In 2013, Carol Cassil, AFMC’s communications director, was one of the approximately 6,000 Americans a year who become a living organ donor, making life-saving kidney and liver transplants possible. Another 10,000 organs are transplanted annually from deceased donors. While this is laudable, demand far exceeds supply. There are currently more than 100,000 people in the United States in need of an organ transplant. About 17 people die every day waiting for a transplant. The average wait time for a kidney is 36 months.
Although most Americans (90%) are willing to donate their organs and tissues for transplantation after their death, many don’t register to be organ donors because they have misconceptions about the process. One donor can potentially save or enhance the lives of more than 100 people.
Here are some facts about organ donation and transplantation:
It’s easy to be a donor. In Arkansas, state law allows you to designate yourself as a donor on your driver’s license, a state identification card, at the state’s online registry or by signing an official donor document. This gives hospitals the legal authority to proceed with organ procurement without consent from the family.
If you did not made the organ donation designation when you renewed your driver’s license, you can also go to AURORA’s website and use the state’s online registry to become a donor in less than a minute.
Who gets the organ? You must be on a transplant waiting list in order to be considered for a transplanted organ or tissue. Organs and tissue are provided to patients who have the most compelling set of circumstances. This is determined by the severity of the patient’s illness, time spent on the waiting list, blood type and antigens, size and location (donated organs are typically offered locally first, then regionally and nationally) to insure a successful match.
Anyone can be a donor. People of all ages, races and medical histories can be potential donors. It is your medical condition at the time of death that determines what organs and/or tissue are suitable for donation. However, most hospitals require organ donors to be under age 65. However, people over 65 can be successful tissue donors.
Kidneys from older donors are often overlooked because they cannot be transported over long distances without dangerous deterioration. Under the revision of the kidney transplant rules made last year, kidneys from older donors can now be put to greater use. Patients can now get kidneys from older donors in their local area.
All major organized religions consider organ donation an act of charity.
Transplants save money and lives. Most people on organ waiting lists are waiting for a kidney transplant. Medicare alone spends more than $34 billion per year to care for patients with end-stage-kidney disease. Having more donated kidneys would substantially reduce these public costs.
Successful transplantation is truly a miracle of modern medicine. An enormous amount of research and experimentation have made it possible for organs and tissue to be successfully transplanted and not rejected by the recipient’s body.
Statistically, patients live longer with a transplant than those on dialysis. Ninety percent of kidney-transplant patients have normal renal function within a year of their surgery. The one-year survival rate for liver transplants is more than 86 percent. It is over 90 percent for pancreas transplantation. For heart transplant patients, the one-year survival rate is almost 90 percent. There are more than 2,000 heart transplants annually in the United States. About 3,500 patients are on the heart waiting list.
Recovery starts with AURORA
At time of a death, family members are in grief and shock. Organ donation, even if the deceased clearly indicated their wish to donate organs or tissue, is generally not the family’s chief concern. In Arkansas, AURORA, the Arkansas Regional Organ Recovery Agency, provides the support and information the family needs to make a decision about donation at this overwhelming time. Trained AURORA counselors sensitively lead the family though the donation process, coordinate the recovery of organs and tissues for transplant, and provide after-care support.
Because organ and tissue donation is truly a gift, AURORA assumes the cost of the donation process. The funeral and burial costs remain the responsibility of the family.
The donation process
When there is a life-threatening injury or other trauma, doctors make every effort to save the patient’s life. If that is not possible, doctors run tests to determine the cause of death and confirm that the person’s brain has died. Brain death occurs when the flow of blood and oxygen to the brain permanently stops. Doctors make sure no other medical condition is causing the brain not to function.
All transplanted organs must be living organs. After death is confirmed, the person is kept on a ventilator in the intensive care unit. This is a machine that helps support breathing so that the lungs and heart can keep oxygen flowing to the organs. Organs are the first priority because they must be kept healthy by using a ventilator. If appropriate, the recovery of tissue is the next step in the donation process. Tissue and eyes can be recovered from a deceased person.
