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. Back to top 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). Back to top 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