The organ donation process is a complex process that is coordinated by medical professionals in organ procurement organizations, like the Legacy of Hope, and hospitals across the country. There are two avenues for organ donation to take place – after brain death has been determined or after the family chooses to withdraw life-sustaining therapies.
Step 1: The patient is admitted to the hospital because of illness or accident in an attempt to save his life. Most organ donors are victims of severe head trauma, a brain aneurysm, stroke or lack of oxygen to the brain. Healthcare professionals do everything possible to save the patient’s life while maintaining the patient on mechanical devices, like a ventilator or breathing machine.
Step 2: Testing for brain death begins when the medical team has exhausted all possible life-saving efforts and the patient is not responding. A physician will perform a series of tests to determine if brain death has occurred. In Alabama, two licensed physicians must evaluate the patient and agree that brain death has occurred before organ donation after brain death can occur. Patients who are brain dead have no brain activity and cannot breathe on their own. Without brain function, the rest of the body cannot survive. If organ donation is being considered, the ventilator or breathing machine is used to keep the organs functioning. Brain death is not a coma. Brain death is death and it is irreversible.
Step 3: In compliance with federal regulations, the hospital notifies the local organ procurement organization, like the Legacy of Hope, of every patient that has died or is nearing death.
Step 4: Before speaking with the family, Legacy of Hope will check the state registry (Legacy Organ & Tissue Donor Registry) and the national registry (RegisterMe.org) to determine if the patient is a registered donor. If he/she is a registered donor, Legacy of Hope will discuss the registry status with the family and make them aware that their loved one decided while he/she was living to give the gift of life to someone in need. This is called donor designation. The state of Alabama recognized donor designation as a legally binding decision.
1. If the patient is not registered, a Legacy of Hope staff member works with the family to ensure that the opportunity to donate is offered to them in a sensitive manner. Once the family decides to donate, an authorization form is signed by the next-of-kin.
2. Once authorization has been obtained and death has been pronounced, Legacy of Hope is financially responsible for additional medical expenses incurred. The family is responsible for the costs prior to death and for the funeral expenses.
3. Legacy of Hope will also complete a donor risk assessment interview, medical/social history interview, with the family and/or other individuals who may have helpful information.
Step 5: The donor is maintained on artificial support while the condition of each organ is carefully monitored and evaluated. A number of tests may be performed to ensure that each gift, each organ, is suitable for transplant.
With the family’s knowledge and permission, most donors are transferred to the Legacy of Hope’s Donor Recovery Center. This Center is located on UAB Hospital’s campus and has a state-of-the-art area to care for the donor prior to surgery and surgical area for the recovery of organs and tissues.
Step 6: The United Network for Organ Sharing (UNOS) manages the organ matching system in the United States. Legacy of Hope will enter information about the donor, i.e. blood type, age, height, weight and hospital zip code, into the UNOS database to find patients awaiting transplants who best match the donor’s heart, lungs, liver, kidneys and other organs.
For more information about the sharing system and UNOS, please visit Transplant Living.
Step 7: Transplant surgeon(s) will travel to the hospital or Legacy of Hope’s Donor Recovery Center to remove the donor’s organs for transplant. Like other operations, this surgery takes place in an operating room. The organ(s) are then taken to the transplant center where a recipient(s) is waiting for their second chance at life.
Step 8: After the donation, the donor is taken to the Medical Examiner office or funeral home of the family’s choice. Generally, funeral services are not delayed by donation, and donation itself does not prevent an open-casket funeral.
Step 9: About two weeks after the funeral, the family receives a letter from Legacy of Hope expressing our condolences, our thanks and a little information about what has been transplanted. Very little information about the recipient is revealed since the names of donor and recipients are kept confidential. The family will receive a separate packet of information from our aftercare coordinator who will become the family’s point of contact.
Organ Donation after Circulatory Death (DCD)
Donation after Circulatory Death (DCD) is an opportunity for families of patients who do not meet the criteria for brain death and have chosen to withdraw life-sustaining therapies to donate organs. This opportunity is offered to families after the medical team and the patient’s family have established that the patient will not have meaningful recovery and life-sustaining measures will be discontinued. The process for DCD is almost the same as described above.
After the organ evaluation is complete, the transplant surgeons have arrived for the surgery and the family is ready, life-sustaining therapies will be removed by the patient’s primary care team. After the heart has stopped beating and the patient has been pronounced dead, the transplant team will recover the organs for transplant.
While it is estimated that less than one percent of in-hospital deaths meet the criteria for organ donation, tissue donation is open to nearly everyone. The first step is to try to save the life of the individual, if possible. When those efforts are not successful, the hospital will call the organ procurement agency, like Legacy of Hope, and notify them of the death. Legacy of Hope will carefully screen each patient for donor eligibility. If the patient is an eligible donor, Legacy of Hope will check the state and national donor registries. Once authorization is verified through the registry(s) or the family provides authorization, then a detailed donor risk assessment interview, medical/social history interview, is conducted with the family or individuals who may have knowledge of the donor’s history. Normally, the authorization and donor risk assessment interview is conducted over the telephone.
The tissue recovery frequently takes place at the Legacy of Hope’s Donor Recovery Center. With the family’s knowledge, we will transport their loved one to our Donor Recovery Center in Birmingham. The costs associated with transportation to our Donor Recovery Center are paid by Legacy of Hope. If this is not feasible, the tissue recovery will take place at the local hospital. Legacy of Hope uses a staff of specially-trained Tissue and Recovery Coordinators to recover the tissue for transplant. Once finished, the donor will be transported to the Medical Examiner Office or funeral home of the family’s choosing.
What is tissue donation? Bone, tendons, ligaments, heart valves, etc. can all be recovered after the heart stops beating and dramatically improves the lives of the people who receive these gifts.
Living donation enables a healthy individual to donate a kidney or a part of his lung or liver to someone in need of a transplant. Due to the lack of available deceased-donor organs, living donation programs help to meet the growing need for organs among those awaiting a transplant. A living donor may be a relative, spouse, a close friend or even a stranger of the recipient.
For more information about UAB’s Living Kidney Donor Program visit the Living Donor Program Page.
Organs and tissue that are unable to be transplanted may be used for invaluable medical research, education and development. Medical advancement would not be possible without this generous gift.
The Alabama Brain Collection is a unique resource housed in the Department of Psychiatry at the University of Alabama, Birmingham, and is dedicated to promoting brain tissue research. Brain tissue with and without a history of a neuropsychiatric disorder may be donated. For more information, visit the Alabama Brain Collection