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anonymous Organ Donation - Questions and Answers August 13, 2006 4:46 AM

Many people have questions about Organ donation, or are unsure about it for one reason or another; these questions & answers are from the UK transplant site, but they apply all over the world.

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anonymous  August 13, 2006 5:43 AM

1. What is organ donation?

Organ donation is the gift of an organ to help someone who needs a transplant. The generosity of donors and their families enables nearly 3,000 people in the UK every year to take on a new lease of life. In addition thousands of people have their sight restored by donated corneas.

2. When was the first transplant?

A cornea was first transplanted in 1905. Blood transfusion became established in 1918 and the first successful kidney transplant was in 1954. The first heart transplant took place in 1967.

3. What can be transplanted?

Kidneys, heart, liver, lungs, pancreas, small bowel, corneas, heart valves and bone can all be transplanted. Skin can be used to treat patients with severe burns. Techniques are improving all the time and it may soon be practical to transplant other parts of the body.

4. What organs or tissue can I donate?

The organs that can be donated include heart, lungs, kidneys, pancreas, liver and small bowel.

Tissue that can be donated includes corneas, skin, bone and heart valves. Corneas can be transplanted to restore the sight of a person who has a severe eye disease or injury. Bone and tendons are used for reconstruction after an injury or during joint replacement surgery. A bone transplant can prevent limb amputation in patients suffering from bone cancer.

Heart valves are used to help children born with heart defects and adults with deseased or damaged valves. Skin grafts are used as protective dressings to help save the lives of people with sever burns.

Most people can donate tissue. Unlike organs, tissue can be donated up to 24 hours after a person has died and can be stored for longer periods.

Reproductive organs and tissue are not taken from dead donors.

5. Why are even more donors needed?

Every year hundreds of people die while waiting for a transplant and many others lose their lives before they even get on to the transplant list. There is a serious shortage of organs and the gap between the number of organs donated and the number of people waiting for a transplant is increasing.

Transplants are very successful and the number of people needing a transplant is expected to rise steeply due to an ageing population, an increase in kidney failure and scientific advances which mean that more people are now able to benefit from a transplant.

The number of available organs has fallen for several reasons. Only a very small number of people die in circumstances where they are able to donate their organs. Because organs have to be transplanted very soon after someone has died they can only be donated by someone who has died in hospital. Usually organs come from people who are certified dead while on a ventilator in a hospital intensive care unit, generallyas a result of a major accident like a car crash, a brain haemorrhage or a stroke.

The numbers of people, particularly younger people, dying in these circumstances is falling mainly because of welcome improvements in road safety, medical advances in the treatment of patients and the prevention of strokes in younger people. While only a very few people die in circumstances which would enable their organs to be donated, Virtually everyone can donate their corneas to help others to see, or give bone, skin or other tissue after their death.

Another major reason is that many people have not thought about donation or discussed it with their families. Too few peopl have joined the NHS Organ Donor Register and made sure that their families know their wishes.

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anonymous  August 13, 2006 7:57 AM

6. How do they know you are really dead?

Organs are only removed for transplantation after a person has died. Death is certified by a doctor or doctors who are entirely independent of the transplant team. Death is certified in the same way for people who donate organs as for those who do not.

Most organ donors are patients who die as a result of a severe head injury, brain haemorrhage or stroke and who are on a ventilator in a hospital intensive care unit. In these circumstances death is diagnosed by brain stem tests. The ventilator provides oxygen which keeps the heart beating and blood circulating after death. These donors are called heartbeating donors. Organs such as heart and lungs, which deteriorate very quickly without an oxygen supply, are usually only donated by a heartbeating donor.

Patients who die in hospital but are not on a venitlator can, in some circumstances, donate their kidneys, and in certain circumstances, other organs. They are called non-heartbeating donors.

Both heartbeating and non-heartbeating donors can donate their corneas and other tissue such as skin, bone and heart valves.

7. Can they keep you alive with machines?

No. The patient is dead. A ventilator keeps the body supplied with oxygen and this means the heart will continue to beat and circulate blood. This preserves the organs so they can be donated for transplant. When the ventilator is turned off the heart will stop beating within a few minutes.

8. Will they just let you die if they know you want to be a donor?

No. The doctors looking after a patient have to make every possible effort to save the patient's life. That is their first duty. If, despite their efforts, the patient dies, only then can organ/tissue donation be considered and a completely different team of doctors would be called in.

9. Can I donate if I die in the accident and emergency department?

Yes, in a small number of hospitals, patients who are certified dead on arrival or die in the accident and emergency department can donate organs, in particular kidneys which are able to tolerate longer periods without oxygen than other organs.

