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organ donation

Transplantable organs: 1) lungs 2) heart 3) kidneys* 4) liver 5) pancreas 6) intestines * kidneys in greatest demand (76%), followed by liver (17%) * kidneys most suitable organ for transplantation from brain dead potential donors [10] Other harvestable tissues: 1) corneas 2) bone 3) skin 4) tendon 5) fascia 6) cartilages 7) heart valves Contraindications: contraindications to organ donation or tissue harvesting 1) age > 80 years may not be limitation [1] 2) death from infectious disease, cancer, or toxic exposure 3) lethal exposure to cocaine, carbon monoxide, lead, or barbiturates have donated organs successfully, but case-by-case analysis is necessary * prophylaxis with direct-acting antivirals may enable safe kidney transplantation from hepatitis C-infected deceased donors to uninfected patients [5] Epidemiology: - healthcare professions approach only 43% of the families of potential organ donors - < 50% of families of potential donors consent to donations - 50% of families of U.S. adults willing to donate organ(s) subsequently refuse [10] - longevity of kidney donors unchanged [2,3] Procedure: - 5-minute observation period prior to proceeding with organ donation after circulatory determination of death* * after planned withdrawal of life-sustaining measures, the longest duration after pulselessness before resumption of cardiac activity was 4 minutes 20 seconds [8] - dead donor rule [9] - brain death must be documented prior to the removal of organs - the act of organ procurement & donation must not cause the donor's death Complications: - Lazarus syndrome (autoresuscitation) after donor prounounced dead Notes: The correct time to approach family members is after they have viewed the patient's body. The family should be given time for bereavement & to accept their loved one's death. Steps to tank to ensure donation: - inform your family, friends & physician - fill out a donor card, driver's license - assign a durable power of attorney for health care - advance directives Identification of unsurvivable out-of-hospital cardiac arrest (criteria) for potential organ donation [4] - cardiac arrest unwitnessed by emergency medical services or medical personnel - nonshockable initial rhythm - lack of return of spontaneous circulation before receipt of a third dose of 1-mg epinephrine

Related

blood donation organ transplantation

Specific

heart donation intestinal donation kidney donation liver donation pancreatic donation

General

clinical process

References

  1. Stevens LM et al, Glass RM (ed) Organ Donation JAMA patient page 2007, 299:244
  2. Segev DL et al Perioperative Mortality and Long-term Survival Following Live Kidney Donation JAMA. 2010;303(10):959-966. PMID: 20215610 http://jama.ama-assn.org/cgi/content/short/303/10/959
  3. Ibrahim HN et al Long-Term Consequences of Kidney Donation N Eng J Med 2009 360:459-469 PMID: 19179315 http://content.nejm.org/cgi/content/short/360/5/459
  4. Jabre P, Bougouin W, Dumas F et al Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation. Ann Intern Med. Published online 13 September 2016 PMID: 27618681 http://annals.org/article.aspx?articleid=2552075
  5. Durand CM, Bowring MG, Brown DM et al Direct-Acting Antiviral Prophylaxis in Kidney Transplantation From Hepatitis C Virus-Infected Donors to Noninfected Recipients: An Open-Label Nonrandomized Trial. Ann Intern Med. 2018. March 6. PMID: 29507971 http://annals.org/aim/article-abstract/2674335/direct-acting-antiviral-prophylaxis-kidney-transplantation-from-hepatitis-c-virus
  6. Tullius SG, Rabb H. Improving the Supply and Quality of Deceased-Donor Organs for Transplantation. N Engl J Med 2018; 378:1920-1929. May 17, 2018 PMID: 29768153 https://www.nejm.org/doi/full/10.1056/NEJMra1507080
  7. Rosenbaum L Altruism in Extremis - The Evolving Ethics of Organ Donation. N Engl J Med 2020;382:493-496. Feb 6. PMID: 32023370 https://www.nejm.org/doi/full/10.1056/NEJMp2000048
  8. Dhanani S, Hornby L, van Beinum A et al. Resumption of cardiac activity after withdrawal of life-sustaining measures. N Engl J Med 2021 Jan 28; 384:345 PMID: 33503343 https://www.nejm.org/doi/10.1056/NEJMoa2022713
  9. Sade RM Consequences of the Dead Donor Rule Ann Thorac Surg 2014 Apr;97(4):1131-2 PMID: 24694402 PMCID: PMC4100619 Free PMC article
  10. Kneisel K The Lazarus Syndrome in Extremis? A bizarre case of autoresuscitation during donor organ procurement MedPage Today June 14, 2021 https://www.medpagetoday.com/casestudies/emergencymedicine/93094
  11. FaceBook Organ Donation Site Sharing for Organ Donor Status https://www.facebook.com/help/?page=368924819806375 - Richtel M and Sack K Facebook Is Urging Members to Add Organ Donor Status New York Times, May 1, 2012 http://www.nytimes.com/2012/05/01/technology/facebook-urges-members-to-add-organ-donor-status.html - .gov organ donation sites http://www.organdonor.gov/ http://www.nlm.nih.gov/medlineplus/organdonation.html - Transplant Recipients International http://www.trioweb.org - United Network for Organ Sharing (UNOS) http://www.unos.org - Donate Life America http://www.donatelife.net - National institute on Aging Organ Donation: https://www.nia.nih.gov/health/topics/organ-donation