Family, physicians, organ center all involved in process of organ donationcomment (0)
April 19, 2012
By Carrie Brown McWhorter
Approximately 23,000 hospital deaths occur in Alabama each year, and under federal law, every one of those patients must be screened as a potential donor, regardless of age or diagnosis, according to Ann Rayburn, senior manager of professional education for the Alabama Organ Center (AOC).
“There are so many people waiting for organ transplants, so if there is a possibility, we try to make it happen,” Rayburn said.
Alabama law recognizes death in one of two ways. Cardiopulmonary death occurs when a patient’s heart stops. Neurological death, or “brain death,” occurs when a patient’s brain stops functioning. Organ donation is possible after either type of death. But while donation after cardiopulmonary death has more limitations, donation after brain death can be emotionally confusing for the family.
“When a patient is brain dead, there are no brain stem reflexes, so there is essentially no input or output to the brain,” said Derek DuBay, assistant professor of surgery in the division of transplantation at the University of Alabama at Birmingham (UAB) and a deacon at Liberty Park Baptist Church, Vestavia Hills, in Birmingham Baptist Association.
“The reflex to breathe is on the brain stem, so a patient who is brain dead is not breathing independently of machines,” DuBay said.
Before a patient can be declared brain dead, two licensed physicians must agree that brain function has ceased based upon tests and examinations. To avoid any conflict of interest, neither physician may be involved in the procurement of organs or have an interest in the potential organ recipient.
For family members, concepts like “brain death” and “life support” can be very difficult to understand because what appears to be “life” may not be, DuBay said. For example, when a “brain dead” patient is on a ventilator, the patient is incapable of initiating a breath — the machine is solely responsible for respiration. In the next bed, however, a patient could be in a coma and on a ventilator, yet that patient’s brain is still functioning for respiration and other autonomic reflexes.
“People want to know for sure that everything is being done for their loved one, and when there is no visible difference between one patient and another, yet one is declared brain dead, it can be very confusing,” DuBay said.
When the AOC is notified of a potential donor, the first step is to check the AOC’s organ and tissue donor registry, named Legacy. If the patient’s name is on the registry, a representative of the AOC will take that information and speak with the family about the individual’s wishes.
“We can’t assume that a patient’s family is going to know about their wishes just because someone’s name is on the registry,” Rayburn said. “We want to work with the family to carry out the individual’s wishes.”
If no documentation is available or if the patient is under the age of 18, the family must make the donation decision. Rayburn said this is why it is important for you to talk to your family about your decision, regardless of your age.
Whether the individual is a registered donor or the family chooses to donate organs, once the family has given permission for the donation, further testing begins. The individual is tested for transmissible diseases like HIV, hepatitis and other diseases that might harm the recipient.
They also test to see how well the organs are functioning.
“The testing (for transmissible diseases) takes six hours, but at the same time, we are identifying recipients that are going to be the best match,” Rayburn said.
Potential recipients are listed on a national registry operated by the United Network for Organ Sharing (UNOS), the nonprofit organization that operates the federally approved Organ Procurement and Transplantation Network. Everyone on a waiting list for a transplant is listed with UNOS, Rayburn said.
When a donor is available, officials at UAB access UNOS and enter information about the donor, including height, weight, age and the zip code of the patient’s hospital. The site then generates a list of recipients in order of priority, which is determined by how long a patient has waited and how well a patient matches the donor. Patients waiting for hearts, livers and lungs have a critical status affiliated with them as well.
“The sicker a patient is, the higher [his or her] place on this list,” Rayburn said.
According to DuBay, research studies have shown that there is a lot of mistrust about how organs are allocated. However, he said the process is very transparent and carefully organized to withstand public scrutiny.
“You can’t do things like pay more money to work yourself to the top of the list,” DuBay said.
And just because a donor dies in Alabama doesn’t mean individuals on the waiting list from Alabama will receive an organ.
“All the guidelines for determining recipients are dictated by UNOS,” Rayburn said.
Once the recipients have been identified, the hospital staff and AOC representatives work together to schedule an operating room and surgeons to recover the organs. Once the surgery is completed, the organs are taken to the hospital where the transplant will take place.
The time between recovery and transplant is critical, she said. Hearts and lungs must be transplanted within four to six hours of recovery, livers and pancreata must be transplanted within 12 to 24 hours and kidneys must be transplanted within two to three days.
“In each case, the transplant happens as soon as possible,” she said.
Patients who wish to donate their eyes do so through the Alabama Eye Bank, Rayburn said, and if a patient is going to donate organs and eyes, representatives work together so the family does not have to complete multiple sets of paperwork.
Once the donor patient’s organs are recovered, the body is released to the family for burial. Within about two weeks, the donor family will receive a letter of condolence and thanks from the AOC. The family also will learn what organs and tissues were recovered and what the AOC knows about the recipients, Rayburn said. Since the donation and transplant process is anonymous, no information about either the donor or recipient is released without consent.
Because the process of organ donation involves tragedy, death and grief, often in a short period of time, approaching a family about the decision can be awkward, DuBay said. However, he regularly meets with families of organ donors and regularly hears positive thoughts from family members.
“The prevailing comment I hear from families is that donating their loved ones’ organs helped them deal with a very difficult situation in a positive way,” he said. “Especially when the death feels premature, the family feels a sense of closure, that something good came out of a bad situation.”