The success of any transplant program depends on the number of individuals who indicate in advance of their death their willingness to be donors. While most Americans say they approve of donation, only about one person in four has indicated that by signing forms. In Europe, where you are considered a potential donor unless you expressly declare that you do not want to be one, more than 90 percent of people are organ donors.
Age is no longer a limit to donation. So consider indicating willingness to be a donor on your driver's license or in your living will. Even more helpful is to tell your next of kin or health care agent that you want to be a donor. And carry a signed organ donor card in your wallet.
Through the efforts of the national Organ Procurement Transplantation Network and its regional chapters, more hospitals today have a system in place that fosters donation. When patients who may be suitable donors are dying, families are more often asked to consider donations.
But more hospitals need to expand their use of brain-dead donors who are less than perfect, including people older than 60 and those with high blood pressure. Studies have shown that their organs can be successfully transplanted.
Another approach is to retrieve more organs from individuals who suffer cardiac deaths, that is irreversible loss of heart and respiratory function rather than irreversible loss of all brain functions, the criterion for brain death. Although organs retrieved from victims of cardiac death account for just 8 percent of donations from dead donors, they are the most rapidly increasing source of donations.
According to Robert Steinbrook, a consultant for The New England Journal of Medicine, the potential for a much higher percentage of donations from victims of cardiac death has been demonstrated at organ banks in Wisconsin, the Boston metropolitan region and the Finger Lakes region of New York, places where cardiac death donors account for more than 20 percent of all deceased donors.
Steinbrook said potential donors included patients on ventilators after devastating and irreversible brain injuries, as might follow a hemorrhagic stroke, as well as patients with high spinal cord injuries and terminal musculoskeletal diseases like ALS, for whom further medical treatment is deemed futile.
These patients are technically not dead. But if they are considered suitable donors and the families agree to donation, life-support measures are ended. When the patient's heart stops, doctors wait five minutes before declaring the patient dead and removing viable organs for transplant.
If the heart does not stop within a reasonable time, planned donations have to be canceled, which occurs in about one in five cardiac deaths.
To be transplanted successfully, the liver has to be retrieved within 30 minutes and the kidneys and pancreas within an hour after a patient is removed from life support. When this protocol is followed, Steinbrook said, the success of a transplant after cardiac death is similar to that of a transplant after brain death.
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