Nearly everybody who dies could donate tissue or organs for the benefit of others. It is a very sensitive matter for families to consider at the time of a death and many families say that it has been made easier if they have discussed this prior to death occurring and are aware of the wishes of the person who has died.
There are two types of donors – tissue donors and organ donors
Tissue donors are people who may have died in many circumstances at home or in hospital. The tissues that are most commonly retrieved are the corneas and heart valves. Occasionally we will also be able to retrieve skin and bone. There are a few contra-indications to tissue donation. These include:
· certain infections including HIV, Hepatitis B or C
· any high risk factor for HIV
· Alzheimer’s disease and some other diseases of unknown cause
· Motor Neurone disease (MND)
· Cruetz Feld-Jakob disease (CJD)
HIV and hepatitis can be detected through blood tests, Alzheimer’s, MND and CJD are excluded on the basis of an accurate medical history
Corneal grafting is very successful in restoring sight to individuals with corneal damage due to trauma, disease or congenital defect. For corneal donation the donor should be three years plus of age but there is no upper age limit. The corneas may be retrieved up to 24 hours after somebody has died and this will normally occur in the mortuary. There are very few more specific contra-indications to corneal retrieval, scarring of the cornea is one. Cancer is not necessarily a contra-indication but some types of leukaemia or lymphoma are. Many people are surprised that poor eye sight or even blindness is not a contra-indication as long as the cornea itself is not damaged.
Human heart valves are known as homographs. They may be transplanted into children who are born with defects in their own valves or used for adults who have diseased valves. Normally we are able to obtain two heart valves from each heart.
There is no lower age limit but heart valves will normally only be retrieved from people up to the age of around 60 years old. Heart valves may be retrieved up to 48 hours after death and retrieval will normally take place in the Mortuary.
The main contra-indications to heart valve retrieval is if the person had a disease that would have affected their own heart valves. Death from a heart attack is not a contra-indication to donation. Heart valves, once prepared, can be stored for many years, although normally they are required for transplantation within a very short time.
Skin that has been donated can be used as a dressing for people or children who have a severe degree of burns or scolds. This skin is used as a protective layer to prevent infection to reduce the loss of fluid and protein and it assists in the formation of scar tissue. It is not a permanent graft.
When skin is retrieved it is only taken from the back and the backs of the legs so that no disfigurement is seen. The skin is also removed as a very fine layer after death when there is no circulation so there is very little change in the appearance of the body. Donors of skin must be between 16 and 85 years of age and the skin can be retrieved up to 48 hours after death has occurred.
Contra indications to skin retrieval include prolonged treatment with steroids, a chronic skin disease such as psoriasis. Cancer is a contra-indication to skin donation.
Donated bone will be given to patients who require replacement of an area of their own bone. This may be because, for example, they have had an area of bone removed following trauma or if they have had cancer in the bone. Bone will not actually grow through a space but if that space is filled with donated bone then the patient's own bone will grow across using the donated bone as a scaffolding, eventually replacing the donated bone completely. This allows the normal length of a limb to be restored or, if it is used around a knee replacement, it will make the joint firm again.
If someone is to donate bone they must be between 16 and 65 years of age. Bone can be retrieved up to 24 hours after death and this again would often take place in the Mortuary.
Contra-indications to bone transplantation include a medical history of cancer, osteomyelitis (infection of the bone), rheumatoid arthritis or traumatic bone fractures. Bones from one donor may be used to treat a large number of patients.
Most solid organs which includes heart, lung, liver, kidneys and pancreas can only be retrieved from people who have died in a very specific way. This type of death is known as a brain stem death and these people will have died whilst being ventilated on the intensive care unit. Two doctors carry out very specific set of tests before making the diagnosis of brain stem death.
Once somebody has been declared brain stem dead it is possible to artificially maintain respiration and circulation or the blood and to eliminate waste products from the body. This means that the organs can be maintained until the body is transferred to theatre for retrieval of those organs.
There are various criteria for the different organs that may be transplanted. The heart donor will be under 60 years of age whilst the liver may be retrieved from somebody into their 80's. Kidneys will not normally be retrieved from a person over 75 years of age but in each case the actual functioning of those organs will be investigated first and then a decision will be made as to which organs are suitable for retrieval and transplantation.
Consent will be obtained from the next of kin of the person who has died. Where possible enquiries will be made as to the wishes of the person who had died regarding organ donation. This may be via the national donor register or if they carried a donor card or by asking the family as to whether this had ever been discussed. If the death is a Coroners case, that is if it has been a very sudden death or within 24 hours of the person coming into hospital or undergoing surgery then permission is also required from the Coroner. One of the doctors involved in treating the patient or the transplant co-ordinator will contact the coroner to obtain his/her permission in each case.
The transplant co-ordinator will be contacted when there is a potential donor. S/he will liaise with the nursing and medical staff who have been caring for the patient until their death and then meet with the family of the potential donor. During this meeting, s/he will provide information and answers questions in order to help them make a decision regarding organ donation. If the decision is made to go ahead with organ donation, the co-ordinator will stay with the potential donor and assist in their care and management until they can be transferred to theatre for the retrieval operation.
During this time the co-ordinator arranges various tests to assess the functions of the organs and to establish the blood group and tissue typing of the donor. This information will then be used to consider who the suitable recipients are. The co-ordinator will arrange for the surgeons from the different transplanting centres to travel to the hospital where the donor has died and to undertake the retrieval surgery. The organs that have been retrieved are kept as cold as possible and transferred back to the retrieval centre for the transplant operations to take place.
The transplant co-ordinators maintain contact with the donor families and provide bereavement support where necessary.