denial

When such a happening as the loss of a loved one occurs, it is a common for an individual to develop denial and opt to stay in solitude (Shear, 2015). The reaction is always associated with the shock of receiving the sad news and does not last long.


It occurs as a second stage after the immediate denial and is explained by the reality of the loss. Although the individual is aware of whom to blame for the loss, the immediate reaction may make the person direct the anger and frustration to any person near or even non-human objects nearby (Shear, 2015). For instance, after an accident and the loss of a loved one, you can easily get a person overwhelmed by anger and react by abusing other people and even hitting what is on the hand at the closest object.


The stage that follows is the feeling of helplessness in the situation and contemplating if the occurrence could have been prevented (Shear, 2015). For instance, it is common to have the deceased’s family members have the internal bargaining processes and ask, what if the emergency medical services were quickly reached when the patient fainted. What if the doctor did not prescribe the surgical procedure? What if the victim did not drive while drunk? All the bargaining indicates a different occurrence that could have been achieved if something had been done differently before the loss. In fact, in some instances, the individual gets to bargain internally with a higher authority like God on how that occurrence could have been prevented.


This almost obvious stage occurs in all people during bereavement (Shear, 2015). Accordingly, an individual feels lonely and detached from the departed as one comes to terms with the loss. In such instances, one may be depressed because of the many thoughts ranging from the costs of burial to other associated preparations. Besides, there is also the inner depression as one struggles to bid farewell to the departed from the personalized level, as explained by the level of attachment shared.


The stage entails feeling peace and contentment with the occurrence (Shear, 2015). Often, the stage of acceptance comes with the assurance that the occurrence was fit, and if it was death, then one must expect its inevitability. Acceptance enables one to start the healing process, and the health care professionals play a critical role in helping the affected people reach this stage. For instance, after a death is reported, the health care professionals prepare for the appropriate time to break the news to the loved ones, prepare them psychologically, and then disclose the information. In many instances, the doctor sticks close to console the individual or individuals and in some instances, offer counseling services (Shear, 2015).

How Attitudes Toward Death have Changed Over Time

Over the years, people’s perceptions and attitudes towards death have been changing. Before the advancement of education and general health standards, people expected early deaths (Berger, 2010). However, the advancement of education has brought a different attitude towards death because a person can live more comfortably and avoid an early death. In fact, to the majority of the people, death does not come as an expected reality about life. Hence, they do not take the least of precaution or preparation for death (Berger, 2010). In other cases, the surety of death after some diagnosis with some terminal illnesses help people to develop positive attitudes towards it, or even prepare for the same. For example, people are increasingly writing death directives when they are still healthy and sober in preparation for the anticipated occurrence of death (Berger, 2010).

In some cultures, people would never talk about death; studying it would be taboo. With modernization, people have changed their attitudes, and the subject can be studied even in the schools (Berger, 2010). Surprisingly, people even prepare their graves in anticipation of death. Besides, people are even planning for their death through death policies and insurance schemes, which explain that people have gradually eroded the traditional attitude of the undesirability of death (Berger, 2010). Other professions have even come up with initiatives that care for the dead such as the hearse transportation services and morgue attendance. While these were nearly inconceivable in the past, the modern society enjoys the change and the positive attitudes people accord to death.

Caring for Dying Patients, Including Palliative Care, Curative Care, and Hospice Care

The changing attitudes towards death have enabled people to embrace death as an important phase of life. Therefore, they develop programs that improve the quality of life in the last or dying stage (Morrison & Meier, 2004). The palliative care, curative care, and hospice care are examples of the programs meant to improve the quality of life for the patients in the dying phase. The hospice care is concerned with all elements of a patient’s well-being, including the physical, emotional, social, and spiritual elements.  For the hospice services, people from all age segments can be incorporated into the programs as long as they are confirmed to be in their late stages of life (Morrison & Meier, 2004).

The services offered in the hospice care are together with the counseling, medical attention, dietetic services, nursing services, social services, as well as different forms of therapy (Morrison & Meier, 2004). While the services are offered to different patients in a single setting, the specialized attention is offered to the individual patients according to personal needs. However, some hospice services are offered at home, and hence the relatives become the primary care providers to the patients (Morrison & Meier, 2004). The majority of the hospice services reduce suffering through the management of pain. Besides, the spiritual and emotional services are offered to the patients (Morrison & Meier, 2004).

Palliative care, on the other hand, explains the form of care meant to induce relief to the sufferings of the patients but not inducing the cure (Morrison & Meier, 2004). This care is extremely important for terminally ill patients because of their extreme pain. In fact, it is administered with the understanding that the conditions cannot be medically cured. As such, the patients are in their late stages of life. Therefore, the palliative care services are meant to improve the experience of the patients as they move closer to their death (Morrison & Meier, 2004). For instance, at some stage of renal condition, a patient cannot have his/her body system excrete the wastes naturally. Therefore, dialysis must be conducted. Without such a service, the patient would suffer a lot before dying. Nevertheless, the dialysis procedure for the renal case would not be for curative purposes but rather for relieving pain to the patient.

However, there are instances when the curative services are required even after a terminal condition is diagnosed. It is worth appreciating that the curative services are not meant to induce recovery or healing from the terminal condition but rather to counter other opportunistic conditions (Morrison & Meier, 2004). For example, when an individual is diagnosed with the renal condition, other conditions, such as diarrhea, may ensure, despite having no connection with the terminal condition. Therefore, the patient may equally need the curative services to assist in overcoming the opportunistic condition while they receive the palliative services. As such, the services of curative care, palliative care, as well as the general hospice care are quite important in caring for the dying and are highly recommended and practiced in the United States (Morrison & Meier, 2004).



Berger, E. (2010). From Dr. Kildare to Grey’s Anatomy. Annals of Emergency Medicine.

Hanto, D. (2007). Ethical Challenges Posed by the Solicitation of Deceased and Living Organ Donors. New England Journal of Medicine N Engl J Med, 1062-1066.

Michael, G., & Jesus, J. (2012). Treatment of Potential Organ Donors in the Emergency Department: A Review. Annals of Emergency Medicine, 485-491.

Morrison, R., & Meier, D. (2004). Palliative Care. New England Journal of Medicine N Engl J Med, 2582-2590.

Shear, M. (2015). Complicated Grief. N Engl J Med, (372), 153-160.

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