What is organ donation?

Organ and tissue donationOrgan donation is a procedure in which one person receives organs or tissues from another person. These organs are transplanted into the person in hospital to save or improve the quality of his or her life.

Organs that can be donated in Australia include the heart, lungs, liver, kidneys and pancreas. Other tissues that can be donated are bone, heart valves, skin and the cornea.

Some donations may be made while the donor is still living. This includes the donation of kidneys, blood and bone marrow.


Why is organ donation important?

For many people, organ donation is their last hope of survival. Some serious conditions can cause organ failure, which may not respond to medications or other therapies. A new kidney can enable a person with kidney failure to come off dialysis. Corneal transplants may restore sight to people suffering from eye diseases. Skin can be grafted onto people who have suffered serious burns. Lungs can allow people with chronic respiratory conditions to breather easier. In fact, each donor has the potential to save 10 lives.

Unfortunately, there is a high demand for organs and a very limited supply, and many people on the waiting lists will die before an organ becomes available.


Why are organ donation rates low in Australia?

Australia’s rate of organ donation is very low compared to other countries. Spain leads the way with 35 donors for every million people. Australia, however, has only 10 donors per million people. In 2006, 202 deceased Australians donated their organs. This enabled 738 organs to be transplanted. However, 1780 people were on transplant waiting lists. This means that most people wait at least 3 years before an organ becomes available for transplant.

When surveyed, a large percentage of the Australian population expresses a desire or an intention to donate. However, few people make their wishes known to their family. Relatives of the deceased person are unlikely to consent to donation if they are uncertain of his or her beliefs. This is presumably because they do not want to deal with the consequences of making the ‘wrong decision’. Australia has a system that allows people to register their consent or objection to organ donation. However, many remain unaware of the Australian Organ Donor Register (AODR).

Public perceptions may also contribute to the low donation rate in Australia. It is hoped that basic education about the process and procedures involved can allay some unfounded fears. In particular, the concept of ‘brain death’ appears to be widely misunderstood. Some people mistakenly believe that retrieving organs from a brain dead person will cause them to die prematurely. Also, there is the fear that allowing organ donation is agreeing to mutilation. Again, information about the surgical procedure itself may reassure family members and make them more comfortable with the decision to donate.

Organ and tissue donationWhen a person dies, it is an extremely difficult time for friends and family. Relatives may be dealing with strong emotions such as profound sadness, shock and grief. Family members may feel overwhelmed and unable to discuss the sensitive issue of organ donation. However, previous exposure to the issue through education or by discussing donation with loved ones can make it easier for them to make the decision in the face of death. By registering to be a donor, you can take this burden away from your family.

Australia needs more people to register their consent to donate because very few people in hospital die in circumstances that allow their organs to be donated. Human organs are damaged and become unusable if their blood supply is cut off for a prolonged period of time. Only about 1% of people die in circumstances where their organs remain healthy and with a continued blood supply. However, human tissue such as skin and corneas can be stored for much longer, making them more available to people who require a transplant.

Not everyone will be a suitable donor. People who have had cancer or HIV/AIDS usually cannot donate because of the risk of passing the disease on to the recipient. Other factors that will be considered include the age of the donor and their medical history. However, you should not simply assume that you are too old or unhealthy to donate. This is an assessment that medical practitioners will make at the time of donating.


What does organ donation involve?

Organ donation is more likely when a person has died on a ventilator machine in a hospital’s intensive care unit (ICU). Often this is due to stroke or a catastrophic injury caused by a motor vehicle accident. Even after brain death, blood will be artificially pumped around the body to keep the organs healthy. In brain death, the brain can no longer function at all, and there is no possibility of recovery. The brainstem is also be dead, and there is no blood flow to the brain.

A person may also be able to donate if he or she has suffered irreversible injuries and will not recover. After treatment is ceased, the heart will stop beating and the blood will stop circulating around the body. After death, the body will be prepared for organ retrieval.

