ORGAN & TISSUE DONATION
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In memory of
Howard Smith Vereen
QUESTIONS & ANSWERS ABOUT ORGAN DONATION
Compiled by the U.S. Department of Health and Human Services
WHO CAN BE A DONOR?
CAN YOU STILL CHOOSE TO DONATE IF
YOU ARE YOUNGER THAN 18 YEARS OF
WHAT CAN BE DONATED?
WHY SHOULD YOU CONSIDER
BECOMING AN ORGAN/TISSUE
HOW DO YOU BECOME A DONOR
WHAT IS BRAIN DEATH?
WHAT IF MEMBERS OF YOUR FAMILY
ARE OPPOSED TO DONATION?
ARE THERE RELIGIOUS OBJECTIONS
TO ORGAN/TISSUE DONATION?
IS THERE A NATIONAL REGISTRY OF
INDIVIDUALS WHO WISH TO BE
ORGAN/TISSUE DONORS? WHAT IF
YOU CHANGE YOUR MIND ABOUT
DOES THE DONOR’S FAMILY HAVE TO
PAY FOR THE COST OF ORGAN
WILL THE QUALITY OF HOSPITAL
TREATMENT AND EFFORTS TO SAVE
YOUR LIFE BE LESSENED IF STAFF
KNOW YOU ARE WILLING TO BE A
DOES ORGAN DONATION LEAVE THE
IS IT PERMISSIBLE TO SELL HUMAN
WHAT IS “REQUIRED REQUEST?”
WHAT ARE ORGAN PROCUREMENT
HOW MANY TRANSPL ANT PROGRAMS
AND OPOs ARE THERE IN THE UNITED
WHAT ARE THE STEPS INVOLVED IN
ORGAN DONATION AND
HOW ARE RECIPIENTS MATCHED TO
WHY SHOULD MINORITIES BE
PARTICULARLY CONCERNED ABOUT
CAN ANYTHING BE DONE TO IMPROVE
ACCESS TO A DONOR ORGAN FOR
THOSE IN CRITICAL NEED OF AN
ORGAN TRANSPL ANT? WHAT ABOUT
SPECIAL PUBLIC APPEALS?
WHAT ABOUT LIVE LIVER DONOR
WHO CAN BE A DONOR? »Back to top
Individuals over the age of 18 can indicate their desire to be an organ donor by signing a donor card or expressing their wishes to family members. Relatives can also donate a deceased family member’s organ and tissues, even those family members under the age of 18.
Donation of heart, liver, lung, pancreas or heart/lung can occur only in the case of brain death. The donation of tissue such as bone, skin, or corneas can occur regardless of age and almost any cause of death.
CAN YOU STILL CHOOSE TO DONATE IF YOU ARE YOUNGER THAN 18 YEARS OF AGE? »Back to top
Yes, but only with the consent of an adult who is legally responsible for you, such as your parents or legal guardian. The adult or adults should witness your signature on a donor card.
WHAT CAN BE DONATED? »Back to top
Organs that can be donated include: Kidneys, Heart, Liver, Lungs, and Pancreas. Some of the tissues that can be donated include: Corneas, Skin, Bone, Middle-Ear, Bone Marrow, Connective Tissues, and Blood Vessels.
Total body donation is also an option. Medical schools, research facilities and other agencies need to study bodies to gain greater understanding of disease mechanisms in humans. This research is vital to saving and improving lives. If you wish to donate your entire body, you should directly contact the facility of your choice to make arragements.
WHY SHOULD YOU CONSIDER BECOMING AN ORGAN/TISSUE DONOR? »Back to top
Advances in medical science have made transplant surgery increasingly successful. Transplantation is no longer considered experimental, but a desirable treatment option. The major problem is obtaining enough organs for the growing number of Americans needing them. As of November 2000, there were more than 78,0000 registrants on the national transplant waiting list. Each month, the waiting list grows by approximatley 500 registrants. By contrast, in 1999 there were only 10,538 donors in the United States. Even though most donors contribute multiple organs, there still are not enough to meet the need and many people die while waiting for an organ.
Everyone’s help is needed to resolve the donor shortage. The best way to assure that more organs and tissues are made available is to sign and carry a donor card or go to the Department of Motor Vehicles and sign the back of your license. It is especially important to let your family know of your wishes to dontate if the opportunity arises. It will most likely be a family member who is in a position to see that your wishes are carried out.
HOW DO YOU BECOME A DONOR CANDIDATE? »Back to top
Fill out a donor card and carry it in your wallet. Most states have some way that you can use your driver’s license to indicate your wishes to be a donor. Some states have a donor card on the back of the license; others have a place to check or a colored sticker to put on the license.
It is also extremely important that you let your family know that you want to become an organ and tissue donor. Ask family members to sign your donor card as a witness. When you die, your next-of-kin will be asked to give their consent for you to become a donor. It is very important that they know you want to be a donor because that will make it easier for them to follow through on your wishes.
It would also be useful to tell your family physician, religious leader and attorney that you would like to be a donor.
