Wednesday, June 18, 2008

Health Care and Organ Donation

Are you an organ donor? You should be. While most solid organ and tissue donations occur after the donor has died, some organs and tissues can be donated while the donor is alive. The first successful transplant in the U.S. was made possible by a living donor and took place in 1954. One twin donated a kidney to his identical twin brother. As a result of the growing need for organs for transplantation, living donation has increased as an alternative to deceased donation, and about 6,000 living donations take place each year. Most living donations happen among family members or between close friends. Some living donations take place between people unknown to each other. There is much information available online (such as the HHS) and with other sources about organ donation. According to the Mayo Clinic, enough people to populate a small city — nearly 100,000 — are on the U.S. organ transplant waiting list, waiting for an organ donation. On an average day, about 77 people receive organ transplants. Being an organ donor can make a big difference, and not just to one person. By donating your organs after you die, you can save or improve as many as 50 lives according to the Mayo Clinic.

According to the U.S. Department of Health and Human Services, all people of all ages should consider themselves potential organ and tissue donors. There are few absolute exclusions (HIV positive, active cancer, systemic infection) and no strict upper or lower age limits. Potential donors will be evaluated for suitability when the occasion arises. No one is too old or too young. Both newborns and senior citizens have been organ donors. The condition of your organs is more important than age. Someone 35 years old with a history of alcohol abuse may have a liver that is in worse condition than someone 60 years old who has never consumed alcohol. In addition, people on the waiting list might need to be transplanted with an organ that is less than ideal if there is no other suitable organ available in time to save their lives.

Doctors will examine your organs and determine whether they are suitable for donation if the situation arises. If you are under 18, you will need the permission of a parent or guardian to donate. You may still be able to donate your organs even if you have had an illness or disease. Doctors will evaluate the condition of your organs when the time arises. The transplant team’s decision will be based on a combination of factors, such as the type of illness you have had, your physical condition at the time of your death, and the types of organs and tissues that would be donated.

There are many types of organ donations according to the HHS. The organs of the body that can be transplanted at the current time are kidneys, heart, lungs, liver, pancreas, and the intestines. Kidney/pancreas transplants, heart/lung transplants, and other combined organ transplants also are performed. Organs cannot be stored and must be used within hours of removing them from the donor's body. Most donated organs are from people who have died, but a living individual can donate a kidney, part of the pancreas, part of a lung, part of the liver, or part of the intestine.
Local organ procurement organizations (OPOs) around the country coordinate organ donation. OPOs evaluate potential donors, discuss donation with surviving family members, and arrange for the surgical removal and transport of donated organs. A national computer network, the OPTN (Organ Procurement and Transplantation Network) matches donated organs with recipients throughout the country.

Tissues can also be donated: Corneas, the middle ear, skin, heart valves, bone, veins, cartilage, tendons, and ligaments can be stored in tissue banks and used to restore sight, cover burns, repair hearts, replace veins, and mend damaged connective tissue and cartilage in recipients.

Stem cells can also be donated according to the HHS. Healthy adults between the ages of 18-60 can donate blood stem cells. In order for a blood stem cell transplant to be successful, the patient and the blood stem cell donor must have a closely matched tissue type or human leukocyte antigen (HLA). Since tissue types are inherited, patients are more likely to find a matched donor within their own racial and ethnic group. There are three sources of blood stem cells that healthy volunteers can donate:

1.) Marrow-This soft tissue is found in the interior cavities of bones and is a major site of blood cell production and is removed to obtain stem cells.
2.) Peripheral blood stem cells-The same types of stem cells found in marrow can be pushed out into a donor's bloodstream after the donor receives daily injections of a medication called filgrastim. This medication increases the number of stem cells circulating in the blood and provides a source of donor stem cells that can be collected in a way that is similar to blood donation.
3.) Cord blood stem cells-The umbilical cord that connects a newborn to the mother during pregnancy contains blood and this blood has been shown to contain high levels of blood stem cells. Cord blood can be collected and stored in large freezers for a long period of time and therefore, offers another source of stem cells available for transplanting into patients.

Additionally, you can donate blood. Blood and platelets are formed by the body, go through a life cycle, and are continuously replaced throughout life. This means that you can donate blood and platelets more than once. It is safe to donate blood every 56 days and platelets twice in one week up to 24 times a year. Blood is stored in a blood bank according to type (A, B, AB, or O) and Rh factor (positive or negative). Blood can be used whole, or separated into packed red cells, plasma, and platelets, all of which have different lifesaving uses. It takes only about 10 minutes to collect a unit (one pint) of blood, although the testing and screening process means that you will be at the donation center close to an hour. Platelets are tiny cell fragments that circulate throughout the blood and aid in blood clotting. Platelets can be donated without donating blood. When a specific patient needs platelets, but does not need blood, a matching donor is found and platelets are separated from the rest of the blood which is returned to the donor. The donor's body will replace the missing platelets within a few hours.

The decision to be a living donor must be weighed carefully as to the benefits versus the risks for both the donor and the recipient. Often, the recipient has very little risk because the transplant will be life saving. However, the healthy donor, does face the risk of an unnecessary major surgical procedure and recovery. Living donors may also face other risks. For example, a small percentage of patients have had problems with maintaining life, disability, or medical insurance coverage at the same level and rate. And, there can be financial concerns due to possible delays in returning to work because of unforeseen medical problems. The decision to be a living donor is a very personal one and the potential donor must consider the possibility of health effects that could continue following donation. In most cases, that decision must also take into consideration the life-saving potential for a loved one—the transplant recipient.

The Mayo Clinic also advises that contrary to popular belief, signing a donor card or your driver's license does not guarantee that your organs will be donated. The best way to ensure that your wishes are carried out is to inform your family of your desire to donate. Doing this in writing ensures that your wishes will be considered. Hospitals seek consent of the next of kin before removing organs. If your family members know you wanted to be donor, it makes it easier for them to give their consent. If you have no next of kin or your family will agree to donate your organs, you can assign durable power of attorney to someone who you know will abide by your wishes. An attorney can help prepare this document.

There are many additional facets about donating organs, blood, and tissue. Considerations should be made for either partial or solid organ donation, suitability to donate, follow-up for living donors, donation after brain death, donation after cardiac death, and whole body donation. You should contact local organizations and government agencies about organ donation if you wish to consider this health care option. Other lives have been saved as a result of the generosity of Americans who wish to contribute a part of themselves to the greater good. Organ donation should not be taken lightly, and those who wish to pursue this medical procedure need to consult their family and their physician about the pros and cons of the decision. Whatever your decision, you can feel good about helping others with their health care crisis. Being an organ donor is a generous and worthwhile decision that can be a lifesaver. Understanding organ donation can make you feel better about your choice.

Until next time. Let me know what you think.

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