ORGAN and TISSUE DONATION after death

Modern tissue matching, surgical and storage techniques, as well as anti rejection drugs have made it possible for miracles to occur in the form of tissue and organ transplantation.

Moreover it is the generosity and practical thinking of people which has made the difference, those of us who are not afraid to discuss with their family the notion of donation organs after death. They understand that by electing to donate their organs after death they can make a difference to other people’s lives. It is not bad luck or bad taste to discuss organ donation in a family situation.

There are many more people awaiting transplantations than there are organs available. Without donated organs many or even all of these people, some of them children, will die. More education is necessary in order for families to feel comfortable discussing their views on organ donation so that if a tragic death were to ever occur then the rest of the family would not be left wondering what the person would have wanted.

What organs or tissue may be used for transplantation after death?

Organs : Kidneys, Lungs, Heart, Liver, Pancreas.

Tissue : Bone, Heart Valves, Skin.

Certain restrictions do apply. Probably the most important factor to take into account is the time from death to organ retrieval. Organs such as heart lungs kidneys and pancreas deteriorate quickly once circulation ceases. For this reason these organs are only accepted for donation in certain situations. Typically this is where the donor has died while on life support ventilator equipment. Other factors may be the physical condition of the organ or medical history that may preclude organs being used in transplantation. There are age restrictions on donation of some tissue. These are discussed below. 

Is there any cost or payment associated with organ donation?

In Australia the answer to both questions is an emphatic NO. Obviously the cost of medical care up to the time of death is borne by the patient or family. No one receives payment for making a donation of organs or tissue. Organ and tissue donation is a gift. 

 At what point are organs removed and how do they make sure the donor is really dead?

Organs are not removed until the person is deceased. If a person is surviving on a respirator this machine can maintain blood flow around the body. If the person becomes "brain dead" (there is no hope for recovery. This implies that without the aid of the respirator their brain would not be able to carry out any bodily functions. Brain death is defined as the irreversible cessation of brain function. Doctors can perform tests to identify this situation. Brain death is identifiable as different from Coma. Protocol dictates usually that two senior doctors, not involved with the transplantation, perform the tests.

Donors are treated with absolute respect. The retrieval procedures are proper surgical techniques and wounds are sutured and dressed like any other procedure. Loved ones can view the body after donation operation has occurred without fear.

The family makes normal funeral arrangements.

You can register your wish online at

  http://www.hic.gov.au/yourhealth/our_services/aaodr.htm#role

You MUST  inform your family  of your wishes so that they know what to do  in case of a tragedy.

 How many people are awaiting a transplant?

It is estimated that at any time there are 2000 people in dire need of a transplant. Those waiting far exceed the donations made. Of course every donation is a tragedy but these tragedies can have at least some positive out come. One family’s loss can become someone else’s gift of life.

Transplantation Tissue Bank

While it is critical that most organs be retrieved and transplanted very soon after death there are some other bodily tissue which are not so time dependant and these can be donated even when the person has died somewhere other than hospital. These tissues includes bone, skin, heart valves and cornea. After retrieval and processing they can be stored under special conditions in a "tissue bank" for up to several years.

Bone

When a person has a bone tumour removed or if a particular bone is weakened for example when a fracture has failed to heal of an joint replacement is loose, a surgeon may fill the cavity with a donated bone graft. This is often more effective than artificial grafts

There are age restrictions for bone donations are as follows. Age at death must be between 18-65 years (males) and 18-50 years (females).

Bone may also be donated at the time of surgery like hip replacement for osteoarthritis when the tissue would other wise be discarded.

Bone is processed and stored at -80 degrees Celsius and can remain frozen at this temperature for a maximum of five years.

Skin

Skin banking has been a life saver for people suffering severe burns. For many years experts have been able to culture, or grow, skin in laboratory conditions. Skin is the perfect protective dressing and donated skin can be laid over burns promoting healing, reducing infection risk, and making the patient more comfortable while their own skin is cultured for permanent grafting.

The age restrictions on skin donation are 18 –55 years for males and females.

Skin is stored in the vapour phase of liquid nitrogen at a temperature of -170 degrees Celsius, and can be stored for a maximum of five years.

Heart Valve

Just like a valve on a garden tap directs water flow so too the heart has valve which ensure blood flows in the right direction. Some people are born with faulty valves but damage can occur through certain diseases, the result can be that blood flow is impeded so replacement becomes necessary. Although artificial and animal heart valves are available for use in transplantation, human heart valves have advantages, which include being more resistant to infection and being able to avoid the need for potentially dangerous drugs. Artificial valves can be quite noisy

Heart valve donations are used to repair congenital defects in babies who could die without surgery and to replace diseased aortic valves in adults.

The age restrictions on heart valve donation are a newborn to 55 years for males and females.

Heart valves are stored in the vapour phase of liquid nitrogen at a temperature of -170 degrees Celsius and can be stored for a maximum of five years.

Cornea

The cornea is the glassy part of the eye which covers the iris (coloured part). Some diseases cause it to become opaque and perforation may result from some accidents or diseases. There are no artificial equivalents to replace a damaged or diseased cornea. Donated corneas have made it possible for many blind or partially blind Australians to regain or improve their sight.

As long as the donor was over 18 months at the time of death there is no upper age restriction for cornea donation. For more information check out http://cera.unimelb.edu.au/eyebank.htm