What is Organ Donation?Organ donation is donating a vital organ to a recipient whose own organ has failed or is failing. That organ can either come from a deceased donor or a living donor. Depending on the type of donated organ that is transplanted the outcome will be either life saving or life enhancing.
Almost a thousand people died last year whilst waiting for an organ to become available.
Organ Transplants are the best possible treatment for most people with organ failure. In the UK last year 2,700 people benefitted from an organ donation.
Who can donate?Some organs such as a kidney, lung and segment of liver, can be donated during life. However, most organ and tissue donations come from people who have expressed a wish during their lifetime to help others upon their death. Often they do this formally by registering their desire to donate on the Organ Donor Register or by discussing donation with their loved ones.
The Department of Health has stated that the offer of organ and tissue donation should be integral to all bereavement services, and that donation should always be considered when it becomes certain that a patient will die or has died. (When a patient dies; advice on developing bereavement services in the NHS, DoH, 2005)
To ensure the quality of organs donated they have to be transplanted soon after someone has died. The donor will normally be in hospital in an intensive care unit or emergency department.
What organs can be donated after death?
KidneysKidneys from a deceased donor will normally be transplanted into two separate patients. An individual can live quite adequately with only one kidney. Kidneys were the first organs to be successfully transplanted in 1954. 1453 kidneys were transplanted last year.
HeartThe heart can be transplanted singularly or combined with the lungs in a heart and lung transplant. The first heart transplant took place in 1967. 127 hearts were transplanted in the UK last year.
LungsLungs can be transplanted as a pair or separated for two recipients. Lobes of lung can also be donated. 115 lungs were transplanted in the UK the last year.
LiverLivers can be transplanted as one organ or can be split into two if liver is suitable. 636 recipients received a liver transplant last year.
PancreasThe pancreas can be transplanted singularly or with the right kidney dependent on the recipient's requirements. 249 recipients received a pancreas transplant last year.
Small bowelThe small bowel can be transplanted and is becoming a more frequent operation in the UK.
Can anyone donate organs and tissue?Most people can be considered for organ and tissue donation. In order to ensure that donations are as safe as possible, the donor's medical and behavioral history is reviewed in a similar manner to that of blood donors. This reduces the risk of transmitting disease to a patient. A blood sample is taken from the donor and tested for viruses including HIV and hepatitis. Family interviews are carried out by specially trained Organ or Tissue Donor Co-ordinators, who will try their utmost to carry out the wishes of the donor and their families.
Joining the
Organ Donor Register and discussing your wishes with your family are the most important steps in ensuring your donation is carried out.
Can tissue be donated just for medical research purposes?It is sometimes possible to donate tissues just for medical research and development if that is the expressed wish of the donor and their family.
What is Tissue Donation?Every year hundreds of lives are saved with the help of donated organs such as hearts and kidneys. But you may not realize that donated tissues such as corneas and heart valves can dramatically improve the quality of life for recipients, and even save lives.
Who can donate?Some tissues, such as bone, can be donated during life. But most tissues are donated after death, by people who have expressed a wish during their lifetime to help others in this way by joining the NHS Organ Donor Register.
Many people can be considered for tissue donation after death. Unlike organs, tissues can be donated up to 24 hours after a person's heart has stopped beating. The Department of Health has stated that the offer of organ and tissue donation should be integral to all bereavement services, and that donation should always be considered when it becomes certain that a patient will die or has died. (When a patient dies; advice on developing bereavement services in the NHS, 2005)
What tissues can be donated after death?Many kinds of tissues can be donated after death.
CorneasCorneas can be transplanted into patients suffering from severe eye disease or injury. Sometimes the sclera of the eye is also needed for transplant during reconstructive eye surgery. About 2,500 corneal transplants were performed last year.
Donor Age 3 years- no upper age limit
Contraindications HIV, CJD, dementia, Hepatitis, previous organ or tissue transplant (for others please discuss with Donor Co-ordinator)
The ONLY malignancies that contraindicate corneal donation are LEUKAEMIA, LYMPHOMA and MYELOMA .