For this to happen however, steps have to be taken to preserve the kidneys until the next of kin can be contacted. This includes a special technique in which the kidneys are flushed with a cold preservative fluid. This is done through a small tube which is inserted into a blood vessel in the groin.

This must be done within minutes of death to ensure the kidneys remain suitable for transplantation and the deceased is not deprived of the oppurtunity to donate. However, organ donation itself will never take place without checking if you had given your consent, by registering on the NHS Organ Donor Register and/or telling the person closest to you in life.

10. Can you donate an organ while you are still alive?

Yes, in some cases. The shortage of organs has led to an increasing number of organ donations by living people.

The most common organ donated by a living person is a kidney as a healthy person can lead a completly normal life with only one functioning kidney. Kidneys transplanted from living donors have a better chance of long-term survival than those transplanted from people who have died. There are a number of reasons for this, the main on being that the donor is alive and healthy. About one in five of all kidney transplants are from a living donor.

Most living donor kidney transplants are between close family members because they usually provide the best match. The donor might be a brother, sister, mother, father, aunt, uncle, grandparent or child. The majority are between parent and child but living donor kidney transplants between people who are not blood relatives - such as husband and wife or between partners or close friends - are becoming increasingly common.

Before a living donor transplant can go ahead there are strict regulations to meet and a thorough process of assessment and discussion.

Part of a liver can be transplanted and it is also possible to donate a segment of a lung and, in a small number of cases, part of the small bowel.

Hearts are also donated by living people. This is because for some patients with diseased lungs who need a lung transplant it is more effective to give them a combined heart and lung transplant, even though their heart is perfectly healthy. In these cases, the patients healthy heart is then transplanted into a patient needing a heart transplant. This is known as a "Domino" transplant. 

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anonymous  August 13, 2006 9:13 AM

11. Why do we need to make a decision now about whether to become an organ donor?

In the UK organs from a potential donor can only be used if that is their wish. Putting your name on the NHS Organ Donor Register and carrying a card makes it easy for the NHS to establish your wishes. If you do not add your name to the register the person closest to you in life will be asked what you would have wanted, so it is important that you make sure they are aware of your views on organ donation.

12. What is the NHS Organ Donor Register?

The NHS Organ Donor Register is, quite literally, a life-saver.

It is a confidential, computerised database which holds the wishes of more than 12 million people who have decided that, after their death, they want to leave a legacy of life for others. The register is used after a person has died to help establish whether they wanted to donate and, if so, which organs.

13. Do I need to register if I have a donor card?

Yes. Cards can and do get lost or damaged and you may not be carrying one when you are taken to hospital. Adding your name to the register is a more permanent way of expressing your wishes. You can still carry a card if you wish to. Don't forget to tell your relatives what your wishes are.

14. Will my name and address be given to other organisations?

No. This information will only be used by UK Transplant to register your wishes on the NHS Organ Donor Register. Your personal details would not be passed to any individual or organisation without seeking your explicit consent.

15. I'm not sure if I've already registered, what should I do?

Either write in and ask, (the confidential nature of the register means that you cannot be told over the phone), or apply to join and the system will identify if you are already on the register and update any relevant details.

16. Who would get my organs if I became a donor?

Many things need to match or be very close to ensure a successful transplant. Blood group, age and weight are all taken into account. For kidneys the most important factor is tissue type which is much more complex than blood grouping. The more accurate the match, the better the chances of success.

There is a national, computerised list of patients waiting for an organ transplant. The computer will identify the best matched patient for an organ or the transplant unit to which the organ is to be offered. Normally, priority is given to patients who most urgently need a transplant.

UK Transplant operates the transplant list and donor organ allocation system. It works round the clock, every day of the year and covers the whole of the UK.

17. Are donors screened to identify if they have a transmittable disease?

Yes. Blood is taken from all potential donors and tested to rule out transmittable diseases and viruses such as HIV and hepatitis. The family of the potential donor is made aware that this procedure is required.

18. Can I be a donor if I have an existing medical condition?

Yes, having a medical condition does not necessarily prevent a person from becoming an organ or tissue donor. The decision about whether some or all organs or tissue are suitable for transplant is made by a doctor, taking account of the medical history. Usually, but not always, it is possible for some organs or tissue to be donated.

A set of guidelines, called the MSBT guidelines is available. The guidelines stress that it is the responsibility of the medical teams caring for both donor and recipient of any organ/tissue to determine the relative benefits and risks of any transplant.

19. Can a donor be under 16?

Yes, if he or she has expressed such a wish and is competent to do so and the parents or guardian agree to donation.

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anonymous  August 13, 2006 12:28 PM

20. Can older people be donors?

Yes, in the case of cornea and some other tissue, age does not matter. For other organs it is the persons physical condition, not age, which is the deciding factor. Doctors decide in each case which organs/tissue are suitable. Organs from people in their seventies and eighties are transplanted successfully.

