Questions & Answers about Organ Donation

Organ Donation -- A Gift Of Life To Another

Through the miracle of transplantation, many people here in Florida, are living healthy, productive lives. However, the need for donated organs and tissues continues to outpace the supply. Right now, there are thousands who could be helped if more of us were to become organ and tissue donors. Organ and tissue donations provide each of us with a special opportunity to help others.

Donation of vital organs and tissues can save lives where no other hope is available. Heart, liver, lung, and kidney transplants save lives everyday. Additionally, bone, skin, and cornea transplants often restore sight and save burn victims. What follows are some common questions asked about organ donation.

20 Questions & Answers about Organ Donation

1) Who can donate?

Individuals over the age of 18 can indicate their desire to be an organ donor by signing a donor card or expressing their wishes to family members. Relatives can also donate a deceased family member's organs and tissues, even those family members under the age of 18.

Donation of heart, liver, lung, pancreas, or heart/lung can occur only in the case of brain death. The donation of tissues such as bone, skin, or corneas can occur regardless of age and in almost any cause of death.

2) Can you donate an organ while you are still alive?

Certain kinds of transplants can be done using living donors. For example, almost 25 percent of all kidney transplants are performed with living donors. They are often related to the person needing the transplant, and can live normal lives with just one healthy kidney. Also, there are new methods of transplanting a part of a living adult's liver to a child who needs a liver transplant. Parts of a lung or pancreas from a living donor can also be transplanted.

3) Can you still choose to donate if you are younger than 18 years of age?

Yes, but only with the consent of an adult who is legally responsible for you, such as your parents or legal guardian. The adult or adults should witness your signature on a donor card.

4) What can be donated?

Organs that can be donated include: kidneys, heart, liver, lungs, and pancreas. Some of the tissues that can be donated include: corneas, skin, bone, middle-ear bones, bone marrow, connective tissues, and blood vessels.

Total body donation is also an option. Medical schools, research facilities and other agencies need to study bodies to gain greater understanding of disease mechanisms in humans. This research is vital to saving and improving lives. If you wish to donate your entire body, you should directly contact the facility of your choice to make arrangements.

5) Why should you consider becoming an organ / tissue donor?

Advances in medical science have made transplant surgery increasingly successful. Transplantation is no longer considered experimental, but a desirable treatment option. The major problem is obtaining enough organs for the growing number of Americans needing them. Approximately 2,500 individuals are added to the waiting list each month. Even though most donors contribute multiple organs, there still are not enough to meet the need and many people die while waiting for an organ. Everyone's help is needed to resolve the donor shortage. The best way to assure that more organs and tissues are made available is to sign and carry a donor card and encourage others to do so.

6) How do you become a donor candidate?

Fill out a donor card and carry it in your wallet. Most states have some way that you can use your driver's license to indicate your wishes to be a donor. Some states have a donor card on the back of the license; others have a place to check or a colored sticker to put on the license.

In Florida, please visit the Florida Department of Highway Safety and Motor Vehicles web site to see their pages about donation and the state's on-line form you can print, fill out, and mail in to join Florida's donor registry.

It is also extremely important that you let your family know that you want to become an organ and tissue donor at the time of your death. Ask family members to sign your donor card as witnesses. When you die, your next-of-kin will be asked to give their consent for you to become a donor. It is very important that they know you want to be a donor because that will make it easier for them to follow through on your wishes.

It would also be useful to tell your family physician and your religious leader that you would like to be a donor. And it would be a good idea to tell your attorney and indicate in your will that you wish to be a donor.

7) What if members of your family are opposed to donation?

You can have an attorney put your request in writing. This document, along with your donor card, may help ensure that your wishes will be honored. In any event, tell your family that you want to become a donor in the event of your death.

8) What is brain death?

Death occurs in two ways: 1) from cessation of cardiopulmonary (heart-lung) functioning; and 2) from the cessation of brain functioning. Brain death occurs when a person has an irreversible, catastrophic brain injury which causes all brain activity to stop permanently. In such cases, the heart and lungs can continue to function if artificial life-support machines are used. However, these functions also will cease when the machines are discontinued. Brain death is an accepted medical, ethical, and legal principle. The standards for determining that someone is brain dead are strict. Tissue and bone may be useable in either type of death. Organs, however, are useable only in cases where brain death occurs.

9) Are there religious objections to organ / tissue donation?

Most major religious groups in the United States approve and support the principles and practices of organ/tissue donation. Transplantation is consistent with the life preserving traditions of these faiths. However, if you have any doubts, you should discuss them with your spiritual leader.

10) What if you change your mind about donating?

If you change your mind, tear up your donor card. If you have indicated your wishes to be a donor on your driver's license, ask your local office of the Division of Motor Vehicles (DMV) what steps you need to take to revoke your decision. An increasing number of states maintain registries of individuals who indicate on their drivers licenses that they wish to be donors. If your state has a registry, your DMV personnel can tell you how to get on or off the registry. In all instances, be sure to let your family know whether you wish or do not wish to become a donor.

11) Does the donor's family have to pay for the cost of organ donation?

No. The donor's family neither pays for, nor receives payment for, organ and tissue donation. Hospital expenses incurred before the donation of organs in attempts to save the donor's life and funeral expenses remain the responsibility of the donor's family. All costs related to donation are paid for by the organ procurement program or transplant center.

12) Will the quality of hospital treatment and efforts to save your life be lessened if staff know you are willing to be a donor?

No. A transplant team does not become involved until other physicians involved in the patient's care have determined that all possible efforts to save the patient's life have failed.

13) Does organ donation leave the body disfigured?

No. The recovery of organs and tissues is conducted in an operating room under the direction of qualified surgeons and neither disfigures the body nor changes the way it looks in a casket.

