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Frequently Asked Questions About Organ Donation

What is organ donation?

Why be a donor?

Will my body be experimented on if I agree to donation?

Am I too old?

I don't think my organs would be good enough - how healthy do you have to be?

Are donors screened to identify if they have a transmittable disease?

Can I be a donor if I have an existing medical condition?

What organs or tissue can I donate?

Can people who wear glasses donate their corneas?

If I say yes to organ donation, does that mean that I have to donate everything?

Will they just let you die if they know you want to be a donor?

How can they be sure you're dead when they take your organs?

Brain death?

Does donation leave the body disfigured?

Can my family over-rule my wishes?

If you donate organs will funeral arrangements be delayed?

Does living in the United Kingdom for a period of six months between 1980 and 1996 prevent me from donating organs for transplantation? 

 Does my religion object?

Does the colour of my skin make a difference?

Isn't it tempting fate?

How are organs allocated to recipients?

If I want to donate my body to medical science, can I donate organs for transplantation?

How is organ donation different from organ retention?

Does a donor's family  know who the recipient is?

Can you donate an organ while you're still alive?


What is organ donation?

Organ donation is when a person, or their family, agrees to the removal of one or more of their organs, so that the organ can be transplanted into someone else.

In most cases, organ donation happens after someone's died but some organs, particularly kidneys, can be donated by a healthy living person. Before an organ can be donated from a deceased donor.

A person can donate a number of different organs, including the heart, lungs, kidneys, liver, pancreas and small bowel. Tissue (that is, a group of cells of the same type packed together as part of an organ, rather than the whole organ) can also be donated. This includes skin, bone, heart valves and corneas (the surface lining the front of the eye).

Heart-beating donors 

The majority of donors are heart-beating donors. These are patients who have died as a result of a severe head injury or brain haemorrhage which has irreversibly damaged their brain and they are cared for on a ventilator in an intensive care unit. They are certified dead by brain stem testing.

The brain injury damages vital centres in the brain stem which are essential to maintain life. No one can survive once these brain centres have been destroyed, and it's the brain stem tests that show conclusively when this has happened.

But although the person is dead, a ventilator keeps the body supplied with oxygen which means the heart will continue to beat and circulate blood. If the ventilators were disconnected, the heart would stop beating.

In this way, the organs can be preserved for a short while until they can be donated for transplant. These patients are called heart-beating donors.

Some organs, such as hearts, deteriorate very quickly without an oxygen supply, so they're only donated by a heart-beating donor.

Non-heart-beating donors
In some circumstances patients who die in hospital but aren't on a ventilator may also donate their kidneys and sometimes other organs, because these organs can last longer without a blood supply. These people are called non-heart-beating donors.

What it's not
Organs aren't removed from people in a 'persistent vegetative state' (PVS). People in this condition have sustained overwhelming damage to a different area of the brain - the cortex (not the brain stem). Their brain stem has not died and while they're unaware of their surroundings, they're able to breathe spontaneously and may survive indefinitely.

By talking about donation with your family and friends, you'll help make others aware of the problem.

How it's handled
When someone who might be an organ donor dies, a carefully coordinated process begins. The local donor transplant coordinator talks to the family and, if they agree to donation, arranges tests such as 'tissue typing' ready to match up with people waiting for transplants.

Specialist surgeons carefully remove and preserve the organs for transport to the transplant unit, where it's transplanted immediately. The donor transplant coordinators support the family throughout the process. Recipient transplant coordinators assess patient's suitability to receive a transplant, organise the operation and support the patient afterwards.

Many more people need organ transplants than there are donor organs available, so a fair and unbiased system, based on need and tissue matching, is used to allocate the donor organ to a recipient.

Tissue donations
Certain body tissues, such as corneas, skin, bone and heart valves, can remain suitable for transplantation for many hours without a blood supply. So people who die outside of a hospital can sometimes become tissue donors.

Live donors
While the majority of donations occur after death, it is possible to donate some organs while you're still alive. People can live very well with just one kidney. These days in one in four kidney-only transplants the kidney is donated by a living relative or friend. For more, see our fact file on living donors.

Why be a donor?

Sometimes when people are very ill, the only way they can recover or lead a normal life-style is to receive an organ transplant. This is when a healthy organ (such as heart, lungs or liver) is taken from somebody who has died and transplanted into the person whose own organ is not performing properly.