WHAT IS BRAIN DEATH? »Back to top
Death occurs in two ways: 1) from cessation of cardio-pulmonary (heart-lung) functioning; and 2) from the cessation of brain functioning.
Brain death occurs when a person has an irreversible, catostrophic brain injury which causes all brain activity to stop permanently. In such cases, the heart and lungs can continue to function if artificial life-support machines are used. However, these functions also will cease when the machines are discontinued. Brain death is an accepted medical, ethical, and legal principle. The standards for determining that someone is brain dead are strict.
Tissue and bone may be useable in either type of death. Organs, however, are useable only in cases where brain death occurs.
WHAT IF MEMBERS OF YOUR FAMILY ARE OPPOSED TO DONATION? »Back to top
You can have an attorney put your request in writing. This document, along with your donor card, may help ensure that your wishes will be honored. In any event, tell your family that you want to become a donor in the event of your death.
ARE THERE RELIGIOUS OBJECTIONS TO ORGAN/TISSUE DONATION? »Back to top
Most major religious groups in the United States approve and support the principles and practices of organ/tissue donation.
IS THERE A NATIONAL REGISTRY OF INDIVIDUALS WHO WISH TO BE ORGAN/TISSUE DONORS? WHAT IF YOU CHANGE YOUR MIND ABOUT DONATING? »Back to top
Yes. You can log onto New York Organ Donor Registry and instantly become a “Gift of Life” individual.
If you have indicated your wises to be a donor on your driver’s license, ask your local office of the Division of Motor Vehicles (DMV) what steps you need to take to revoke your decision. An increasing number of states maintain registries of individuals who indicate on their driver’s licenses that they wish to be donors. If your state has a registry, your DMV personnel can tell you how to get on or off the registry.
In all instances, be sure to let your family know whether you wish or do not wish to become a donor.
DOES THE DONOR’S FAMILY HAVE TO PAY FOR THE COST OF ORGAN DONATION? »Back to top
NO. The donor’s family neither pays for, nor receives payment for, organ and tissue donation. Hospital expenses incurred before the donation of organs in attempts to save the donor’s life and funeral expenses remain the responsibility of the donor’s family. All costs related to donation are paid for by the organ procurement program or transplant center.
WILL THE QUALITY OF HOSPITAL TREATMENT AND EFFORTS TO SAVE YOUR LIFE BE LESSENED IF STAFF KNOW YOU ARE WILLING TO BE A DONOR? »Back to top
NO. A transplant team does not become involved until other physicians involved in the patient’s care have determined that all possible efforts to save the patient’s life have failed.
DOES ORGAN DONATION LEAVE THE BODY DISFIGURED? »Back to top
NO. The recovery of organs and tissues is conducted in an operating room under the direction of qualified surgeons and neither disfigured the body nor changes appearance of deceased.
IS IT PERMISSIBLE TO SELL HUMAN ORGANS? »Back to top
NO. The National Organ Transplant Act (Public Law 98-507) prohibits the sale of human organs. Violators are subject to fines and imprisonment. Among the reasons for this rule is the concern of Congress that buying and selling of organs might lead to inequitable access to donor organs with the wealthy having an unfair advantage.
WHAT IS “REQUIRED REQUEST?” »Back to top
“Required request” is a policy requiring hospitals to systematically and routinely offer the next-of-kin the opportunity to donate their deceased relative’s organs and tissues. This policy enable hospitals and health care professionals to play a key role in increasing donation because families might otherwise not be aware of their right donate. As of 1992, forty-eight states and the District of Columbia had enacted “required request” laws.
The Omnibus Budget Reconciliation Act of 1986 (Public Law 99-509) established additional requirements for hospitals that participate in the Medicare and Medicaid programs. It required each participating hospital to establish written protocols for identification of organ donors and to notify an organ procurement organization designated by the Secretary of Health and Human Services of any potential donors it identifies.
Since January 1988, the Joint Commission for the Accrediation of Healthcare Organizations has required its member hospitals, as a prerequisite for accreditation, to develop policies and procedures on the identification and referral of potential donors.
WHAT ARE ORGAN PROCUREMENT ORGANIZATIONS (OPOs)? »Back to top
OPOs are organizations that coordinate activities relating to organ procurement in a designated service area. Evaluating potential donors, discussing donation with family members, and arranging for the surgical removal of donated organs are some of their primary functions. OPOs also are responsible for preserving the organs and making arrangements for their distribution according to national organ sharing policies established by the Organ Procurement and Transplantation Network and approved by the U.S. Department of Health and Human Services.
In addition, OPOs provide information and education to medical professionals and the general public to encourage organ and tissue donation and increase the availability of organs for transplantation.