21. Are there religious objections to transplants?

No, none of the major religions in the UK object to organ donation and transplantation. If you have any doubts, you should discuss them with your spiritual or religious leader.

22. Does the colour of my skin make a difference?

No. However, organs are matche by blood group and tissue type and the better the match, the greater the chance of a successful outcome. Patients from the same ethnic group are more likely to be a close match. A few people with rare tissue types may only be able to receive an organ from someone of the same ethnic origin, so it is important that people from all ethnic backgrounds donate organs.

Successful transplants are carried out between people from different ethnic groups wherever the matching criteria are met.

23. If someone needs an organ desperately, is there any point in making a special appeal?

Yes and no. Any special appeal usually results in more people agreeing to become donors and can increase the number of organs available in the future.

However, family appeals throught the newspapers and television will not result in an organ immediately becoming available for the person on whose behalf the appeal was made. The patient will still be on the transplant list, just like everyone else, and the rules that govern the matching and allocation of donor organs to recipients still apply.

24. Can I agree to donate some organs or tissue and not others?

Yes. You can specify which organs you would wish to donate. Simply tick the appropriate boxes on the NHS Organ Donor Register form or on the donor card, and let those close to you know what you have decided.

25. Can I agree to donate to some people and not to others?

No. Organs and tissues cannot be accepted unless they are freely donated. No conditions can be attached in terms of potential recipients. The only restriction allowed is which organs or tissue are to be donated.

26. Could my donated organ go to a private patient?

Possibly, but this is unlikely. Patients entitled to treatment on the NHS are always given priority. These include UK citizens, members of Her Majesty's forces serving abroad and patients covered by a reciprocal health agreement with the UK.

Other patients would only be offered an organ if there were no suitable patients entitled to treatment under the NHS. Every effort is made to ensure that a donated organ does not go to waste if there is someone who can benefit.

27. Does being a donor cause delays to funeral arrangements?

No. Surgery is performed as soon as possible. The whole process of donation is usually completed within 12 hours.

28. Would any of my organs be given to someone in another country?

Yes. There is an agreement that any organs that cannot be matched to UK patients are offered to patients in other European countries. Likewise, UK patients benefit from organs offered by other European countries. This co-operation increases the chance of a suitable recipient being found, ensuring that precious organs do not go to waste. 

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anonymous  August 13, 2006 1:47 PM

29. Does donation leave the body disfigured?

No. Organs are always removed with the greatest of care and respect for the person by trained surgeons. This takes place in a normal operating theatre under the usual conditions. Afterwards the wound is carefully stitched and covered by a dressing. Only those organs and tissue specified by the donor or their family will be removed.

Relatives may see the body after the operation if they wish. The transplant co-ordinator will stay with the family during the whole process if the family wishes.

Tissue can be retrieved in an operating theatre, mortuary or funeral home. It is carried out by specially trained teams, who always ensure that the donor is treated with the utmost respect and dignity. The cosmetic appearance of the donor is restored following all types of donation.

If the family wishes to view their relative following donation this will be facilitated by the transplant co-ordinator.

30. Does a donor's family have to pay the cost of donation?

No. There is no question of any payment at all. The NHS meets the costs related to the donation of organs.

31. Will the NHS pay the cost of the funeral?

The NHS will not pay the cost of the funeral. Funeral costs are met either by the family or from the person's estate and not by the NHS or any Government authority.

32. My relative wants to be a donor. What do I need to do when they die?

Inform any of the hospital doctors or nurses involved with your relative's care that they wanted to donate. The earlier you are able to tell staff, the more likely it is that organs can be donated.

If your loved one dies elsewhere, for instance at home or in a hospice, they can still donate tissue. Let the doctor who certifies death know their wishes.

33. Will organs that are removed for transplant be used for research purposes?

Organs that cannot be used for transplant will only be used for medical or scientific research purposes if specific permission has been obtained from the donor's family.

34. How is organ donation different from organ retention?

The problems of organ retention arose because proper consent was not obtained from parents or relatives for organs and tissue removed at post-mortem to be retained for research or other purposes. Organs are only removed for transplantation with the consent of relatives.

35. Can I leave my body for medical education or research after I have donated my organs?

No, bodies cannot be accepted for teaching purposes if organs have been donated or if there has been a post-mortem examination. Corneas can however be donated.

36. Would a donor's family ever know who the recipient was?

Confidentiality is always maintained, except in the case of living donors, who are usually within the same family.

If the family wishes, they will be given some brief details such as the age, sex and family circumstances, (eg father with young children), of the person or persons who have benefited from the donation. The patients who receive the organs can obtain similar details about the donors.