Being a donor means that after your death your healthy organs may be used for transplantation.

One organ donor can give the gift of life or health to up to ten people

Will my body be experimented on if I agree to donation?

No. When you give your consent for your organs or tissues to be used for transplant after your death, and NOT for anything else. You're not giving permission for your body to be used for experimentation, testing or any other activity and these sorts of things would certainly not be done unless further permission was sought from your relatives.

Am I too old?

Anyone up to the age of 80 can be considered as an organ donor. Corneas can be donated up to the age of 85 years.

What matters is that the organs or tissues are in a good enough condition to be used. As we get older, some of our organs are affected by the ageing process and become less efficient and therefore less likely to be suitable for transplantation. This is particularly true with solid organs, such as the kidney, but even then some people reach their 70s and 80s with well-functioning kidneys that are suitable for transplantation.

The oldest solid organ donor ever recorded in the UK was 82. And other tissues taken from donors for transplant, such as corneas, can weather the changes of age well. The oldest recorded cornea donor was 101.

Of course, recipients may be older too. The oldest recipient of a kidney transplant in the UK was 81, while a 104-year-old has being given a cornea transplant.

It's only after you've died that doctors will decide which organs or tissues might be suitable for transplant.

I don't think my organs would be good enough - how healthy do you have to be?

Your age and medical condition at the time of your death will determine which organs are suitable for donation.

Some infectious conditions, such as HIV, do mean that a person can't become a donor, because the infection may be passed on to the recipient. But simply being unfit, overweight or prone to coughs and colds, wouldn't necessarily mean that your organs wouldn't be good enough.

The donor transplant co-ordinator is responsible for getting the medical history of the potential donor by reading the medical notes, speaking with the family, or those closest to the person, and with the GP. Blood tests are also arranged to rule out any infections. The information is then discussed with the doctors responsible for the potential recipients who will decide whether to accept the organ for transplanting into their recipient.

Sometimes it's only once the organs can be seen as they're being removed that doctors discover they're unsuitable for transplant. So if you want to be a donor,let the doctors worry about whether your organs are good enough.

Are donors screened to identify if they have a transmittable disease?

Yes, but this is only done once the person has died. It's vital to be sure that infectious diseases, such as HIV or hepatitis, aren't passed on during organ or tissue transplantation. So once the family have agreed for their loved one to be a donor, blood will be taken to check for transmittable diseases.

Can I be a donor if I have an existing medical condition?

Having an existing medical condition doesn't necessarily rule you out from being a donor. It will depend on what your condition is, but most people can donate some of their organs and tissues. During transplantation a variety of different organs can be used, including kidneys, lungs, heart, liver, cornea and other tissue such as bone, and it's unusual for all these to be affected by a single medical condition. Some may be affected and not others. For example, if you have bowel disease, your heart and lungs or your corneas may be fine.

Infectious diseases, such as hepatitis, and other diseases such as cancer may mean that some of your organs or tissue are not suitable for transplantation because these could be passed on with the transplanted tissue.

The decision about whether your organs could be used would be made after your death by a doctor who would assess your medical history, check what problems you'd had, and arrange blood tests to rule out important infections.
 

What organs or tissue can I donate?

 There are a number of different tissues and organs that you can donate. So, by being a donor you can help a surprisingly large number of people after your death - possibly as many as 50!

Solid organs that can be transplanted include the kidneys, heart, lungs, liver, pancreas and small bowel.

Tissue simply means part of an organ, or a collection of cells of the same type. Tissue transplants include the corneas (the clear layer of tissue that covers the front of the eye), heart valves (flaps of tissue which divide the chambers of the heart) and bone. Pieces of skin (which some people argue is the largest organ in the body) can be transplanted and used to treat patients with severe burns. Bone marrow and blood can only be given while a person is living.

Techniques are improving all the time and it may soon be practical to transplant other parts of the body.

Can people who wear glasses donate their corneas?

In most cases those who wear glasses or contact lenses can become corneal donors.

If I say yes to organ donation, does that mean that I have to donate everything?

 You can specify which organs and tissue are donated. If you have an opinion about this you should let your family know.

Will they just let you die if they know you want to be a donor?

 When you're ill you're looked after by a team of doctors and nurses who do everything they can to save you. They're completely focused on getting you better and out of the hospital. They are unconnected with any transplant team and are not concerned with any patient waiting for a transplant. Only after the brain has died will organ donation be considered.