HOW MANY TRANSPLANT PROGRAMS AND OPOs ARE THERE IN THE UNITED STATES? »Back to top
As of August 2004 there were 124 liver, 246 kidney, 139 heart, 139 pancreas, 73 heart-lung, and 70 lung transplants programs in the United States. Names and addresses of transplant programs can be obtained from the United Network for Organ Sharing (UNOS) at the following address:
United Network for Organ Sharing
700 North 4th Street
Richmond, VA 23219
United Network for Organ Sharing
As of December 2003, 69 OPOs were certified by the Health Care Financing Administration of the U.S. Department of Health and Human Services. Their names and addresses can be obtained from the following organizations:
Association of Organ Procurement Organizations
1364 Beverly Road – Suite 100
McLean, VA 22101
409 Bayshore Boulevard
Tampa, FL 33606
WHAT ARE THE STEPS INVOLVED IN ORGAN DONATION AND TRANSPLANATION? »Back to top
|1.||A potential donor who has been diagnosed as brain dead must be indentified.|
|2.||An organ procurement organization is contacted to help determine organ acceptability, obtain the family’s permission, and match the donor with the most appropriate recipient(s).|
|3.||Next-of-kin must be informed of the opportunity to donate their relative’s organs and tissues, and must give their permission.|
|4.||Organ(s) and tissues(s) are surgically removed from the donor.|
|5.||The donor organs and tissues are taken to the transplant center(s) where the surgery will be performed.|
When a potential organ donor is identified by hospital staff and brain death is imminent or present, and organ procurement organization (OPO) is contacted. The OPO is consulted about donor acceptability and often asked to counsel with families to seek consent for donation. If consent is given, a search is made for the most appropriate recipient(s) using a computerized listing of transplant candidates managed by the United Network for Organ Sharing (UNOS) which operates the National Organ Procurement and Transplantation Network.
It is increasingly common for donors and donor families to contribute multiple organs and/or tissues. Therefore, several recipients may be helped by a single donor. When a match is found, the OPO will arrange for the donated organ(s) to be surgically removed, preserved, and transported to the appropriate transplant center(s). A potential recipient(s) is also alerted to the availability of an organ and asked to travel to the transplant center where he or she is prepared for surgery. The recipient’s diseased or failing organ is removed and the donated organ is implanted.
HOW ARE RECIPIENTS MATCHED TO DONOR ORGANS? »Back to top
Persons waiting for transplants are listed at the transplant center where they plan to have surgery, and on a national computerized waiting list of potential transplant patients in the United States. Under contract with the Health Resources and Services Administration, the United Network for Organ Sharing (UNOS) located in Richmond, Virginia maintains the national waiting list. UNOS operates the Organ Procurement and Transplantation Network and maintains a 24-hour telephone service to aid in matching donor organs with patients on the national waiting list and to coordinate efforts with transplant centers.
When donor organs become available, several factors are taken into consideration in identifying the best matched recipient(s). These include medical compatibility of the donor and potential recipient(s) on such characteristics as blood type, weight, age, urgency need and the length of time on the waiting list. In general, preference is given to recipients from the same geographic area as the donor due to the fact that timing is a critical element in the organ procurement process. Hearts can be preserved for up to 6 hours, livers up to 24 hours, and kidneys for 72 hours. Lungs cannot be preserved outside the body for any extended period of time.
WHY SHOULD MINORITIES BE PARTICULARLY CONCERNED ABOUT ORGAN DONATION? »Back to top
Minorities suffer End-Stage Renal Disease (ESRD), a very serious and life threatening kdney disease, much more frequently than do whites. For example, from 1992 to 1995 African Americans were more than four times more likely than whites to develop ESRD; Native Americans were more than three times as likely; and Asian Americans were almost twice as likely to suffer from the disease.
ESRD is treatable with dialysis, however, dialysis is costly and can result in a poor quality of life for the patient. The preferred treatment of ESRD is kidney transplantation. Transplantation offers the patient “Freedom” from dialysis to lead a more normal lifestyle and can successfully cure ESRD for many years.
As with any transplant procedures, it is very important to assure a close match between donor and recipient blood types and genetic make-up. Members of different racial and ethnic groups are usually more genetically similar to members of their own group than they are to others. It is important, therefore, to increase the minority donor pool so that good matches can be made as frequently as possible for minority patients.
CAN ANYTHING BE DONE TO IMPROVE ACCESS TO A DONOR ORGAN FOR THOSE IN CRITICAL NEED OF AN ORGAN TRANSPLANT? WHAT ABOUT SPECIAL PUBLIC APPEALS? »Back to top
The primary barrier to transplant surgery for most of the people on the waiting list is a lack of donor organs. Quite simply, the demand far exceeds the supply. Therefore, anything that can be done to increase the level of donation in this country would be helpful to all individuals needing transplants.
Families and attending physicians need to maintain close contact with the transplant team to keep them fully up-to-date on the patient’s condition. A family could assist community groups in their on-going efforts to increase public awareness of the need for organ donation.
While family appeals through the media have had a positive effect on increasing donation overall, efforts do not necessarily result in an organ being made available to the individual for whom the appeal has been made. The decision as to which patient on the waiting list will receive any particular ogran is made according to objective criteria which include medical urgency and length on the waiting list, and is not subject to external influences including those that might result in inequitable access to donor organs. All prejudicial or discriminatory practices in organ allocation are forbidden by the policies governing the operation of the Organ Procurement and Transplantation Network. However, creating awareness on organ donation in general will necessarily be of help to all those awaiting transplantation.