The “Ins” and “Outs” of Organ Donation

Abstract

Organ donation, in simplest terms is the donation of viable tissues or organs from one human being to another. Organ donations are received in two ways, living donors and cadaver donors. Donations such as, bone marrow, blood and blood components help enhance another’s life, while vital organs like the liver and kidney can save another’s life. Organ donation is a unique and controversial situation for each individual and their family involved. The controversy throughout the world related to organ donation has specifically been impacted by all aspects of ethical, legal, organizational and societal views. The two programs in debate are opt-in and opt-out programs. Even though the two programs are completely different in how they work the main goal would be to increase potential donors.

Organ donation has been a wide spread controversial issue throughout the world, involving all aspects of ethical, legal, organizational and societal views. Most of the issues surrounding organ donation are consent and ways to increase potential donors to awaiting transplant recipients ratio. Given the lack of organ donors, not just in the UK but across the world, society needs to face up to the fact that, if we want more people to have transplant surgery, organ donation after death has to be discussed more openly (Tantam, 2007). The two programs are concluded to the opt-in and opt-out programs. Even though the two programs are completely different in how they work the main goal would be to increase donors. This type of program hopefully would reduce the number of people on waiting lists and individuals that are dying every day.

More and more people die today waiting on an organ transplant. More than 110,000 Americans are on organ-transplant waiting lists, and demand for kidneys, lungs, hearts and other donated organs far exceeds the supply due to rising incidences of obesity, hypertension and diabetes (Mantel, 2011). The population needs to be better educated on all aspects of the transplant programs, hopefully increasing the number of the population willing to donate organs. Any decision a person makes without experience or knowledge causes distress and anxiety. Then when you throw in something as personal and terrifying as death, the decision can become much more difficult. Who should have to make that decision?

There are many questions concerning this process that the Powers-That-Be have given simple yes and no answers to. This almost makes the whole thing to surreal. The medical field needs to have programs devoted to educating the population in a friendly an informative way. Most everyone who donates goes to the Secretary of State to get their license to drive. While up at the counter with all the paperwork required for a plate the state employee asked the question, “Would you like to be an organ donor?” The answer is going to be a simple yes or no without even knowing how the whole process works. Education would have the benefit of more, not less donors.

Humans can live for example with one kidney, only part of one lung, part of the pancreas, part of the intestines or part of the liver. The body will compensate for the missing parts making it possible to live a long and healthy life. Any surgical incisions left because of removal will be sutured shut and only a scar will be left behind. The deceased will be able to be viewed at their funeral. The family will not have any expense due to this procedure. All costs incurred will be paid by the recipient or through an insurance policy. As a registered donor you will still receive the same life saving medical care. Those are all the pros connected with saving someone.

On the negative side surgery can be dangerous and cause death. Any minor operation carries risk such as; bleeding, infection, blood clots, allergic reactions, or damage to other organs nearby. Organ donation is major surgery therefore can be life-threatening. There is pain and recovery time associated with this procedure. Also there may be scars and any complications that could develop later won’t be covered by insurance.

Once a patient has been referred by a doctor they are evaluated through a transplant program as a potential candidate. In order to get a doctor’s referral a person must be at end-stage organ failure. The website organdonor.gov created by the Health Resources & Services Administration, U.S. Department of Health and Human Services list a number of diseases that can lead to end-stage such as; Cardiomyopathy, Cirrhosis, Chronic Obstructive Pulmonary Disease, Coronary Heart Disease, Cystic Fibrosis, Diabetes, Hepatitis, Hypertension, Idiopathic Pulmonary Fibrosis, Polycystic Kidney Disease, and Short Gut Syndrome.

There is much research to be done at this point. The person should obtain from the Health Resources and Services Administration a pamphlet that gives an overview of the process. This is free of charge for the donor or recipient. Next the person starts looking for a transplant hospital. Things to consider are the location, compatibility with the patient’s insurance company, financial arrangements and the availability of a support group. Once the hospital has been chosen an appointment is made and an evaluation is done by the hospital personnel. This is necessary to see if the patient is a good candidate for a transplant. A successful candidate is then added to the OPTN National Transplant Waiting List. Usually within ten days this person is notified in writing giving the date and time they were put on the list.

Now it is time to figure the tremendous cost and how to afford to pay it. A lot of insurance companies cover most if not all the costs that can be occurred during this procedure. All insurance companies vary in what they cover so the candidate must contact their company to determine what they will pay. The website organdonor.gov lists numerous cost occurring procedures such as; laboratory tests, organ procurement, transplant surgeons, and other operating room staff, in-hospital stays, transportation to and from the transplant hospital for surgery and check-ups, rehabilitation, and medications (including immunosuppressives or anti-rejection drugs). According to organdonor.gov the on average cost in 2008 ranged from $259,000.00 for a kidney transplant to $1,200,000.00 for a heart-lung transplant.

