The Donation Process

• Factors in the Donation Process
  

When an organ is donated from a person who has died, it is made available to an eligible patient on the waiting list. Before the transplant can take place, however, several things happen.

1. The local Organ Procurement Organization (OPO) gathers information about the organ - size, condition, blood and tissue type - and sends this to the Organ Retrieval Banking Organisation (ORBO). ORBO a national organization that operates the patient waiting list, assuring equal and fair access for all patients to organs for transplantation.

2. A patient on the ORBO list who is most qualified for the organ - due to waiting time, blood and tissue match, and other factors - is selected and his or her center is notified.

3. Although a patient meets all the criteria and appears to be a good match for the organ, the organ still has to be accepted by the transplant center. The transplant team has a very short time to consider several factors before accepting that organ for the particular patient. If, in the physician's judgment, the organ offered presents undue risks to the patient, it may be refused. There are a number of reasons for refusing an organ, such as:

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  Patient condition - The patient may currently be too ill to undergo surgery. Or, the patient may be out of town or otherwise unavailable for surgery at that time.
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  Donor condition - The donor might have had high blood pressure, diabetes or some other illness that might have harmed the donated organ.
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  Organ condition - If an organ has been outside the donor's body for too long it might not work as well and may not help the patient. Or, the organ might have been damaged during recovery from the donor or during transit to the transplant center. Sometimes, final examination of the organ shows previously unseen risks, such as too much fatty tissue or badly formed blood vessels.
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  Donor/recipient compatibility - Critical "matching" tests, done just prior to surgery, sometimes reveal unknown incompatibilities that would result in failure of the transplant.

Transplant center factors - Geography may be a factor, as it may not be possible to get the organ to the center within a desirable amount of time.

There are some differences among transplant centers overall in terms of how often organs are accepted or refused. But recent studies have found that how often a center accepts or refuses transplant organs does not seem to affect such important factors as how long patients wait for transplant or how well those patients do either before or after transplant.*

• The Donor/Blood Type Compatibility

Once doctors feel sure that someone is a good transplant candidate, the search for a new liver will begin. The liver received will almost certainly be cadaveric (from a deceased organ donor). Unlike other kinds of organ transplants, the liver recipient and the liver donor do not have to be a perfect "match". There are, however, certain qualifications.

The donor must be:

1. Approximately the same weight and body size as the recipient
2. Free from disease, infection, or injury that affects the liver
3. Usually of the same or a compatible blood type (see table below)

BLOOD TYPE COMPATIBILITY CHART

Blood Type Can receive liver from: Generally can donate a liver to: O O O, A, B, AB A A, O A, AB B B, O B, AB AB O, A, B, AB AB

• The Waiting List and Other Concerns

Many waiting transplant recipients erroneously believe that the waiting list is like a ladder - that they are added to the bottom of the list and move up as recipients ahead of them receive their transplants. Not so. The list is in order of matching priority as indicated, according to medical criteria, length of time waiting, blood type, body weight, size of their present diseased organ(s), and severity of illness. The list is blind to age, sex, and race.

Recipients do not necessarily move up the list. For example, if a waiting recipient has blood type O, his or her name will not appear on the list as a potential recipient for a donor with blood type B. Even though one may have waited longer than another, he or she may not receive the next available organ(s). The list is constantly changing.

Each potential recipient has an equal chance at receiving a transplant. Many medical factors related to a proper match enter the equation. The ORBO registry was designed to assure the equitable sharing of available transplantable organs.

Publicity

The media may help boost the general awareness of the need for organ donation, but they do not enhance a particular patient's chances of receiving an organ. Some waiting transplant recipients publicize their need through radio and television. Others send letters to physicians and transplant centers describing their medical condition. Well-intentioned letters and media coverage have no influence on the distribution of available organs. All matches are made from the UNOS national registry. Preferential treatment does not exist.

Organ Donation Awareness

OPO's (organ procurement centers) communicate the importance of organ donation through a network of volunteers, donor family members, waiting transplant patients and their families. These volunteers participate in a speaker's bureau and help staff booths at health fairs.

Donor Family Identity

The identities of donor families and transplant recipients are kept anonymous and confidential. The donor family that decides to contribute at a time of great personal loss makes a deeply personal and private decision.
If a recipient chooses to write to the donor family, he or she may give or send the card or letter to the transplant coordinator, who will forward the correspondence to an organ procurement center, which in turn will send it on. Many donor families gain a sense of comfort knowing that their gift of life has made a difference.

• Organ Procurement Organization (OPO)
  

Each organ procurement organization (OPO) is one of 69 federally designated organ procurement centers across the United States. An OPO is responsible for matching organs from a patient who has died as a result of traumatic head injury with an individual awaiting a life-saving organ - the gift of life.

When a staff member at one of the hospitals affiliated with an OPO calls to say that a potential organ donor has been identified, the donation process is set in motion. A procurement coordinator offers the next-of-kin the option of organ donation. If the family agrees, the coordinator calls the national computerized registry of the Organ Retrieval Banking Organisation (ORBO), in an effort to match medically and physically the organ donor with a waiting transplant recipient.

The Role of the OPO Coordinator

When a suitable recipient is found, the OPO coordinator notifies the surgeon who will transplant the organ. If the organ is indeed suitable, the transplant surgeon accepts the organ for transplantation at the recipient's transplant center.

The OPO coordinator schedules the use of an operating room suite for the recovery of the donor organ(s) at the hospital where the donor remains. The coordinator also oversees the medical evaluation of each organ and assists in its surgical recovery.

When the transplant surgeon accepts an organ offered by the coordinator, the transplant center's coordinator calls the waiting recipient, prepares the transplant center's operating suite, and coordinates the transportation of the organ procurement surgical team to the transplantation center.

Individuals awaiting transplantation, as well as those who have received a transplant, are monitored medically by the transplant recipient coordinators at each transplantation center.

• Organ Retrieval Banking Organisation (ORBO)

History of the National Organ Procurement and Transplantation Network

In the early 1980s, the advent of the immunosuppressant drug cyclosporine made the transplantation of organs other than kidneys feasible. This development led individuals to appeal to the public through the media and their legislators for assistance in finding suitable donor organs. The demand for these organs greatly exceeded the supply.

There was no centralized network to increase the utilization of scarce donated organs nor were there criteria governing how an individual obtained access to transplantation. To further complicate matters there was a growing concern that wealthy citizens of foreign countries were coming to the United States to take advantage of transplantation technology to the detriment of terminally ill U. S. citizens also in need of the same technology.