The Medical Minute: Organ donation offers a new chance at life

By Zakiyah Kadry

What happens if your daughter or son suddenly goes into nonreversible liver failure and only a liver transplant can save them? What if you suddenly lose your kidney function and only realize it when you are told that you may need dialysis and transplantation?

We all assume that this will not happen to us or a member of our family. However, those who have had the misfortune of being diagnosed with end-stage kidney, liver or heart disease have few options open to them other than transplantation. While transplant procedures have emerged as very successful therapies, not everyone has the good fortune of receiving a donor organ in time. We all agree that saving a life is important, so why do we continue to have a shortage of donor organs?

According to the United Network for Organ Sharing, there are to date 98,729 people waiting for a donor organ in the United States. There were 28,352 transplants from January through December 2007. One person is added to the waiting list every 18 minutes. Fourteen people die everyday while waiting on the list for a transplant.

There are a lot of reasons for this shortage of organ donors. Perhaps the main one relates to the tremendously difficult time at which families are approached about potential donation of organs from a loved one, when they are just coming to grips with the fact of that person’s death. That is why many of us who wish to donate should clearly indicate our wishes to our families — to spare them the agony of making such an important decision at a very distressing time.

Many states, including Pennsylvania, indicate on a driver’s license information whether the driver wishes to act as an organ donor. A person also can carry an organ donor card. It is important, however, that people communicate ahead of time to their family their wish to donate because, ultimately no organ donation will proceed if the family refuses organ donation — regardless of whether a person carries an organ donor card or has donor information indicated on a driver’s license.

Organ donation can come from a living donor (where a person donates either one of their kidneys or part of their liver), but more commonly organs come from deceased donors. One of the limiting factors in deceased donor organ donation is a prevalent fear that if a person carries a donor organ card or a driver’s license indicating a wish to donate, the medical staff will not carry through maximum efforts to keep the person alive. This is a misperception: organ donation only proceeds in the event of brain or cardiac death, which requires stringent criteria, protocols and tests to diagnose. Respect of the individual’s rights is a high priority.

In instances such as a motor vehicle accident with massive injuries or stroke, every effort is made to resuscitate the individual, and organ donation is far from the medical team’s thoughts. The request for organ donation only comes up if resuscitative efforts are unsuccessful, and brain death criteria are ultimately recognized and met.

The process of allocating donor organs follows stringent rules overseen by UNOS that do not allow illegal organ trading. Donor organs are given to those whose clinical condition and waiting time indicate they are the most in need.

Directed donation is a special form of allocation that allows an organ to be directly offered to a person specifically designated by the donor’s family. Usually this occurs if the donor or their family knows someone — either a close relative or friend — in need of a transplant and on a waiting list for a donor organ.

Organ donation causes deep, often complex thoughts and emotional reactions in those associated with it. It allows a second lease on life for the recipient  who previously may not have had any other hope of recovery. Transplantation is a gift of life, the ultimate gesture of generosity that a person can make. At a time of grief and death, organ donation is a gift of joy and hope, thus allowing others to live on through the donation.

Zakiyah Kadry is chief of the Division of Transplantation Surgery and surgical director of Liver Transplantation at Penn State Milton S. Hershey Medical Center. She also serves as a professor in the Department of Surgery at Penn State College of Medicine.

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Last Updated March 19, 2009