The median wait depends on what organ is being transplanted. The waiting period can be from the minimum of 100 days up to a year or longer. Waiting for that call can be terrifying and heartbreaking because someone has to die in order for another person to live. Organdonor.gov implicates a chart breakdown for the waiting period of certain organs as follows; a heart 113 days, lung 141 days, liver 361 days, kidneys 1219 days, pancreas 260 days and intestine 159 days.

Now that the patient is on the list he or she must keep in touch with the transplant hospital at all times. They make sure the hospital can reach them at all hours. Also all traveling plans have been made including alternate means. Some organs can only live outside the body for 4-6 hours such as the heart and lungs, but kidneys can survive up to 36 hours.

In order for an organ to be considered a match the medical field takes into account blood type, the size of the individual, severity of the medical condition and distance between donor and recipient’s hospital. In the case of a heart transplant the person is given a status code designating the severity of damage to the heart. Since a heart can only live outside a body for 4-6 hours a recipient living closest to the donor’s hospital is chosen first. Sometimes there isn’t anyone close and at that point the transplant team searches a greater distance from the donor’s hospital. Also the heart or lung must fit inside the patient’s rib cage so then size match comes into play, and evaluation for prolonged survival following the transplant. Other organs like the liver, kidneys, pancreas and intestines have other considerations that need to be met besides the listed common elements.

As stated above most people register as a donor through their state registry at the Department of State or by telling a family member. Unfortunately this is not always the case since accidents do happen. Most of these people are left with a diagnosis of brain death due to other medical issues occurring. Along with problems with diagnoses, medicine’s technical interests in transplantable organs (hearts) can bias the brain death test, raising serious ethical concerns (Gough, 2012). At this point the hospital does a series of tests to determine if the potential donor has any brain activity. Lack of agreement on determination-of-death criteria has been a roadblock to the development of sound ethical protocols for donation after cardiac death in particular (Grasser, 2007). These people make the best donors because the hospital will keep these folks on life support.. When the patient has been pronounced brain dead a transplant surgeon will then receive a call that they are always prepared for and immediately depart for that hospital. Time becomes critical since the organ may have only a small window to stay valuable. On a compassionate note the donor’s family is in mourning and you do not want to add to their pain by a long drawn out process. In time they will be happy knowing their loved one gave someone else a chance at a normal life.

Every hospital in the country reports to the local Organ Procurement Organization whenever a patient is nearing death or has died. A representative then checks to see if that person has registered as a donor. When the patient is listed in the registry or permission granted the representative goes to the hospital and obtains the patient’s medical and social history. At this point he contacts the OPTN and the hunt is on for a recipient. Donor and recipients are matched through a database based on certain characteristics. This database finds a recipient that matches the common elements listed previously plus distance between the two hospitals. Since one donor may have several useful organs his body may actually help numerous people live. Therefore the database finds all potential recipients that match the donor. Then the surgical team takes off for the donor’s hospital and they remove all and any healthy tissues and organs, using the same sterile and careful method as in any surgery. These body parts have to be transported to the recipient’s hospital immediately since they can only survive for a short time. Finally after all these preparations one person dies but helps another live!

Money and power have a way of creeping into any good program. Therefore the danger exists that the wealthy and powerful will miraculously appear at the top of the list whether they belong there or not. There is no way the average person would ever know if it is operated fairly. In some of the poorer countries people are already selling a kidney or part of a lung or liver. Medical Science has reached glorious heights but also sometimes dehumanizes because of greed. This type of program has the potential to generate enormous profit.

References

Gough, J. (2012, March). Henderson, D. Scott. Death and donation: rethinking brain death as a means for procuring transplantable organs. CHOICE: Current Reviews for Academic Libraries, 49(7), 1299. Retrieved from http://go.galegroup.com.ez.lakemichigancollege.edu/ps/i.do?id=GALE%7CA282213612&v=2.1&u=lom_lakemich&it=r&p=ITOF&sw=w&asid=185fc4d91a4760a3621736a6a444e343

Grasser, P. L. (2007, Fall). Donation after cardiac death: major ethical issues. Issues in Law & Medicine, 23(2), 206+. Retrieved from http://go.galegroup.com.ez.lakemichigancollege.edu/ps/i.do?id=GALE%7CA173187663&v=2.1&u=lom_lakemich&it=r&p=ITOF&sw=w&asid=a48199e4eeced619b300ac6d3fbc2944

Mantel, B. (2011, April 15). Organ donations. CQ Researcher, 21, 337-360. Retrieved from http://library.cqpress.com.ez.lakemichigancollege.edu/cqresearcher/

Tantam, K. (2007). Dying to give? Talk about it: should everyone be regarded as a potential organ donor when they die, unless they have previously opted out? We asked our readers panel. Nursing Standard, 21(51), 26+. Retrieved from http://go.galegroup.com.ez.lakemichigancollege.edu/ps/i.do?id=GALE%7CA168820665&v=2.1&u=lom_lakemich&it=r&p=HRCA&sw=w&asid=1270d24d80928e36655fee62b5fab12c

Health Resources & Services Administration, U.S. Department of Health and Human Services. Retrieved from http://organdonor.gov/about/transplantationprocess.html