The families may want to exchange anonymous letters of thanks or good wishes through the transplant co-ordinators and in some instances donor families and recipients have arranged to meet. 

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anonymous  August 13, 2006 2:45 PM

37. Why should I discuss my wishes with my relatives?

So that they know what you would like to happen after your death and can tell the NHS staff what your wishes were. If you register your wishes without telling the people closest to you, it may come as a surprise at a time when they are trying to deal with their loss. The NHS will always check with the person closest to you in life to establish your most recent wishes.

38. What if I have no family or other relatives?

You can join the NHS Organ Donor Register and tell the person closest to you in life, a friend or close colleague, about your decision.

39. Should I put my wishes in my will?

No. By the time your will is read it would be far too late for you to become a donor because organs and tissue need to be removed within 24 hours of death.

40. Can I change my mind?

Yes. You can simply go to the "Sign me up" section of the NHS website and fill in the form asking for your name to be removed.

If you have an organ donor card, tear it up. Let your family know you have changed your mind.

41. Can a deceased person donate sperm or eggs for future use?

The law is such that while it is possible to retrieve sperm or eggs it is illegal to store either or to create an embryo without the prior, written consent of the donor.

42. Can people buy or sell organs?

No, the transplant laws in the UK absolutely prohibit the sale of human organs.

43. I am interested in giving blood, what do I do?

Blood is needed constantly, for all kinds of things, such as cancer treatments, operations and in childbirth. There are thousands of places all over the country that hold blood donor sessions and new blood donors are always welcome. Almost anyone aged 17 to 60 years and in general good health can give blood.

44. I am interested in donating bone marrow, what do I do?

Without bone marrow, blood cannot be produced. When things go wrong and the bone marrow becomes damaged, for example as a result of treatment for leukaemia or a related cancer of the blood, the patient must receive a transplant to survive.

45. How is transplantation organised?

When death has been confirmed in a patient who could be considered as a potential organ donor, the local donor transplant co-ordinator is contacted. If the family agree to donation the transplant co-ordinator must ensure that the medical tests such as blood group and tissue type matching are carried out. They also research the donor's medical history by reviewing the medical notes, talking to the family and liaising with doctors who may have treated the donor in the past.

All patients who are waiting for transplants are registered on the National Transplant Database at UK Transplant and when organs from a donor become available a search is made to find the most suitable recipients.

A team of specialist surgeons is called to the donor's hospital to carry out the surgery to remove and preserve the organs for transport to the transplant unit. During the operation the surgeon will make a final decision that the organs are healthy and not diseased or damaged in any way which may make them unsuitable for use. This will mean that a waiting patient's hopes are dashed and that their wait for a transplant must continue.

If all is well, the organ is received at the transplant unit and transplanted immediately. The process of recovery and new life can then begin.

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anonymous  August 13, 2006 2:58 PM

46. Who are transplant co-ordinators?

Donor transplant co-ordinators are responsible for the care of the person who has died, speaking to their family and organising the organ donation procedure. They support families before, during and after donation and are there to answer any questions they might have. Part of their role is to ensure that the donor's family is told in general terms about the eventual use of the donated organs, eg the heart went to a young man who is doing well.

Confidentiality is always maintained.

They also work with the local community to make people aware of why organ donation is so important and train and educate health professionals about what is obviously a sensitive and delicate subject.

Recipient transplant co-ordinators help to assess patients' suitability to go on the transplant waiting list and organise the transplant operation as well as follow-up consultations for those patients who have been lucky enough to receive a donated organ. Some co-ordinators work with both recipients and donor families. 

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 August 18, 2006 10:47 PM

I have a question.  It's not about organ donation, or maybe in a way it is.  I wrote a story in the "Inspiring true story" thread that's supposed to inspire people to give life.  Has anyone read it?  It's hard for me to tell without your comments.  I want to know what's on your mind as you read it.  No organs are donated to me in my story, but my life's returned to me after I was in a coma for a long time.

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anonymous  August 19, 2006 1:06 AM

Hi Drew.

I am so sorry my friend, I have read your post but before I could answer I was sidetracked, which is a terrible thing to say I know, but I won't lie to you. I will go and reply to it now.   

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Please donate August 29, 2006 2:40 AM

We lost our son just over two years ago from cancer it was HIS wish to help another child, our son was a donar for a 17yr old (heart transplant) We could not save our son but his gift saved a young mans life. Please give this matter a great deal of thought.  [ send green star]  [ accepted]
anonymous  August 29, 2006 2:54 AM

Thank you so much for sharing that with us Paul. I am so sorry you have lost your son, and it is a great credit to you and the love you have for your son that you agreed to honour his wishes even though you were obviously so distraught at the time of asking. I am sure your son was and is very proud of you. Take care my friend.

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