The need for donated organs is growing at a rate much faster than their availability; unfortunately most Americans are more likely to need a transplant than to have the opportunity to donate. Although the majority of Americans are supportive of donation, the shortage of available organs makes it imperative that every opportunity for donation is recognized. The donation process is a complex series of events coordinated by medical professionals from the organ procurement organization (OPO) and the hospital. This process begins after a patient arrives to the hospital with a severe brain injury. Contrary to a popular misconception, saving the patient’s life is always the first priority. Regardless of your status as a donor, the hospital (with full support from the OPO) will pursue all options within the possibilities of medical science to save your life. Only when every effort has been made to save your life, and death is inevitable, will organ and tissue donation become a possibility.
To ensure that the donation process is carried out in an equitable and ethical manner and in accordance with medical values and principles, many federal and state regulations have been enacted. In addition, the United Network for Organ Sharing (UNOS) was created to govern the national process of fairly matching donor organs to waiting recipients. The donation process generally flows as follows:
- Identifying a potential donor:
When a person is nearing death or has a severe brain injury, hospital staff contact the donor referral line to alert PNTB that they have a patient who may be a potential organ donor. The criteria hospitals use to determine when to call the referral line is based on standards outlined by the Centers for Medicaid and Medicare.
- Determining medical potential for donation:
The hospital provides information to PNTB regarding the patient’s medical status and any known previous medical history. The PNTB donation coordinator evaluates the patient to determine if she or he is medically suitable for organ donation. If she or he is a potential donor, the coordinator will let the medical and nursing staff know. Care continues uninterrupted.
- Authorization and Consent for Donation:
If the patient becomes brain dead or plans have been made by the family to withdraw the ventilator, the donation coordinator and the hospital staff collaborate to ensure that the family is supported and offered the appropriate donation option. Unless a family initiates a conversation about donation, the discussion about donation should occur after the family has been informed of their loved one’s death. If a patient is a registered donor, the family is informed of their loved one’s legally binding authorization for donation. By law, donor designation is irrevocable by any person other than the donor (see donor designation). In the absence of designation, the donation coordinator asks the legal next of kin for consent, and the donation process proceeds after the family has granted authorization.
- Maintaining a patient prior to organ donation:
Once a patient has been declared brain dead, and consent or disclosure has been provided, the PNTB donation coordinator, with the support of the hospital staff, orders a series of diagnostic tests and lab work to further evaluate organ function.
- Matching and offering organs:
When the lab work and diagnostic testing are completed, the donation coordinator contacts the United Network for Organ Sharing (UNOS). The UNOS computer system matches all of the donor’s characteristics with potential recipients. The donation coordinator does not get to choose who receives the donated organs; recipients are determined by body height and weight, blood and tissue type, length of time on the waitlist, geographic location, and medical urgency. Because the timeframe to transplant donated organs is critical, the UNOS recipient list favors recipients at local transplant centers, then regional and national.
- Receiving the Gift of Life:
Organs from donors are recovered in a surgical procedure conducted by transplant surgeons. At all times, the donor is treated with dignity and respect. Once the organs are recovered, they are transported and the process of transplantation into the intended recipient begins.
Our family resource program coordinator follows each donor family after the donation to offer support and grief resources. In addition to the support of our donor families, our hospital services department provides follow-up and debriefing opportunities to hospital staff after every donation case.