Types of Donation
Organ and Tissue Donation from Living Donors
While most
solid organ and tissue donations occur after the donor has died,
some organs and tissues can be donated while the donor is alive.
The first successful transplant in the U.S. was made possible by
a living donor and took place in 1954. One twin donated a kidney
to his identical twin brother. As a result of the growing need for
organs for transplantation, living donation has increased as an
alternative to deceased donation, and about 6,000 living donations
take place each year. Most living donations happen among family
members or between close friends. Some living donations take place
between people unknown to each other.
Solid
Organ Donation
Living individuals
can donate one of their two kidneys and the remaining kidney provides
the necessary function needed to remove waste from the body. Single
kidney donation is the most frequent living donor procedure.
A living donor
can donate one of two lobes of their liver. This is possible because,
just as skin cells grow new skin, liver cells in the remaining lobe
of the liver grow or regenerate until the liver is almost its original
size. This re-growth of the liver to near its original size occurs
in a short period of time in both the liver donor and liver recipient.
It is also possible
for living donors to donate a lung or part of a lung, part of the
pancreas, or part of the intestines. Although these organs do not
regenerate, both the donated portion of the organ and the portion
remaining with the donor are fully functioning.
Surprisingly,
it is also possible for a living person to donate a heart, but only
if he or she is receiving a replacement heart. This occurs only
when it is determined that someone with severe lung disease and
a normally functioning heart would have a greater chance of survival
if he or she received a combined heart and lung transplant. As a
result, the heart-lung recipient's own heart, if it’s in good
condition, is then donated to an individual who needs only a heart
transplant.
Tissue
Donation
Tissues donated
by living donors are blood, marrow, blood stem cells, and umbilical
cord blood. A healthy body can easily replace some tissues such
as blood or bone marrow. Blood is made up of white and red blood
cells, platelets, and the serum that carries blood cells throughout
the circulatory system. Bone marrow contains stem cells. In addition,
stem cells found in circulating blood in adults and from the umbilical
cord of a newborn also can be donated. Both blood and bone marrow
can even be donated more than once since they are regenerated and
replaced by the body after donation.
Suitability
to Donate
Each potential
living donor is evaluated to determine his or her suitability to
donate. The evaluation includes both the possible psychological
response and physical response to the donation process. This is
done to ensure that no adverse outcome, either physically, psychologically,
or emotionally, will occur before, during, or following the donation.
Generally, living donors should be physically fit, in good health,
between the ages of 18 and 60, and not currently have or have had
diabetes, cancer, high blood pressure, kidney disease, or heart
disease.
The decision
to be a living donor must be weighed carefully as to the benefits
versus the risks for both the donor and the recipient. Often, the
recipient has very little risk because the transplant will be life
saving. However, the healthy donor, does face the risk of an unnecessary
major surgical procedure and recovery. Living donors may also face
other risks. For example, a small percentage of patients have had
problems with maintaining life, disability, or medical insurance
coverage at the same level and rate. And, there can be financial
concerns due to possible delays in returning to work because of
unforeseen medical problems.
Follow-up
for Living Donors
The National
Institutes of Health is in the process of conducting a study to
collect information on the outcomes of living donors over time.
At present, follow-up reviews of living donors by some transplant
centers show that living donors, on average, have done very well
over the long term. However, there are some scientific questions
regarding the effects of stress on the remaining organ. There could
be subtle medical problems that do not develop until decades after
the living donation that are not known at this time because living
donation is a relatively new medical procedure. To ensure the safety
of all living donors, it is critical that the long term results
of the effects of living donation are studied further.
The
Decision to Donate
The decision
to be a living donor is a very personal one and the potential donor
must consider the possibility of health effects that could continue
following donation. In most cases, that decision must also take
into consideration the life-saving potential for a loved one—the
transplant recipient.
Because all
of the effects, especially the long term effects, to the donor are
not known at this time, the Federal government does not actively
encourage anyone to be a living donor. The Federal government does
recognize the wonderful benefit that this gift of life provides
to the patient awaiting a transplant and has several ongoing programs
to study, support, and protect the living donors who do choose to
provide this gift.
The decision
to say yes to both organ donation after death and/or as a living
donor is the focus of many very active and successful research projects
that are being conducted across the nation, and these efforts are
supported by the Division of Transplantation, Health Resources Services
Administration, U.S. Department of Health and Human Services.
Federal
Assistance for Living Organ Donors
In September
2006, HRSA awarded a cooperative agreement to the University of
Michigan to establish a national program to provide reimbursement
of travel and subsistence expenses to living organ donors who cannot
afford these expenses. In October 2007, the University of Michigan
in partnership with the American Society of Transplant Surgeons
launched the National Living Donor Assistance Center to help donors
with travel, lodging, and meal expenses associated with the organ
donation process. For more information visit the National
Living Donor Assistance Center Web site
Donation after brain death
Most of the organs used in transplants come from people who have
suffered brain death as the result of an accident, heart attack,
or stroke. Brain death is total cessation of brain function, including
brain stem function. There is no oxygen or blood flow to the brain;
the brain no longer functions in any manner and will never function
again.
The organs and tissues that are in good condition are removed in
a surgical procedure and all incisions are closed so an open casket
funeral can take place. After the organs have been removed, the
patient is taken off artificial support.
While organs must be used between 6 and 72 hours after removal
from the donor's body (depending on the organ), tissues such as
corneas, skin, heart valves, bone, tendons, ligaments, and cartilage
can be preserved and stored in tissue banks for later use.
Donation after cardiac death (DCD)
Some patients that have sustained traumatic brain injury cannot
be declared dead based on the definition of brain death. In these
cases, the patient is declared dead upon cardiac death, which is
the cessation of cardiac and respiratory function when the patient
is withdrawn from life support.
Donation after cardiac death occurs only after the patient or family
has decided to withdraw life-sustaining therapies for reasons entirely
apart from any potential for organ donation.
Whole body donation
People who wish to donate their entire body to medical science
should contact the medical school or willed body program of their
choice and make arrangements to do so before they die. Medical schools
need bodies to teach medical students about anatomy, and research
facilities need them to study disease processes so they can devise
cures. Since the bodies used for these purposes generally must be
complete with all their organs and tissues, organ donation is not
an option. Some programs, however, make exceptions. You can inform
your family that organ donation is your first choice, but if it
is found that you are not medically suitable for organ donation,
your family can carry out your wishes for whole body donation.
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