Organ Transplant Process
This section covers the process involved in bringing organs from donors to recipients. This information pertains to New York State, but may be applicable in other states as well.
Donor Referral
At or near the time of a patient's death, a physician, nurse, or other designated representative from the hospital contacts LiveOnNY at 1-800-GIFT-4-NY (1-800-443-8469). The caller provides confidential information to determine if the patient is a potential donor.
Medical Evaluation
A transplant coordinator travels to the hospital to evaluate each potential donor and to determine the medical suitability of each organ. The transplant coordinator obtains detailed medical information about the patient's current medical condition as well as any past medical history.
Declaration of Death
CARDIAC DEATH
In the circumstance of devastating neurological injury or terminal illness, some patients and/or families may opt to limit or withdraw artificial life supporting medications or devices. When a family decides to take a patient off life support, the patient may be eligible to donate his or her organs once the heart stops beating. This type of donation is called donation after cardiac death.
After a family has decided to withdraw care, a physician will contact the organ donor network (it is mandatory federal law that the organ donor network is called after such discussions). The organ donor network will screen the patient for eligibility and speak to the family if the network believes that the patient is a suitable candidate.
If the family consents for donation, life sustaining machines will be disconnected in an operating room. The family may be present in the operating room during withdrawal of artificial life support if they wish. Once the machines are disconnected, if the patient's heart stops beating within 60 minutes, the organs can be recovered for transplant. Typically, liver, kidney, lungs, pancreas and tissues can be used after DCD.
NEUROLOGICAL DEATH
Donation after neurological death refers to organs that are recovered after a patient has been declared brain dead.
Declaration of Brain Death:
- Brain death is irreversible loss of brain and brainstem function and is equivalent to legal death. In order to declare a patient brain dead, a neurologist or neurosurgeon must perform two neurological exams six hours apart that demonstrate a complete absence of brain function.
- Additionally, an apnea test must be performed. During this test, the patient is briefly disconnected from the ventilator (breathing machine) for 8-10 minutes to see if the patient is able to initiate breaths without the help of a machine. If the patient does not make any attempts to breathe, the apnea test supports the diagnosis of brain death.
- If, for some reason, the physician is not able to perform a part of the neurological exam or the apnea test, then a confirmatory test must be performed. This may be an ultrasound of the vessels in the head, an injection of dye to examine the vessels in the head or a special radionucleotide test of the brain.
- It is most important to understand that brain death is death.
- Organs that can be donated after neurological death include heart, lung, kidneys, liver, pancreas, and intestines. Tissue and eyes can also be donated.
Consent for Organ Donation is Obtained
The transplant coordinator or family services coordinator meets with the potential donor's next of kin, or other authorized party, to offer the opportunity for donation. This conversation is carefully timed and takes place only after the next of kin is given time to understand their loved one is brain dead. Detailed information is provided about the organ donation process including which organs and/or tissues may be donated, how and when the recovery will take place, testing that will be required to determine the medical suitability of the donations, and how the organs and/or tissues will be distributed to the patients needing transplants. After making the decision to donate, the next of kin will be asked to sign a consent form documenting which organs and/or tissues they wish to donate. After obtaining consent, the transplant coordinator also conducts a detailed interview with the next of kin and completes a medical and social history questionnaire about the donor. Many of these questions are similar to those asked when someone donates blood.
Medical Examiner/Coroner
Prior to the recovery of any organs or tissues, the transplant coordinator must also contact the appropriate county medical examiner or coroner if the death is under their jurisdiction.
Organ Allocation and Recipient Identification
Each patient awaiting an organ transplant is listed on a national computerized waiting list that is maintained by the United Network for Organ Sharing (UNOS) in Richmond, Virginia. This registry contains detailed information about each patient including blood type, degree of medical urgency and other data important for matching donors to recipients. This registry changes constantly as new patients are added to the list, and as other patients either receive a transplant, die waiting, or due to a change in medical condition, are removed from the list. Specific information about each donor, including his or her blood type and body size, are entered into the national computer system. An individualized list is generated for each donor that identifies patients who match for those particular organs. There is a different list generated for each and every donor. Each available organ is allocated according to medical urgency, degree of match to the donor and time waiting. The transplant coordinator then contacts the transplant center where each potential recipient is waiting and provides detailed, confidential information about the donor. The transplant surgeon always makes the final decision about whether or not the donor and intended recipient are a good match.
Organ Recovery Procedure
The recovery of the organs is performed in the operating room where the donor is being cared for. The transplant coordinator oversees the arrival and departure of the surgical recovery team. The recovery team consists of surgeons, nurses, the transplant coordinator and an organ preservation technician.
Organ Preservation
Just prior to being removed from the donor, each organ is flushed free of blood with a specially prepared ice-cold preservation solution that contains electrolytes and nutrients. The organs are then placed in sterile containers, packaged in wet ice, and transported to the recipient's transplant center. It is important to transport the organs from the donor to each intended recipient as quickly as possible. Hearts and lungs must be transplanted within approximately four hours after being removed from the donor. Livers can be preserved between 12 - 18 hours; a pancreas can be preserved 8 - 12 hours; intestines can be preserved approximately 8 hours; kidneys can be preserved 24 - 48 hours.
Donor Family Follow-up
After the organ transplants have been completed, a letter is sent to the donor's family from the LiveOnNY that includes information about the outcome of the donations. Care is taken to preserve the identity and location of the recipient(s), but general information is given about how they are doing after receiving their transplant. Similar letters are also sent to the doctors and nurses who cared for the donor at the hospital.
Costs
All costs directly relating to the recovery of the organs, including laboratory tests, use of the operating room, surgeon's fees, transportation, etc., are billed to LiveOnNY. The recipient's transplant hospital then reimburses LiveOnNY for the recovery costs. In turn, the transplant hospital is reimbursed by the recipient's insurance company or through Medicare.