Heart ValvesHeart valves can be transplanted to save the lives of patients, including young children, suffering from diseased or damaged valves. Annually 800 heart valve transplants were carried out last year.
Donor Age < 65 years
Contraindications include HIV, CJD, dementia, Hepatitis, malignancy, previous organ or tissue transplant (for others please discuss with Donor Co-ordinator)
BoneBone is vitally important for grafts that are used in operations aimed at reducing patients' pain, and improving or restoring their mobility. Annually approximately 10,000 bone transplants are performed.
Donor Age 16-70 years
Contraindications include HIV, CJD, dementia, Hepatitis, malignancy, previous organ or tissue transplant (for others please discuss with Donor Co-ordinator)
Osteomyelitis
Rheumatoid Arthritis
Traumatic bone fractures
Long term use of steroid therapy
SkinSkin can help save the lives of severely burned victims. The skin graft helps to reduce pain, and prepare the underlying tissues for later cosmetic grafting. It also helps to reduce scarring in these patients. It can take many donations of skin to treat a severely burned patient.
Donor Age 16-70 years
Contraindications include HIV, CJD, dementia, Hepatitis, malignancy, previous organ or tissue transplant (for others please discuss with Donor Co-ordinator)
MRSA or other viral or bacterial infections
Chronic skin disease
Can tissue be donated just for medical research purposes?It is sometimes possible to donate tissues just for medical research and development if that is the expressed wish of the donor and their family. Again the Co-ordinator will try to arrange this if the family wishes it.
CONSENT
The Human Tissue Act 2004 became law on 1st September 2006. This change in law came about following the organ retention enquiries at Bristol Childrens Hospital and Alder Hey Hospital and makes consent a priority.
If a person makes a decision in life regarding donation by either carrying a Donor Card, registering their wishes on the NHS Organ Donor Register and by expressing a wish, verbally to the next of kin, this is now a legal and appropriate consent and the family, in law, may not override this decision. However, the law also states that if the family have strong objections to donation, it may be inappropriate to proceed.
Children can consent to donation of deemed Gillick competant but the views of the adult with responsibilty for the child should always be required.
DONOR TRANSPLANT COORDINATORS
The majority of Donor Transplant Coordinators (DTC) are registered nurses that have experience in Critical Care. Until very recently most were empoyed by and based in transplant centres. The DoH has accepted the 14 recommendations of the Organ Donation Taskforce and in line with recommendation 9, all DTC teams will eventually be under the employ of NHS Blood & Transplant.
The role and responsibilities of all DTCs are under review at present.
The DTC will take the first referral of a potential donor. They will access suitability and if appropriate, travel to the donor hospital to manage the donation process.
At the donor hospital the DTC will;
• Assess the current situation and condition of the potential donor
• Introduce self to critical care staff, medical and nursing
• Advise on treatment to maintain and manage the donor
• Carry out the family interview and consent process
• Refer to HM Coroner if necessary
• Carry out required investigations; blood tests, CXR, ECG, cardiac echo etc
• Complete all documentation for the referral of the organs
• Offer the organs to the transplant centres in line with NHS Blood and Transplant sharing schemes
• Continue to support the family and staff throughout the process
• Liaise with the operating theatres for space and time
• Continue to maintain the donor and to optimise the organs
• Carry out any wishes of the family, eg. hand prints, hair locks
• Escort the donor to theatre
• Support the theatre staff
• Ensure donor is treated with dignity and respect throughout the retrieval operation
• Act as point of communication with all tranplant centres
• Carry out abdominal perfusion
• Pack organs
• Carry out last offices and ensure patient transferred to mortuary
Following the donation the DTC will;
• Organise tissue retrieval if necessary
• Offer feedback and support to the donor family and all staff involved
• Ensure all documenation completed and sent to relevant agencies
• Offer a visit to the donor family and on going suppprt as required