Two medical practitioners will perform tests to confirm brain death in a patient. The family of the deceased will be consulted about the possibility of donation. If the family gives consent, then the members of the Standing Committee of the Transplantation Society of Australia and New Zealand (TSANZ) will find a suitable recipient. They use specific criteria to decide how to allocate organs. The organs are then harvested from the deceased in exactly the same way as any other surgical procedure. This does not significantly alter the body’s physical shape or appearance. Under Australian law, the donor’s family will not be able to meet the recipient. This is to respect the privacy of both parties involved.

For more information about the process of donation and transplantation, see Heart Transplant, Lung Transplant, Liver Transplant, and Renal Transplantation.


Why should I register as an organ donor?

Organ and tissue donationAt a time of personal loss and tragedy, families who consent to organ donation may be comforted by knowing that their relative has given the greatest gift of all – the gift of life. In 2006, Majella Lazenby wrote an article called “A family’s perspective on organ donation” in the Australian Nursing Journal. In the article, she gives a moving account of her own experiences after the sudden death of her teenage daughter. She writes that, “In the midst of our horrific pain, I just knew this was the only thing to do.” She was confident in her decision because her daughter had told her mother of her intention to donate. For many, the loss and pain associated with losing a loved one will continue forever. However, some may find comfort in the fact that some good has come from their relative’s death. Recipients who have been given a new lease of life are forever grateful. They recognise the fact that their opportunity for a better life has come at a great personal cost to another family.


What do I need to think about?

The decision to donate is very personal and will be influenced by a person’s own experiences, values, religious beliefs and scientific convictions.

One of the most common reasons for choosing to donate after death is a desire to help people who are suffering from debilitating conditions. Some believe that since they don’t need their organs after death, they may as well be put to better use. Others would want their family to find comfort in the fact that they have not died in vain.

However, there are many other reasons why people may object to organ donation. A person should not consent to organ donation unless they feel comfortable with the idea and have considered many aspects of the issue. Some people may feel that organ and tissue donation is too invasive a procedure, or they may find the idea too upsetting to even think about. Others may feel that transplanting organs from a dead person into another person is wholly unnatural. Religious beliefs may also influence a person’s decision about organ donation.


How can I register as an organ donor?

Organ donations in Australia can only be performed with the informed consent of the deceased person, or the family of a person who has not registered either way.

If, after considering the above issues, you decide that you would like to be a donor, then you need to register your consent. If you are 16 or 17, you can register your intent to donate. Persons who are 18 or over can register their consent or objection on the Organ Donor Register.

The easiest way to register your consent or objection is online on Medicare’s Organ Donor Register website (http://www.medicareaustralia.gov.au/public/services/aodr). You will be required to enter your personal contact details and your Medicare Card Number. You will also need to specify which organs and tissues you wish to donate. The nominations are:

  • All
  • Bone tissue
  • Corneas (eye tissue)
  • Heart
  • Heart valves
  • Kidneys
  • Liver
  • Lungs
  • Pancreas
  • Skin tissue

After submitting these details online, you will be sent a written form in the mail. This must be signed and sent back. Once Medicare Australia has received the signed confirmation letter, your legal consent to organ and tissue donation will be registered. You will be issued with a small card that can be placed in your wallet.

It is important to note that, even if a person has registered their consent or objection to organ and tissue donation, the family will still be consulted about the issue. The registered wishes of the deceased will be respected. However, the family will be asked if there are any circumstances that the person would wish to be taken into account. Secondly, they will be asked whether the person may have had a change of opinion since registering.

If the deceased person has not registered their consent, the donation will not go ahead without the consent of the family.


Can I be a donor when I’m still alive?

Organ and tissue donationA person can only donate an organ or tissue when they are alive if they can continue to live a healthy life without it. Tissue such as blood and bone marrow regenerate, so the donor is not left in short supply. If a person donates a part of their liver, then the remaining part will take over and compensate for that lost through the donation. A person can donate one kidney because the body can function well without both. A living lung donation has not yet been performed in Australia, and requires two donors who each donate a part of their lungs.

