This page is designed to offer informatin and inspiration for anyone who may be considering making the most compasionate decision of their lives -- consenting to organ donation.
Please take just a few moments to:
Sign the
Organ Donor Consent Form on the back of your driver's license, and
Tell your friends
and family about your decision.
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In the event we or a loved one are ever in a situation where our life depends on an organ transplant, it is reassuring to know that medical science has advanced to the point where transplants have become so successful that they are considered almost routine surgery. Now the only obstacle to saving the lives of over 42,000 Americans currently waiting for transplants is the availability of donor organs.
It all began over 2,000 years ago when surgeons used skin from foreheads to rebuild noses, and by the eighteenth century, dentists were able to successfully replace teeth. But these early attempts at transplantation were only possible because it was the patient's own tissue that was being used. The first successful transplant of tissue from one person to another took place in 1878 with bone transplants, and the first cornea that remained clear was grafted in 1905. However, until the 1950's transplantation was attempted only intermittently, principally because of the high failure rate when the body rejected 'foreign' tissues.
The first successful kidney transplant, using a living donor, was performed in 1954 at the Peter Bent Brigham Hospital in Boston. The donor and the recipient were twenty-three-year-old male twins. Because identical twins share the same genes, there was no danger that the recipient would reject the donor kidney as foreign tissue.
Rejection of foreign tissue by the recipients continued to be a problem until researchers realized that rejection was an immune reaction and it was necessary to make transplanted tissue appear less "foreign" to the recipient's system. Human tissue typing was made possible by the discovery of the first human leukocyte group in 1958 by Jean Dausset, and programs for matching donors and recipients were soon being organized. A second major advance was the use of an immunosuppressive drug called azathioprine, which in 1962 enabled doctors to perform the first successful transplant of a cadaver kidney from an unrelated donor. The development of tissue typing procedures and immunosuppressive drugs made it possible to successfully transplant tissue from an unrelated donor.
The first liver and lung transplant was performed in 1963. The recipient was a prisoner serving a life sentence for murder. He died eighteen days after the operation.
In 1967, in South America, Dr. Christiaan Barnard performed the first successful heart transplant. The recipient lived only 18 days after the surgery; cause of death was double pneumonia. Ten months later, in the United States, a woman received a donor heart and survived for another eight years. However, she was the exception. Over 100 heart transplants were performed in 1968, and most recipients died within a few weeks. Because of this high failure rate, many hospitals stopped performing heart transplants altogether.
In the late 1970's there was an increase in successful heart transplants thanks to improved surgical techniques, including the use of "piggy-back" hearts. During this procedure, surgeons left the original heart in place as a back-up and positioned the transplanted heart in the chest cavity alongside the original heart.
Today, twenty-five different human body parts are being transplanted routinely, including inner ear, glands, blood vessels, tendons, cartilage, muscles, testicles, ovaries, fallopian tubes, nerves, skin, fat, bone marrow and blood. Kidney recipients have lived for 30 years after transplant, while liver and heart recipients have lived for 20 years. Not only is the life expectancy lengthened considerably after a transplant, but the quality of life improves dramatically.
In 1993, 36,500 Americans were registered with the United Network for Organ Sharing (UNOS) waiting list. Although 18,665 successful organ transplants were performed in 1994, by August 1995 an estimated 42,684 were still on the UNOS waiting list.
While it is possible for kidney patients to be maintained on dialysis machines, there are no such temporary remedies available for heart and lung patients. Approximately one-third of all patients waiting for heart or lung transplants die before a donor heart can be found. In 1992, seven people died every day waiting for a transplant.
Besides the obvious life-saving benefits of organ transplants is the financial consideration. Dating back to when transplants were considered "research", most health insurance companies have historically refused to pay for any transplant procedures. Consequently, Medicare presently assumes all costs associated with organ transplants. The cost for a kidney transplant is currently about $30,000, equal to approximately one year on dialysis. Since the average kidney patient can be maintained on dialysis for up to five years, a transplant presents a considerable cost savings.