Tests are conducted to determine what organs – heart, lungs, liver, kidneys, pancreas and intestines – are suitable for transplant. Prospective organs and tissue undergo a careful evaluation before transplantation that includes medical and social histories, and a careful evaluation of the organ or tissue itself at the time of death.
Once the lab tests confirm an organ is suitable, the placement phase begins. An AURORA coordinator works to find a recipient through the United Network for Organ Sharing (UNOS). UNOS manages the national transplant waiting list, matching donor organs to recipients 24/7. Organ recipients are determined by several factors, including medical urgency, degree of match to the donor and length of time on the waiting list.
The recovery phase begins when a match is made with a recipient. AURORA coordinates the process to ensure that the transplant surgeons and operating rooms are available at the donor’s and recipient’s hospitals. The whole process may take up to 36 hours. AURORA ensures that throughout the process, “the donor is treated with the respect and dignity that would be given to any patient undergoing an operation.”
If organs and tissue are not appropriate for transplantation, AURORA coordinates transportation to the funeral home the family has chosen. An open casket at the funeral service is possible because, after organs are removed, the chest is stitched together.
Potential tissue and eye donations can be made after death and do not require the body to remain on a ventilator. If the person was both an organ and tissue donor, there is just one authorization process.
“A single donor can touch the lives of numerous people through the donation of corneas, bone, skin, veins, tendons, ligaments and heart valves,” according to AURORA.
After-care support for the family may include writing letters to the donor’s family to tell them about the patients who received their loved one’s organs/tissue. AURORA maintains confidentiality throughout the process. AURORA also sponsors events to honor donors and their families and provides opportunities to become an active volunteer.
Living donor option
Another way to donate an organ is from a living donor. This is how Carol and her brother Gus entered the kidney donation process. Gus needed a kidney transplant due to complications of diabetes. Without a transplant, he was facing dialysis for the rest of his life, which would have shortened his life expectancy.
Once he was evaluated and accepted as a transplant candidate, the search began for a donor. Carol did not hesitate to offer one of her kidneys to her brother.
“The decision was a no-brainer for me if it meant having my brother around for a few more years. I was happy I was a perfect match and never had second thoughts during the long testing period. But it got real when they were wheeling me into the OR to remove my kidney. I thought, ‘I’m really doing this!’ I was scared at the moment, but I have never regretted my decision,” she says. “My reward is having by big brother and only sibling around for holidays and birthdays, and as a part of my life and my family.”
Carol and her brother had about 18 months of various blood tests to determine their organs’ compatibility. Additionally, she underwent numerous health screenings such as mammogram, colonoscopy and others. Both surgeries were performed at the University of Arkansas for Medical Sciences in adjoining surgical suites. Both are doing fine and Gus’ body has accepted the kidney without complications or any rejection.
Fairness on the waiting list
Last year, the allocation rules for kidney transplants were given an overhaul to make them fairer to those awaiting a transplant, increase the availability of kidneys, improve the odds for hard-to-match patients/donors and allocate younger kidneys to younger patients to reduce the need for re-transplantation. More than 15 percent of those on the waiting list are waiting for a repeat transplant.
One of the factors in selecting kidney transplant recipients is length of time on the waiting list. Under the revised rules, waiting list time will also include the time spent on kidney dialysis.
Additionally, patients will now be moved to the top of the list if they have hard-to-match blood or antibodies that can cause transplanted organ rejection.
Not all gifts of donated organs or tissue can be used. Less than 1 percent of all deaths meet the criteria to donate organs. Less than 10 percent of all deaths meet the criteria to donate tissue. Preexisting medical conditions or severe trauma can prevent some organs from being used as transplants. In some cases, these organs can be donated for medical research. Organs donated for research can also improve health and save lives because they can lead to new medicines, therapies or procedures.
“In our experience, grieving families welcome an opportunity to consider organ and tissue donation,” according to AURORA. “The knowledge that others’ lives have been enhanced through the gift of a loved one’s organs and tissues is generally a strong solace for a family struggling to accept what they feel is a meaningless death.”
CONTENT CORRECTED 5-2-16.