The Donor Most organ donors are accident victims that have suffered severe and eventually fatal injuries-often a severe head injury. Death is pronounced in one of two situations. -when a person heart stops beating (cardiac death) - when the persons brain stops functioning (brain death) Most donated organs come from people that have suffered brain death. Donated tissues may come from people that have suffered brain death OR cardiac death.

The Donor (cont.) The nature of brain death involves a lack of oxygen getting to the brain, usually due to a brain injury that makes the brain swell and subsequently the blood flow to the brain is impaired. A person who is brain dead shows no brain activity, and no longer feels any pain or suffering. Brain death is a permanent condition and cannot be reversed.

The Donor (cont.) Without a functioning brain, the test of the persons organs can be kept working for a sort time using a mechanical support system. Once this system is switched of the body will stop working. A brain dead person on life support may look as though he or she is asleep, but the person is dead.

The donor (Cont.) A number of tests done at separate times may probe that brain death has occurred so the person is determined to be brain dead. Federal law requires that hospitals report all deaths and imminent deaths (very near death) to the local OPO (organ procurement organization). The OPO coordinator will go to the hospital to determine if the deceased person is medically suitable to be a donor. If they are not an organ donor the family will be contacted to discuss organ donation.

The donor (cont.) If the person has indicated he or she is an organ donor or the family agrees, the body is kept on mechanical support to maintain the organs until the surgery to remove the organs can be done. At the point that the deceased is IDd as a donor organ placement begins.

Organ Placement A lost of potential recipients is generated off of a computer system at the Organ Procurement and Transplant Network. One donor may be able to supply organs and tissues for as many as 50 people. Sometimes a surgeon from each recipients transplant team comes to the hospital to surgically remove the organ to be donated to that recipient. In other cases surgeons at the donors hospital remove the organs. The organs are quickly preserved and taken to the transplant center where the recipients are waiting.

The Transplant Once a person is identified as needing a transplant they are referred to a transplant center for evaluation. If they meet certain criteria the individual is accepted into the program at that center. He or she is placed on a national transplant waiting list. If an organ or tissues become available the patients doctor is notified. If the doctor decides that match is good and the patient is still in suitable condition to undergo a transplant the recipient is prepped for the surgery.

The Transplant (cont.) The old organ or tissue is removed during the surgery and the new organ or tissue is transplanted. The recipient begins a period of recovery to include use of immunosuppressive drugs.

Matching Donors with Recipients Our bodies have blood and tissue proteins called antigens that make us unique. We have six antigens that are considered when matching donors and recipients. Ideal compatibility is a six-antigen match. A six-antigen match occurs 25 % of the time between siblings with the same mother and father. It also occurs from time to time in the general population.

Matching Recipients with Donors Another test is called crossmatching. Blood cells from a potential donor is mixed with serum from the recipient. If it is positive (it clumps) there are already antibodies in the recipients blood that will attack the donor organ. No amount of immunosuppressive drugs will prevent the antibodies from attacking the organ.

The Waiting List When a persons name is added to the national waiting list, his or her medical profile is entered and stored in the OPTN network. The person is not placed on a ranked list at that time. The persons name is added to the pool of names of other people waiting for that organ.

The Waiting List When a donor organ becomes available the computer system matches each individual in the pool against the donors characteristics. The computer generates a list of individuals ranked in order of which potential recipient is the best match. This process ensures that all individuals in the pool are compared to that particular donor before being ranked in the order of who makes the best match.

The Waiting List The following criteria is used to determine the best match: –Body size –Blood type –Time waiting –Medical urgency –Proximity of donor and potential recipient

The Waiting List After the list is produced, the OPO coordinator contacts the transplant-team MD responsible for the care of the individual who appears first on the list. The transplant MD decides whether this potential recipient and the donor organ are suitable for one another. The MD must decide if the recipient is available, healthy enough to undergo major surgery and willing to undergo a transplant immediately.