How can they be sure you're dead when they take your organs?

Doctors must carry out a series of formal, carefully regulated tests to establish that a person is dead. In the case of the certification of death by brain stem testing (where a ventilator is needed to breathe for the person) the tests are repeated by a different doctor.

BRAIN DEATH?

One certainty in life is that we all die. In most cases it is easy to tell when someone has died; they do not breathe or move, they do not have a pulse and their skin changes colour because blood is no longer circulating. This applies whatever the cause of death.

Then what is brain death?
When someone is dead, due to brain death, the brain stops functioning and will never function again. It means there is no supply of blood or oxygen to their brain, the brain cells die and cannot grow again or be replaced. However, the person will be in an intensive care unit connected to a mechanical ventilator (breathing machine) which pumps oxygen into the lungs making the chest rise and fall. Some of the illnesses that can result in brain death are, head injury, bleeding into the brain, brain tumour and brain infection.

Is brain death different from what is commonly understood to be death?
No. It is not different. In actual fact, no one dies until their brain dies. That is why it is possible for doctors and ambulance officers to resuscitate people who have had a cardiac arrest, when the heart may have stopped for several minutes. Such people can recover only because the brain has not died.

In the same way, the hearts of patients undergoing open heart surgery are stopped for one or more hours during the operation. These people are not dead, because while the heart is stopped the blood flow to the brain is maintained by a machine.

By contrast, the patient in an intensive care unit whose brain has died will never recover because there is no blood flow to their brain, even though their heart keeps beating while the body is connected to a mechanical ventilator. Brain death is death - it is just detected in a different way in these patients.

How can someone's brain die while their body is kept going in intensive care?
When someone suffers a severe injury to the brain or a haemorrhage (bleeding) inside the brain, it becomes swollen (in the same way that muscle becomes swollen when injured). The brain is contained within the skull which is rigid and cannot expand to make room for the swelling. The pressure of the swollen brain may keep increasing to the point that it blocks the blood vessels. This stops the flow of blood to the brain (this may occur despite all the efforts by the doctors and nurses to control the swelling). Without blood flow to the brain, it dies and cannot recover.

How can the doctors tell when a patient's brain has died?
In patients who are in intensive care with a severe head injury, frequent observations are carried out by the nurse, to monitor the patient's responses and level of consciousness. There are a number of functions that the brain controls all the time that we are not aware of, such as eye movements, size of the pupils, and breathing. These controls continue in unconscious patients, but they disappear when the brain dies.

The doctors may suspect that brain death has occurred if no evidence of brain function can be found. If that is the case, two doctors then follow carefully laid out clinical tests to formally examine the patient and determine if there is any brain function left, or if the brain has died. Sometimes a special brain x-ray may be required to show that there is no blood flow to the brain.

Are there any cases where a patient was declared brain dead and later returned to life?
No. If you hear about people who were reported to have been brain dead and subsequently recovered, the term was not used accurately and these people were not actually brain dead. It is most likely that they had been in a deep coma with some brain function and blood flow to the brain and may have been able to breathe when the mechanical ventilator was removed. The crucial difference between brain death and coma is confirmed by the strict clinical tests (or special brain x-ray) that must be carried out to determine if there is any brain function.

What is the time of death for a brain dead patient - when the patient is declared brain dead, or when the heart acutally stops beating?
The recorded time of death is when the two doctors have completed the second set of required clinical tests that confirm the diagnosis of brain death.
 

Does donation leave the body disfigured?

No. Doctors remove organs and tissue from a donor very carefully, just like in a normal operation, leaving a neatly stitched and dressed wound afterwards. Even when the heart and lungs are removed, the rib cage keeps the shape of the body and all someone might notice would be the wound, which is covered anyway. Being disfigured is a common concern. Organ donation will not interfere with funeral arrangements such as an open casket.

Can my family over-rule my wishes?

Yes, Your family will be asked at the time if they know your wishes about organ donation, and for their agreement. Your wishes can be over-ruled, 

That is why it is so important to discuss organ donation with your family,now, and to let them know your wishes.

If you donate organs will funeral arrangements be delayed?

Funeral arrangements are not affected by organ donation. Organ donation happens within a few hours after death and there is no reason to delay arrangements.