Most living donors are relatives of the person who requires the organ or tissue. This is because the recipient’s body may reject the tissue if it is not compatible. Relatives may have more similar tissues, which reduces the risk of rejection. Some donations may also be made anonymously, and are simply directed to any suitable recipient on the waiting list. Living donors must be healthy and free of diseases that can be passed on to the recipient.

The risks involved with donating depend on the organ being donated and the donor themselves. Generally, a living donation will not go ahead unless there is only a very small risk of harm to the donor, and a high probability that the transplant operation will be successful. The decision to donate must be a free choice, and the donor must not be expecting any kind of reward in the future. Potential donors must undergo rigorous medical, psychological and social assessments.


Donating blood

People require blood transfusions for many different reasons. For example, women may need blood during pregnancy. People with leukaemia or blood disorders such as haemophilia may require frequent transfusions. Blood is also needed by people who have an acute injury. The Australian Red Cross Blood Service organises blood donations across the country.

For more information, see Blood Transfusion.


Donating bone marrow

Bone marrow is required for people who have been diagnosed with leukaemia or other blood disorders. If possible, patients look for a tissue match within their own family. However, others must rely on the Australian Bone Marrow Donor Registry (ABMDR) to find a suitable donor.

The ABMDR website (http://www.abmdr.org.au/) provides information on how to join the registry. To register, you must:

  1. Be between 18 and 40 years of age at registration
  2. Be prepared to give a blood donation
  3. Be prepared to be a match for anyone in the world
  4. Be in good health
  5. Meet the blood donor eligibility criteria set by the Australian Red Cross Blood Service

If you decide to volunteer to join the registry, complete the consent form available at any Australian Red Cross Blood Service donor centre. You will be asked to complete a Blood Donor Declaration Form and some questions about your medical history.

You will be asked to undergo screening tests to ensure that you cannot pass on any viral or other infections to the patient via the bone marrow. In most instances, you will be asked to make a blood donation of 470 mL. An additional 10–20 mL will be collected to determine your tissue type.

For more information, see Bone Marrow Transplant.

References

  1. National Health and Medical Research Council. Organ and tissue donation by living donors: guidelines for ethical practice by health professionals. Canberra: Australian Government; 23 May 2007 [cited 14 January 2008]. Available from URL: www.nhmrc.gov.au/ publications/ synopses/ _files/ e71.pdf
  2. Mathew TH, Chapman JR. Organ donation: a chance for Australia to do better. Med J Aust. 2006; 185(5): 245-6.
  3. Australian Government Department of Health and Ageing. National clinical taskforce on organ and tissue donation final report: think nationally, act locally [online]. Canberra: Commonwealth of Australia; 18 February 2008 [cited 20 February 2008]. Available from URL: http://www.health.gov.au/ internet/ main/ publishing.nsf/ Content/ organ-donation-nctf-final-report.htm
  4. Australia and New Zealand Organ Donation Registry. Organ donation attitudes research, 1995. In: West R, Burr G. Why families deny consent to organ donation. Aust Crit Care. 2002; 15(1): 27-32.
  5. West R, Burr G. Why families deny consent to organ donation. Aust Crit Care. 2002; 15(1): 27-32.
  6. National Health and Medical Research Council. Making a decision about organ and tissue donation after death [online]. Canberra: Australia Government; 25 May 2007 [cited 14 January 2008]. Available from URL: http://www.nhmrc.gov.au/ publications/ synopses/ _files/ e74.pdf
  7. Bhonagiri D, Wills P. Potential for organ donation in Victoria: an audit of hospitals. Med J Aust. 2007; 186(3): 157.
  8. Australians Donate. Collaborative hospitals increase organ donor rates by one third [media release]. 18 February 2007 [cited 14 January 2008]. Available from URL: http://www.australiansdonate.org.au/ images/ downloads/ DonationsIncreased_FinalRelease18Feb07.doc
  9. Lawrence A. Presumed consent under Australian law [online]. Australian Medical Association; 3 June 2004 [cited 14 January 2008]. Available from URL: http://www.ama.com.au/ system/ files/ node/ 4018/ Organ_Donation_Lawrence_paper.pdf
  10. The West Australian. UK patients could give up organs to address shortage. 13 January 2008.

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