An Overview of Organ and Tissue Donation: Ethics and Logistics

Another lecture on transplantation! A lot of this was covered in previous posts, so be prepared for some links :P

Pathways to donation

See previous post: Organ Transplant: The Surgeon's Perspective

For this post, we'll mainly be talking about donations after death (i.e. complete cessation of blood circulation and/or brain function). Brain death can be caused by a variety of causes, such as haemorrhage, oedema, trauma, hypoxia (from cardiac arrest, drowning, etc.), and tumours. Usually, injury leads to brain swelling, then intracranial hypertension, ischaemia, and brain death. Brain death can be determined by clinical testing and/or radiological imaging, such as 4-vessel angiography and radionuclide scanning.

Legal requirements

There are several legal requirements for organ donation. Firstly, a certificate of death is needed to prove that the donor is, indeed, dead (you wouldn't want to rip out someone's heart if they're still alive!). Next consent is required- from the donor (if they consented before death), from the next-of-kin, and from the coroner. Certain designated officers at the hospital should also be notified.

Referral process

Firstly, the family of a potential donor needs to be informed about the death and about the donation process. These are obviously difficult conversations to have, so there is specialised training for clinicians who are going to deal with this. Next up you have to deal with consent, as I just stated above. When the decision to donate has been made, information is gathered about the donor and a variety of tests (e.g. serology, tissue typing, and nucleic acid testing) are done in order to ensure safety and match up donor to recipient. Matching is done according to compatible blood type and size. The sickest patients are prioritised.

Different organs have different optimal age ranges. Hearts can be donated from those less than 60 years, livers from those less than 80 years, pancreas from 3-50 years (islet cells 10-70 years), lungs from 5-70 years, intestines less than 50 years, and kidneys less than 80 years.

Surgical retrieval

See previous post: Organ Transplant: The Surgeon's Perspective

After donation

After donation, there is some documentation and follow-up. The donor family is supported, and the recipient is monitored for adverse events following transplantation.