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Organ Donation
CHAPTER 86
ORGAN DONATION Benjamin T. Suratt, MD, and Kapil Patel, MD
1. Who governs the rules and regulations for organ donation? n The Organ Procurement and Transplantation Network (OPTN) is a system for operating and monitoring the unbiased allocation, through established medical criteria, of organs donated for transplantation and maintaining a recipients’ waiting list (including the listing and delisting of recipients). n The United Network for Organ Sharing (UNOS) is a nonprofit organization awarded the contract by the Department of Health and Human Services in 1986 to implement the OPTN. n Organ Procurement Organizations (OPO) serve specific regions in the country for clinical services including working with hospital staff to maintain donor-organ function, working with UNOS to match donor organs with recipients, coordinating organ recovery surgery, and giving compassionate and professional support to donors’ families. 2. Who can be a potential organ donor? Potential for organ or tissue donation has few absolute contraindications: human immunodeficiency virus infection, active hepatitis B virus infection, active visceral or hematologic neoplasm, or active bacterial infection, with no age limitation. Appropriateness for donation is assessed when the occasion arises. The majority of cases that are considered for organ donation occur within the intensive care unit (ICU). Despite severe organ shortage, no set universal protocol exists for organ donation. It is at the discretion of the intensivist to consider cases for organ donation. If a case is considered, then the next step is to notify the local OPO, which will then gather data and discuss the critical care management with the regional organ donation specialist, usually an intensivist. The general rule for the possibility for organ donation is that there should be no evidence of end-organ damage (e.g., acute tubular necrosis, myocardial depression, or pneumonia), with the final decision per the accepting transplant center. 3. Which organs can be donated? n Organs: kidney, heart, lung, liver, pancreas, and the intestines. Of note, combined organ transplantations (kidney-pancreas, heart-lung, other transplant) can be performed. n Tissue: corneas, the middle ear, skin, heart valves, bones, veins, cartilage, tendons and ligaments. 4. What is the current standard for organ donation? Organ donation is possible in patients who are declared brain dead. New brain death guidelines have been published (see Box 86-1). Despite efforts to promote organ donation, an enormous shortage of available organs for transplant continues to exist. As a result, efforts have been undertaken to expand the settings in which organs may become available (i.e., donation after cardiac death (DCD); see later). See Boxes 86-2, 86-3, and 86-4 and Tables 86-1 and 86-2. 5. What is organ DCD? DCD is considered in patients who have expressed a wish to donate organs and who sustain severe, irreversible brain injury short of meeting criteria for brain death (see earlier), but in whom withdrawal of life support is planned. In this case, organ procurement occurs immediately
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ORGAN DONATION Benjamin T. Suratt, MD, and Kapil Patel, MD
1. Who governs the rules and regulations for organ donation? n The Organ Procurement and Transplantation Network (OPTN) is a system for operating and monitoring the unbiased allocation, through established medical criteria, of organs donated for transplantation and maintaining a recipients’ waiting list (including the listing and delisting of recipients). n The United Network for Organ Sharing (UNOS) is a nonprofit organization awarded the contract by the Department of Health and Human Services in 1986 to implement the OPTN. n Organ Procurement Organizations (OPO) serve specific regions in the country for clinical services including working with hospital staff to maintain donor-organ function, working with UNOS to match donor organs with recipients, coordinating organ recovery surgery, and giving compassionate and professional support to donors’ families. 2. Who can be a potential organ donor? Potential for organ or tissue donation has few absolute contraindications: human immunodeficiency virus infection, active hepatitis B virus infection, active visceral or hematologic neoplasm, or active bacterial infection, with no age limitation. Appropriateness for donation is assessed when the occasion arises. The majority of cases that are considered for organ donation occur within the intensive care unit (ICU). Despite severe organ shortage, no set universal protocol exists for organ donation. It is at the discretion of the intensivist to consider cases for organ donation. If a case is considered, then the next step is to notify the local OPO, which will then gather data and discuss the critical care management with the regional organ donation specialist, usually an intensivist. The general rule for the possibility for organ donation is that there should be no evidence of end-organ damage (e.g., acute tubular necrosis, myocardial depression, or pneumonia), with the final decision per the accepting transplant center. 3. Which organs can be donated? n Organs: kidney, heart, lung, liver, pancreas, and the intestines. Of note, combined organ transplantations (kidney-pancreas, heart-lung, other transplant) can be performed. n Tissue: corneas, the middle ear, skin, heart valves, bones, veins, cartilage, tendons and ligaments. 4. What is the current standard for organ donation? Organ donation is possible in patients who are declared brain dead. New brain death guidelines have been published (see Box 86-1). Despite efforts to promote organ donation, an enormous shortage of available organs for transplant continues to exist. As a result, efforts have been undertaken to expand the settings in which organs may become available (i.e., donation after cardiac death (DCD); see later). See Boxes 86-2, 86-3, and 86-4 and Tables 86-1 and 86-2. 5. What is organ DCD? DCD is considered in patients who have expressed a wish to donate organs and who sustain severe, irreversible brain injury short of meeting criteria for brain death (see earlier), but in whom withdrawal of life support is planned. In this case, organ procurement occurs immediately
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