Q - Gordy Racette

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Criteria For Organ Donation
Fewer than one percent of deaths can result in potential organ donation. Most deaths allow
you to be a donor for tissue such as skin, cornea, and bone, but more exact criteria must be
met before solid organs such as heart and kidneys can be donated.
In order to become an organ donor, a patient must meet strict criteria and be declared brain
dead. Brain death can occur as the result of a severe head injury or a brain hemorrhage. All
attempts are made to save the patient's life. If brain death occurs, it is not reversible. Tests
to determine brain death are conducted by two doctors who are not connected with the
organ donation or transplantation process. The potential donor's organs are artificially
maintained on a ventilator until the organs can be transplanted.
Current Need--A Shortage of Organs
There is a critical shortage of organs available for transplantation in British Columbia and
around the world. More than 400 British Columbians are waiting for a life-enhancing or lifesaving organ transplant, many of them will die before an organ comes available. This is
because fewer people are dying of causes that historically led to brain death, and therefore
potential solid organ donation, including such things as: improved safety features on
vehicles, helmet laws, as well as continued advancements in medical care.
Surveys indicate that almost 85% of British Columbians support organ donation, yet only
15% have registered their decision on BC's Organ Donor Registry. The Registry allows
individuals to make an informed decision about organ donation and removes the burden and
onus of making a difficult decision at an already difficult time, from a grieving family
Organ Retrieval
BC Transplant (BCT) is contacted only after the patient is diagnosed as terminal and death
is imminent. A check of the Organ Donor Registry will follow to determine consent. Tests are
completed to diagnose brain death. When a referral hospital calls BCT, the organ retrieval
team mobilizes to locate a suitable recipient based on established criteria for organ
donation. In Canada and the United States, a network of donor coordinators ensures that if
the organ(s) cannot be used in their own area, they are made available to people on waiting
lists across the continent.
BCT organ retrieval team operates as a mobile, specialized unit because most of the
hospitals in the province do not have the personnel and equipment to independently handle
multiple-organ procurement. The retrieval team (on call 24 hours a day, 365 days per year)
travels to referral hospitals in the province to perform the organ retrieval surgery. The
organs are then brought back to the transplanting hospital in Vancouver and transplanted
as quickly as possible.
What Happens Before, During, and After a Donation
The patient is admitted to the hospital, and all attempts are made to save the patient's
• life. If it is determined that the patient's death is imminent, BCT is notified before
mechanical ventilation is removed.
•
The patient is pronounced "brain dead" after evaluation, testing and documentation by
two doctors who are independent of the transplant program.
•
The nurse or doctor checks the new Organ Donor Registry for a record indicating a
potential donor's decision.
•
The patient's family is presented with the record of consent regarding the potential
donor's decision.
•
If there is no recorded consent, then the next of kin is approached for consent for organ
donation on behalf of their loved one.
• The donor is maintained on a ventilator and stabilized with fluids and drugs.
•
Many lab test are completed to assess organ function, tissue type, and absence of
infection
•
Recipients are identified for placement of the organs by BC Transplant's Retrieval Team
Coordinator.
•
Surgical teams are mobilized and coordinated to arrive at the donor hospital for the organ
recovery surgery.
•
After the surgical teams have arrived at the donor hospital, the donor's body is brought to
the operating room on the ventilator.
•
The organ recovery surgery is performed. The organs are cooled and preserved with
special solutions. The ventilator is discontinued at this time.
• The organ is transported to the hospital and transplanted to the recipient.
• The body of the donor is released to the funeral home.
•
The donor's family will receive a letter shortly after donation, letting them know how many
people received organs and tissues. Confindentiality is always maintained.
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Organ Transplantation in British Columbia
Organ transplantation has evolved in specialized centres throughout the world. In British
Columbia, the provincial government established a comprehensive transplant program to
meet the needs of patients in the province.
BC Transplant (BCT), an agency of the Provincial Health Services Authority, is a non-profit,
comprehensive health care organization, created in 1985 to deal with the full spectrum of
clinical, fiscal and organizational aspects of organ transplantation.
In 1989, BCT opened regional clinics outside the lower mainland as part of its phased
development to better meet the needs of people across the province. Three transplant
centres (St. Paul's Hospital, the Vancouver Hospital and Health Services Centre and the BC
Children's Hospital) and six regional clinics (Victoria, Kamloops, Kelowna, Prince George,
Penticton and Trail) have been established to treat adult patients. Improved local resources
promote health and rehabilitation closer to home for many patients. The David Foster
Foundation has provided financial and emotional support, and counselling services for
children and their families, partly because of the ned for family and patient travel out of the
province for transplants.
