http://www.kidney.org/general/news/procurementfacts.cfm
Deciding about organ and tissue donation usually comes
after a sudden and unexpected death, an emotionally traumatizing time. Trying to
comprehend the organ/tissue procurement process at that time can be very
difficult due to the overwhelming emotions that occur. This can lead to
confusion, or even suspicion, which may be why some families decline to donate
the organs/tissues of their loved ones. The National Kidney Foundation wants to
help educate the public about the process to alleviate the myths and
misconceptions surrounding organ donation, thereby increasing donation to help
the more than 55,000 people waiting for life-saving organ transplants and the
400,000 more that benefit each year from tissue and cornea donation. This fact
sheet is designed to outline the process that usually occurs (though each
experience may be somewhat different depending on the circumstances). We
encourage families to discuss the issue of organ/tissue donation and make their
wishes known.
The procurement process is a complex series of events that
involves medical professionals at all levels in varied settings. Federal and
state legislation has been enacted to help ensure that the process is carried
out in a fair and efficient way, leading to an equitable distribution of donated
organs. This legislation recommended the establishment of a national computer
registry, called the National Organ Procurement and Transplantation Network (OPTN),
for the purpose of matching donor organs to waiting recipients. The OPTN is
managed by an organization known as the United Network for Organ Sharing (UNOS),
located in Richmond, Virginia. UNOS cooperates with regional organ procurement
organizations throughout the country to place organs locally, regionally and
nationally. Here's how the process works:
- The hospital identifies a
potential donor. This may be done by an attending or consulting physician,
donor coordinator, house supervisor, emergency room or intensive care unit
nurse. An individual who is brain dead but is on a respirator and has a
beating heart is an acceptable donor for: heart, liver, pancreas,
eyes/corneas, kidneys, intestine, heart valves, skin, bone and lungs. An
individual who has died due to a cardiac arrest and has no cardiac or
respiratory activity is an acceptable donor for: eyes/corneas, blood
vessels, cartilage, skin, bone, pericardium, and soft tissues. Other
criteria for potential organ and tissue donors include certain age limits
and the absence of unresolved systemic infections or extra-cerebral
malignancies.
- The hospital contacts the
local organ procurement organization (OPO) to assess the potential donor's
status and confirm his or her suitability.
- A physician declares brain
death. This must be done in accordance with state law, preferably by an
neurosurgeon or neurologist.
- A medical evaluation of the
potential donor is conducted by a representative of the organ procurement
organization or an in-house donor coordinator. This includes a complete
history and physical examination of the potential donor.
- The potential donor's
next-of-kin are asked to sign a donor consent form. Most states have passed
"required request" laws, which make it mandatory for the hospital
to offer the family the option of donating their deceased loved one's organs
and tissues. Some states have what is called "required referral"
laws which require the hospital to notify the OPO of all deaths, and if
appropriate, in collaboration with the OPO, to advise the family of their
right to donate.
- The donor is maintained
medically by a representative of the organ procurement organization, the
in-house coordinator or the nurse in the unit after brain death has been
declared.
- The donor coordinator
arranges the arrival and departure times of the surgical transplant teams
and schedules the operating room time. The surgical team consists of
surgeons and operating room clinician or organ/tissue preservationist.
- When the surgical team
arrives, the donor is taken to surgery. A complete operating room staff
should be available for multiple organ retrieval. A special surgical team is
usually required for removal of heart, liver, lungs and pancreas; kidneys
may be removed either by local surgeons or by a special team.
- Disposition of the body
takes place according to the guidelines of the hospital. There is no change
in the body's appearance after organ and tissue donation, and open-casket
funerals are still possible.
- The organs are matched to
potential recipients. Tissue typing takes about 6 hours. This testing is
done for all kidney transplants, is recommended for pancreas transplants and
may be required for other types of transplants. UNOS has developed a point
system for selecting recipients as objectively as possible. In addition to
the tissue type and blood group, other criteria include: percent of reactive
antibody, waiting time on the list, medical urgency, and, in the case of
liver and heart transplants, distance from the transplant center.
- Once the recipients have
been identified, they are called in for their preoperative workups.
- The donor
coordinator/preservationist sends the organs and/or tissues to the
institution where preservation or the transplant will take place.
- The selected individuals
are taken to surgery and the transplants are performed.
- The procurement
organization takes care of follow-up, which may include letters to the donor
family, staff physician and nurses, regarding the transplanted organs and/or
tissues.
While the procurement process
is well-organized and efficiently run, it cannot be fully successful as long as
the shortage of donated organs and tissues persists. Through its Organ Donor
Program, the National Kidney Foundation is striving to reverse these shortages
through special programs and annual public information campaigns, such as
National Organ and Tissue Donor Awareness Week, the U.S. Transplant Games,
National Donor Family Council, transAction Council and Making the Critical
Difference, an educational program for critical care nurses.