Regardless of the incredible strides made by the medical community in human organ transplantation, no transplants would be possible without the availability of organs. But who can provide suitable organs? The most suitable donor should have been previously healthy. The cause of death should not have been associated with infection, malignancy, or prolonged low blood pressure. Suitable donors will have died from accidents, primary brain tumors, or sudden brain hemorrhages. Only those who are HIV positive, had hepatitis B, or whose cancer had spread throughout the body are excluded from consideration as suitable donors. This does not preclude cancer patients from safely donating corneas. The size of the donor organ is also of considerable importance. An adult liver would be too large to be grafted into a child. A small child's heart would not be able to maintain the circulation in an adult. The age of a potential donor is generally irrelevant. Skin and bone donors must usually be between fourteen and seventy, while heart valve donors can be from birth to sixty. Recently, a liver from an eighty-year-old woman was successfully transplanted.
The most critical criteria for an organ donor is the diagnosis of brain death. Brain death is the cessation of all brain function, including brain-stem function. Unlike a person in a coma, a person who suffers brain death can never again have consciousness, memory, knowledge, thought, feeling, sight, hearing, touch, speech, or any other sense. Most people think that death occurs when the heart stops beating and respirations cease. That's not the case with brain death. The appearance of life continues, but only because a ventilator is simulating what appears to be normal breathing and delivering enough oxygen to the heart to keep it beating. The patient's skin still feels warm to the touch, but clinically she's brain dead. The ventilator is kept running until the option of organ and tissue donation is offered to the family.
Clinically, brain death is determined by flat brain waves on an EEG test. Additionally, the declaration of death can only be made if the patient's body temperature is above 32.2 C, the patient must exhibit cerebral unresponsiveness, and apnea testing must not produce spontaneous respirations.
Brain death is very different from a coma. Unlike brain death, a patient in a coma can breath and pump blood without life support.
A patient in a coma isn't dead. Brain waves and brain stem function are still present, and the body is able to maintain vital homeostatic functions such as regulating temperature, blood pressure, and respiration.
The concept of brain death is difficult to accept because patients who are brain dead, while on life-support machinery, appear to the layman to be very much alive. This often causes confusion, even among medical professionals. One study found that one-third of all physicians and nurses consider "brain-dead" patients to be alive. The Uniform Brain Death Act of 1968 recognizes "for legal and medical purposes, an individual with irreversible cassation of all functioning of the brain, including the brain stem, is dead". Consequently, the official time of death is when the person is declared brain dead, not when the heart stops beating or the person is removed from ventilatory support.
Once brain death has been determined, a series of events take place to ensure that the successful retrieval of healthy organs for transplant. Time is of the essence, since the body of a patient who has suffered brain death can be kept functioning for only about 24 hours on life support before the organs begin to break down and organ donation is no longer possible. Hospital personnel will notify the local Organ Procurement Organization (OPO), relaying pertinent information regarding the potential donor's size and blood type, as well as the patient's medical status. The OPO immediately begins matching the donor organs with possible recipients, using UNOS's national transplant waiting list. The National Organ Transplant Act of 1984 ensures equitable organ distribution, utilizing a nationwide computerized system called the United Network for Organ Sharing. This system eliminates the possibility of anyone receiving special treatment. Potential organ recipients are given points based on the gravity of their medical condition, including urgency of need and length of waiting time, and are ranked by a computer that selects who will get an available organ.
Meanwhile, the patient's family should be kept informed of the situation and given the opportunity to consent to organ donation. However, the family must clearly understand that the patient is dead before being offered the option of organ donation. Telling the family about the patient's brain death well before making the request for organ donation, and making the request in a suitable, private setting, will greatly increase the likelihood of securing consent.
Once consent has been given, the patient is moved to an operating room, at which time the ventilator will be disconnected and the patient's heart will immediately stop beating. To recover internal organs, the surgeon makes a midline incision that's later sutured closed. Skin is recovered only from areas of the body that won't be visible. When eyes or bones are recovered, reconstructive materials is used so that the body appears normal.
Because the body is not disfigured by the removal of donor organs, traditional funeral arrangements with open casket are possible. For transplants to be successful, time is a critical factor. The window of opportunity varies for different organs: the kidneys are viable for forty-eight to seventy-two hours, the heart and lungs for only four to six hours after recovery. Corneas, however, are usually preserved using a procedure similar to freeze-drying and can be stored indefinitely.
The identity of all parties involved is always kept confidential. The donor's identity will not be revealed to the recipient, and the recipient's identity will not be revealed to the donor's family. However, the donor family and the transplant recipient may receive such information, relayed through the OPO, as age, sex, and occupation. Individually, the recipient may be told the circumstances of death, and the donor's family may be told how the transplant is functioning. Although organ recipients frequently want to say thank you to the deceased donor's relatives, transplant centers have established the convention of keeping the donors and the recipients anonymous in order to minimize the extent to which the recipient feels beholden to the donor and his family.