Does living in the United Kingdom for a period of six months between 1980 and 1996 prevent me from donating organs for transplantation?

No. The donation of blood is now prohibited from those people who have lived in the United Kingdom for a six-month period between 1980 and 1996 because of the risk of transmission of Creutzfeld-Jakob Disease. This does not apply to organ donation. Transplant units believe that further restrictions in donor suitability would mean that more potential recipients would die waiting for a transplant, and the risk to the recipient is believed to be extremely small.

Does my religion object?

Religions support donation on the grounds that it is a gift of life to another person. If you are in doubt you should talk to your minister, priest or elder. major  religions support organ donation and transplantation. It doesn't matter whether you're Hindu, Muslim, Christian, Jewish, Sikh or Buddhist, you can choose to be an organ donor. If you are in doubt you should talk to your minister, priest or elder.

Does the colour of my skin make a difference?

Skin colour isn't a guide to whether a donor and recipient are well matched. Organs are 'colour-blind' and an Asian person, for example, doesn't have to receive an organ from another Asian person.

But certain genetic types are more likely to occur within particular populations. So, for example, matching up of blood groups is very important when deciding which person on the transplant list should receive an organ that has become available.

Slightly more unusual blood groups are often found among particular minority ethnic groups. So a person from a minority group who has one of these unusual blood groups is more likely to find a good match from within the same unusual group if they're from the same ethnic community, than in the general population.

Isn't it tempting fate?

Part of the superstition and fear around death comes from the feeling many of us have that if you think about dying, it's more likely to happen. Similarly some people who are waiting for a transplant often feel guilty that simply by wanting a transplant and thinking about it, they're willing someone else to die.

If we're calm and logical about it, we know that thinking about death is completely unlinked to how and when we die. We can't will ourselves or someone else to die, whether we want to or not. It's no different to thinking about winning the lottery. No matter how much we simply think about it, it's no more likely to happen.

We'll all die in the end and making plans for what will happen after our death is a simple practical step. Deciding to be an organ donor isn't that different to making a will. You're making a formal statement about your wishes. Telling your family is important so that in the event of your death, they'll be able to fulfil your wish.

How are organs allocated to recipients?

There are a number of factors that are considered when organs are being allocated, including blood group, tissue typing, height and weight compatibility, medical urgency,and time on the waiting list.

Hearts, lungs, livers and pancreas are retrieved only after the recipients have been selected by the transplant units. Because there are so many people waiting for kidney transplants in New Zealand, the kidneys can be retrieved before the recipients have been identified by the National Kidney Allocation System.

If I want to donate my body to medical science, can I donate organs for transplantation?

A decision to donate your body to medical science generally means that organ donation is not an option.

How is organ donation different from organ retention?

Organ retention is a completely different issue to organ donation.

Organ retention describes the situation where organs are removed from a person after death, during a post mortem, in order to examine the tissues further and help doctors understand how the death had occurred. Organs may also be retained for research purposes or occasionally for teaching of other health professionals.

In organ donation, the organs or tissues are removed solely for the purpose of transplant into another person. Relatives are always asked to give their agreement. Organ retention hit the headlines in NZ a few years ago when it was found that the parents or relatives of patients hadn't been asked to give proper consent for the organs to be taken and kept. Now informed consent must be obtained before organs can be retained.

Does a donor's family know who the recipient is?

An important ethical principle that guides organ donation and transplantation is confidentiality - the principle that your medical information, and your views and choices, should be kept private. Confidentiality is always maintained, except in the case of living donors, who are usually within the same family and know exactly who they're donating to.

The family of a person who has donated organs and tissues after their death are not told who receives those organs or tissues. However, if the family wishes, they can be given some basic details such as the age, sex and family circumstances (for example, father with young children) of the person or people who've benefited from the donation.

Confidentiality works the other way round too - the person who receives an organ or tissue donation doesn't know the exact identity of the donor but can obtain similar basic details. Sometimes, if families wish, they exchange anonymous letters of thanks or good wishes. This is arranged through the transplant coordinators. In a few instances, donor families and recipients have arranged to meet.

Can you donate an organ while you're still alive?

Yes, you can donate some of your organs while you're alive. It's possible to live with only one functioning kidney, for example, or donate part of your liver or lungs. This is known as being a living donor. most donate to a close family member.



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