The Donation Process
On September 30, 1986, the federal government awarded a contract to the United Network for Organ Sharing (UNOS), located in Richmond, Virginia, to operate the Organ Procurement and Transplantation Network (OPTN). UNOS maintains a 24-hour, seven-days-a-week computer system that assists organ procurement organizations (OPO’s), including the Center for Donation & Transplant (CDT), and transplant centers to equitably match donor organs with transplant candidates. This computer system maintains the status of thousands of potential recipients, allowing for up-to-the-minute changes in patient status.
In most cases, in order to be an organ donor the patient must be declared brain dead and be connected to a ventilator. Circumstances that can lead to brain death include head trauma injuries, anoxic injuries, cerebral bleeds like strokes or aneurysms or brain tumors. All of these events are injuries or insults to the brain which can cause swelling and ultimately cut off all blood flow to the brain, causing death. Brain death is declared by two physicians according to neurological criteria approved by the American Medical Association. Most individuals who have died due to cardiac arrest and have no cardiac or respiratory activity are potential donors for tissue but are unable to donate organs. However, there are some circumstances in which a patient can donate organs after cardiac death, termed donation after cardiac death.
Hospitals are required to notify their federally designated organ procurement organizations of all deaths and all imminent brain deaths as stipulated in the Hospital Conditions of Participation issued in 1998. The initial call made to CDT, usually by a physician, nursing supervisor or emergency room or intensive care unit nurse, will require the following information: patient name, age, sex, race, unit where the patient expired and the date and time of death. In cases of organ donation, to determine if there are conditions that will preclude donation, we will ask for known past medical/social history, current hospital course, blood culture results and medications the patient received.
Talking to Families About the Option of Donation
The Hospital Conditions of Participation issued in 1998 states that only qualified requestors trained by the hospital’s federally designated OPO will be allowed to offer the option of organ and tissue donation to families.
After brain death has been declared and the physician has discussed death with the family, a CDT organ procurement coordinator will determine if the patient is a registered organ or tissue donor. If the patient has legally documented his/her decision to donate by joining the New York State Donate Life Registry, the patient’s consent to donate will be honored. If the patient had not documented his/her decision to donate, the patient’s next of kin will be asked to consent to donation. Once the patient or next of kin has consented to donation, the coordinator will review the donor’s medical and social history with the family to ensure the person is an appropriate candidate for donation. Coordinators will then begin matching donors to potential recipients.
Matching Donors and Recipients
When a family has consented to organ donation, the organ procurement coordinator accesses the UNOS computer system, available 24 hours a day, 7 days a week, to equitably match donor organs with transplant candidates. Each patient currently on the UNOS waiting list for an organ transplant is matched against the donor’s characteristics. The computer, following organ allocation policies, then generates a ranked list of patients who are potential recipients for each donor organ. Factors that affect the ranking may include blood type, immune status, length of time on the list, medical urgency, tissue match and geographical distance between the donor and potential recipient. Factors such as race, gender, age, income level or celebrity status are never considered.
After receiving a printout of the waiting list and beginning with the first name, the CDT organ procurement coordinator contacts the transplant teams of the patients on the list. Often the patient ranked first on the list will not get the organ for one of several reasons. When selected, he or she must be available, healthy enough to undergo major surgery and willing to be transplanted immediately. Also, a laboratory test to measure compatibility between the donor and recipient may be necessary for some organs. For example, patients with high antibody levels often prove incompatible to the donor’s organ and cannot receive the organ because the patient’s immune system would reject it. Once the patient is selected and contacted and all testing is complete, the recipient’s surgical team comes to the hospital to surgically remove the donor’s organ(s). Like other operations, this surgery takes place in a sterile environment in an operating room. The organ(s) is then taken to the transplant center where a recipient(s) is waiting.
After the donation has taken place, families can proceed with their preferred funeral or burial arrangements. Being an organ donor will never interfere with a family’s wishes for burial or funeral arrangements, including the desire for an open casket service.