14) Is it permissible to sell human organs?

No. The National Organ Transplant Act (Public Law 98-507) prohibits the sale of human organs. Violators are subject to fines and imprisonment. Among the reasons for this rule is the concern of Congress that buying and selling of organs might lead to inequitable access to donor organs with the wealthy having an unfair advantage.

15) What is "required request?"

"Required request" is a policy requiring hospitals to systematically and routinely offer the next-of-kin the opportunity to donate their deceased relative's organs and tissues. This policy enables hospitals and health care professionals to play a key role in increasing donation because families might otherwise not be aware of their right to donate.

The Omnibus Budget Reconciliation Act of 1986 (Public Law 99-509) established additional requirements for hospitals that participate in the Medicare and Medicaid programs. It required each participating hospital to establish written protocols for identification of organ donors and to notify an organ procurement organization designated by the Secretary of Health and Human Services of any potential donors it identifies.

Since January 1988, the Joint Commission for the Accreditation of Healthcare Organizations has required its member hospitals, as a prerequisite for accreditation, to develop policies and procedures on the identification and referral of potential donors.

16) What are organ procurement organizations (OPOs)?

OPOs are organizations that coordinate activities relating to organ procurement in a designated service area. Evaluating potential donors, discussing donation with family members, and arranging for the surgical removal of donated organs are some of their primary functions. OPOs also are responsible for preserving the organs and making arrangements for their distribution according to national organ sharing policies established by the Organ Procurement and Transplantation Network and approved by the U.S. Department of Health and Human Services. In addition, OPOs provide information and education to medical professionals and the general public to encourage organ and tissue donation and increase the availability of organs for transplantation.

17) What are the steps involved in organ donation and transplantation?

A potential donor who has been diagnosed as brain dead must be identified.
Next-of-kin must be informed of the opportunity to donate their relative's organs and tissues, and must give their permission.
An Organ Procurement Organization is contacted to help determine organ acceptability, obtain the family's permission, and match the donor with the most appropriate recipient(s).
Organ(s) and tissue(s) are surgically removed from the donor.
The donor organs and tissues are taken to the transplant center(s) where the surgery will be performed.

When a potential organ donor is identified by hospital staff and brain death is imminent or present, an organ procurement organization (OPO) is contacted. The OPO is consulted about donor acceptability and often asked to counsel with families to seek consent for donation. If consent is given, a search is made for the most appropriate recipient(s) using a computerized listing of transplant candidates managed by the United Network for Organ Sharing which operates the National Organ Procurement and Transplantation Network.

It is increasingly common for donors and donor families to contribute multiple organs and/or tissues. Therefore, several recipients may be helped by a single donor. When a match is found, the OPO will arrange for the donated organ(s) to be surgically removed, preserved, and transported to the appropriate transplant center(s). A potential recipient(s) is also alerted to the availability of an organ and asked to travel to the transplant center where he or she is prepared for surgery. The recipient's diseased or failing organ is removed and the donated organ is implanted.

18) How are recipients matched to donor organs?

Persons waiting for transplants are listed at the transplant center where they plan to have surgery, and on a national computerized waiting list of potential transplant patients in the United States. Under contract with the Health Resources and Services Administration, the United Network for Organ Sharing (UNOS) located in Richmond, Virginia maintains the national waiting list. UNOS operates the Organ Procurement and Transplantation Network and maintains a 24-hour telephone service to aid in matching donor organs with patients on the national waiting list and to coordinate efforts with transplant centers.

When donor organs become available, several factors are taken into consideration in identifying the best matched recipient(s). These include medical compatibility of the donor and potential recipient(s) on such characteristics as blood type, weight, and age; urgency of need; and length of time on the waiting list. In general, preference is given to recipients from the same geographic area as the donor, because timing is a critical element in the organ procurement process. Hearts can be preserved for up to 6 hours, livers up to 24 hours, and kidneys for 72 hours. Lungs cannot be preserved outside the body for any extended period of time.

19) Why should minorities be particularly concerned about organ donation?

Minorities suffer end-stage renal disease (ESRD), a very serious and life-threatening kidney disease, much more frequently than do whites. Asian Americans are three times more likely than whites to develop ESRD; Hispanics are three times as likely; and blacks are twice as likely as whites to develop ESRD.

ESRD is treatable with dialysis. However, dialysis is costly and can result in a poor quality of life for the patient. The preferred treatment of ESRD is kidney transplantation. Transplantation offers the patient "freedom" from dialysis to lead a more normal lifestyle and can successfully cure ESRD for many years.

As with any transplant procedures, it is very important to assure a close match between donor and recipient blood types and genetic make-up. Members of different racial and ethnic groups are usually more genetically similar to members of their own group than they are to others. (For example, blacks are usually more genetically similar to other blacks than they are to whites.) It is important, therefore, to increase the minority donor pool so that good matches can be made as frequently as possible for minority patients.

20) Who pays for transplant surgery?

Most transplants are paid for by private health insurance, although the Medicare and Medicaid programs pay for certain transplants for eligible beneficiaries. Coverage for transplants, other than kidneys, by major third party payors is described below:

Some private insurers, including some health maintenance organizations, now include heart, liver, pancreas, and heart-lung transplantation in their benefit package. Individuals should contact their insurance company to determine if they are covered.
Medicare coverage is provided for almost all kidney transplants through the End-Stage Renal Disease program. Heart and liver transplant recipients can also be reimbursed by Medicare if the recipient is Medicare eligible and the transplant is performed at a Medicare approved center. Only a small percentage of heart and liver transplant recipients are Medicare eligible.
Medicaid coverage for particular organ and tissue transplants is determined by the individual State Medicaid program. For those States providing such coverage, the Federal Government will provide funds on a matching basis.

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