Improvements in the delivery of care, advancement in research, and the expansion of
professional education programs, continue to hold promise for individuals living with endstage organ failure. Public education programs also play a role in increasing the number of
organs available for transplantation.
Benefits
Organ transplantation can literally be the difference between life and death for some
patients. For others it represents a total transformation in their quality of life. For a kidney
transplant recipient, it means freedom from kidney dialysis treatment - a treatment that is
required 3 days a week for 4-hour sessions.
Organ transplantation also has a long-term economic benefit in reducing patient care costs.
The typical kidney dialysis treatment cost approximately $50,000 a year, while a kidney
transplant costs about $20,000, plus about $6,000 a year for the immunosuppressants
(anti-rejection medication).
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Facts, Myths and Frequently Asked Questions
The following information may be useful in preparing to respond to questions about session
participants. There are certainly many more personal and technical questions you may be
asked that are beyond the scope of this guide.
Q: If I am in an accident and the hospital knows that I want to be a donor, the
doctors will not try to save my life.
A: The medical team that treats patients is separate from the transplant team. BC
Transplant is not notified until all lifesaving efforts have failed and death has been
determined. Registering for organ donation will not affect the kind of medical care you
receive.
Q: I do not want my body mutilated.
A: Donated organs are removed surgically, in a routine operational incisions are surgically
closed. You can still have an open casket funeral.
Q: I might want to donate one organ but I do not want to donate everything.
A: You may specify which organs you want to donate or not donate at all. Your decision will
be respected.
Q: I have a history of medical illness. Can I still be an organ donor?
A: At the time of death, medical staff will determine donor suitability.
Q: What is the success rate of transplantation?
A: Excellent. For example, liver and kidney recipients enjoy survival rates over 85 percent.
Q: How long can a heart be preserved?
A: The optimum for a heart is 3 to 4 hours between removal and transplantation.
Q: How are organs preserved?
A: Most transplant centres use a cold solution of iced salt water to temporarily store
organs. The time that the organ is in the cold solution and out of the body is called cold
ischenic time.
Q: Are organs allocated based on race?
A: Race does not play a part in the allocation of organs.
Q: Is it legal to sell my own kidney?
A: It is illegal to buy and/or sell organs in Canada.
Q: What is a coma?
A: Coma describes unconsciousness that may occur because the brain has been injured in
some way but is still alive. It can still function and may heal in such a way that the person
will regain consciousness or even completely recover.
Q: Can an organ or tissues be taken after biological death has occurred? How long
after death can organs and tissues be taken?
A: There are two basic types of donation: organ donation and tissue donation. Organs that
can be donated are the heart, lungs, liver, kidneys, pancreas and small intestine. These can
only be taken while the heart is still beating and after the donor is "brain dead".
Q: What is brain death?
A: Brain death is the irreversible loss of all function of the brain. It can be established by:
1. absence of electrical activity in the brain as determined by an EEG;
2. absence of blood flow to the brain as determined by blood flow studies; or
3. absence of function of all parts of the brain as determined by clinical assessment
(no movement, no response to stimulation, no breathing, no reflexes).
Brain death can be caused by anoxia, drowning, respiratory diseases, drug overdose,
blockage of an artery leading to the brain, heart attack, head injury (a blow to the head),
intracranial aneurysm (the ballooning of a blood vessel supplying the brain can cut off blood
supply or rupture), and brain tumors.
A person who is declared brain dead is legally dead.
Q: Is age a factor in organ donation?
A: The quality of the organ is more important than the age of the donor. The important
thing is that people of all ages should make their wishes known to their families.
Q: Is organ transplantation expensive?
A: The vast majority of transplant surgeries in BC are for kidneys, and kidney
transplantation actually saves money. Kidney dialysis costs $40,000 to $50,000 per year.
On the other hand, a successful kidney transplant costs approximately $20,000 for the
surgery and $6,000 per year for the follow-up cost of the immunosuppressants. Cost
savings are about $150,000 per transplant patient over a five year period.
Religious Views
Virtually all religious groups approve of organ and tissue donation, viewing it as a
humanitarian and charitable act that is the individual's choice. Anyone concerned about how
their religion views organ donation should discuss it with an official of their religious
organization.
Information courtesy of BC Transplant website
www.transplant.bc.ca
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