From a recipient's standpoint, the gift of a donated organ is a second chance. A 37-year old high school teacher with a transplanted kidney reports that you want to run out and thank the donors for your new life. But, of course, you never know them. So you just say thank you to God and ask Him to pass it along. Recipients often feel a sense of guilt while waiting for someone to die so that they can live. One recipient overcomes these negative feelings by resolving that she gave this heart life the same way this heart gave me life.
It's a human responsibility to give your organs and tissues away when you don't need them anymore. Yet, of the estimated 20,000 to 25,000 brain deaths in the United States every year, only twenty percent are organ donors. Of the remaining eighty percent, half of the families deny consent, and the rest are lost because the family simply isn't asked.
In 1990 a Swedish survey questioned whether or not respondents would be willing to consent to donation or either their own of a loved one's organs.
According to the survey, those who were not willing to donate their own organs listed the following reasons: their organs were too bad, they conceived of transplantation as contrary to nature, they were afraid of not being dead during the procedure, or they were uncomfortable with the thought of something being taken away from the dead body.
Rarely are religious beliefs cited as a reason to refuse organ donation. In fact, most major organized religions support organ donation, typically considering it a generous act that is an individual's choice: Roman Catholics view organ donation as an act of charity. The Church of Christ Scientist, while normally relying on spiritual means rather than medical for healing, says that organ donation shall be the individual decision of a church member. Judaism teaches that saving a human life takes precedence over maintaining the sanctity of the human body. Provided the moral integrity of the donor is not violated, the Episcopal Church finds nothing offensive in organ transplants. Baptists approve organ transplant when the transplantation offers real medical hope for the recipient.
However, strict Jewish religious law traditionally requires the burial of corpses intact on the day of death and has forbidden mutilation of the body whether dead or alive. Likewise, in Russia, the Orthodox Church places considerable emphasis on the value of the heart, so that the concept of brain death is not readily accepted, even by doctors. There is little prospect of heart transplants in the near future in Russia.
An interesting parallel to organ donation is the autopsy procedure. Understandably so, the general public would be outraged if all dead bodies were routinely taken by the state without consent of the family, drained of all fluids, had the brain and all other organs and glands removed, and were then returned to their families for burial. However, this is exactly the accepted procedure for autopsies; the difference being that after an autopsy, the organs are either stuffed back into the abdominal cavity or simply disposed of.
If an individual chooses to consent to organ donation, they would generally sign an organ donor card or signify their wishes on the back of their driver's license, although even if a signed donor card is found, the ultimate decision whether or not to make a donation comes from the family. In fact, the National Gallup polls indicate that 85% of Americans believe in organ donation, but they fail to take the critical step of conveying those wishes to family members. A signed organ donor card will not authorize consent, although it will indicate the patient's wishes, making his family's final decision easier.
It should be noted that a Will is not an appropriate way to give consent since the terms of a Will do not take effect until the will is probated -- often a considerable time after.
The Uniform Anatomical Gift Act (UAGA) of 1968 stipulates the right of individuals to determine the disposition of their bodies and ensures that right by requiring that hospital personnel ask family members to consider giving permission for donation.
Maryland and Pennsylvania have considered legislation for "presumed consent", which would allow physicians to recover organs routinely, unless expressly vetoed by the victim. While not accepted as legal consent in the United States, presumed consent is considered valid in several foreign countries, especially Switzerland where doctors don't even ask the relatives for permission. In France parental consent for removal of organs from children is presumed; and in Austria any deceased foreigners' organs may be taken.
Continued public awareness of the donation option will expand the current donor pool. When people are asked if they would help at least 200 people if given the opportunity, most would answer "yes." And that is exactly what can be done through organ tissue donation. Anyone who is still uncertain with the decision about donating organs might ask themselves a simple question: "If my son or daughter needs an organ, will it be there?".
Roy Calne, in his book A Gift of Life, best summed up organ donation: "The relief of human suffering by organ transplantation depends on the generosity and charity of mankind"
Are you up to the challenge?
site prepared by:
MaryBeth Ottman
January 18, 1997
As a donor mother, I am deeply interested in issues relating to
organ donation and transplantation. Please
e-mail me with your comments.
This site is dedicated to
who's tragic death meant new life for five organ recipients.
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