The Organ Donation Process

Identifying a Potential Organ Donor
Most potential organ donors have suffered an unforeseen accident or illness (e.g., motor vehicle accident or stroke) resulting in irreversible damage to the central nervous system. Among donors, cerebrovascular disease/stroke and head trauma account for the majority of all causes of death. At the hospital, the patient may be placed on a ventilator to provide support for breathing and respiratory function. If the patient is brain dead, the ventilator and other medical support help maintain organ viability while the family decides about donation.
 
Notifying the Organ Procurement Organization (OPO)
The hospital notifies the OPO in a timely manner of all imminent deaths and deaths in the hospital. Timely notification of imminent death is critical to allow families’ sufficient time to make informed decisions about donation while the potential donor’s organs are still viable. Imminent death is defined under hospital policies devised in conjunction with the OPO and generally involve a severely brain-injured individual on a ventilator. OPO staff members gather information needed for a preliminary assessment of the patient’s medical suitability as an organ donor.
 
Declaring Brain Death
Brain death is the irreversible loss of all brain function. Initial requirements for determining brain death include clinical or radiographic evidence of a catastrophic cerebral event consistent with brain death, exclusion of medical conditions that may confound clinical assessment, and confirmed absence of drug intoxication, poisoning, or neuromuscular blockade. Repeated clinical evaluation is recommended. The clinical examination should be consistent with the absence of all brain stem, cranial nerve, motor, and autonomic responses (no movement or autonomic response to painful stimulation, no breathing with apneic oxygenation, no brain stem reflexes). Declaration of brain death should be performed by a physician with the requisite training, skills, and expertise and must be done in accordance with state laws and sound medical practice. Hospital policy may dictate additional practice requirements.
 
Requesting Consent
After hospital staff have explained the diagnosis of brain death and given the family sufficient time and support to absorb this information, a trained OPO staff member and/or hospital’s designated requestor will approach the patient’s family members for consent to donate their relative’s organs. A family may refuse to give consent, or it may give consent for donation of all or only some organs and/or tissues. A release from the medical examiner or coroner also may be required for donation to proceed. Once the consent forms are signed and witnessed, all hospital costs from this point forward are paid by the OPO, not the family. Only now is the patient considered a “donor”.
 
Evaluating the Donor’s Medical Suitability
Under its Conditions of Participation, the OPO determines the suitability for organ donation (and eye and tissue donation if the hospital has made no alternative arrangements). For legal liability purposes, most medical and social histories are conducted by organ, tissue, or eye bank staff members specifically trained to complete this task. The questions included in the medical and social history are very carefully worded and designed to elicit critical information related to the potential donor that may eliminate him or her from consideration, based on medical or behavioral circumstance. In addition, staff members conduct a review of the donor’s organ systems; evaluate the donor’s body for markings, tattoos, or evidence of intravenous drug use; conduct initial serology testing and tissue typing; and note findings from the medical and social history. Hospitals, OPOs, and eye and tissue banks have developed protocols to facilitate this process.
 
Providing Donor Management
Donor management techniques (e.g., medications, respiratory care, fluid resuscitation) to optimize oxygenation of organs, maintain hemodynamic stability, and sustain fluid and electrolyte balance must be initiated to ensure the integrity of the organs and tissues for transplantation. Without aggressive support, cardiac arrest occurs in 20 percent of potential donors within six hours after the declaration of brain death; and in 50 percent of donors within 24 hours.
 
Recovering Organs
Organs are recovered during a sterile surgical procedure while the donor is on a ventilator. When organs are removed, they are flushed with a solution that helps preserve them until they are transplanted. After flushing, they are placed in sterile bags in a cooler with ice and transported to various transplant centers for transplant to patients who have been matched to the organs through a national database. Tissue recovery may occur after the removal of organs.
 
Making Funeral Arrangements
The disposition of the body follows hospital guidelines and the wishes of the family. Organ and tissue donation does not preclude an open-casket viewing. The funeral director should be contacted regarding funeral arrangements.
 
Ensuring Follow-up
Without revealing recipients’ identities, OPOs generally send letters to donor families within a few weeks of the donation telling them about the recipients who received their loved one’s organs. Most OPOs offer grief support services to organ and tissue donor families and conduct donor recognition ceremonies to publicly recognize the generosity of those who have given the gift of life. OPOs provide feedback to hospital staff and others (e.g., medical examiners/coroners, emergency response personnel) regarding the positive impact their efforts have had on the lives of recipients and donor families alike.