Jeff's Journal

How Do You Donate?

Several people have asked, about how to donate. At the moment, there are two ways to donate; a cadaveric donation and a live donation. (I’ll save my post for self donation via therapeutic cloning for another time.)

One type of donation is cadaveric. This is after a person dies. You might think that if you have a donor card in your wallet at the time of death your organs would be harvested for donation. That is not necessarily the case.

The non-profit corporation United Network for Organ Sharing (UNOS) operates the Organ Procurement and Transplantation Network (OPTN) through a contract with the Department of Health and Human Services. OPTN coordinates the work of Organ Procurement Organizations (OPO’s). The OPOs educate about organ donation and work with agencies (hospitals, transplant centers, etc.) to identify potential donors, secure consent and distribute donated organs. These groups create and maintain the national waiting list. (There is a national waiting list, but the donor lists are not centralized.)

Although 85% of the US population supports organ donation, actual donation rates are below the national need. At the time of death when circumstances are favorable for donation, a representative from the OPO speaks with the family about donating. If the deceased had not discussed organ donation with their family, the family will often decline to give consent. Currently, in our country (USA) a person must “opt-in” to the organ trade. You do this by signing a Donor Card, or checking the box when you renew/get your driver’s license, or in some states, signing up on the state registry, but if you have not informed your family of your intentions, those standing around the bedside are the ones who will make the decision. Even when a person has opted in, the family has the last word. Sometimes the family will decline even when they know their loved one’s intentions.

Our system for cadaveric donations is opt-in, but what would happen if the system were set up as an opt-out system? In this scenario, if you did not want your organs donated, you would register on a national list. What would happen if we were to register the opt-out with the OPTN? Then when a person died and circumstances would allow organ donation, the OPO would search through the registry to see if the person opted out of donating. If a name did not appear on the registry, it would be presumed the deceased had consented to be a donor. This would reduce the very emotional triangles and other issues with the grieving family.

Other countries have an opt-out policy. They have about a 2% rate of those who have opted out of donating. It would be easier to track down 2% rather than miss out on a potential 98% donation. (Of course, this is the logic from a guy waiting on the list!)

Another issue is with accountability for those maintaining lists. One of my potential donors is a State Representative and he has looked into the donor list in Texas. Apparently, the Texas Department of Public Safety was allocated funds for creating and maintaining the database of donors a couple of state sessions ago. When my friend went to investigate it this last session, guess what? The database had not been created. So, he is making the TDPS accountable for their funding. So, even though you have checked the box when you got your driver’s license, it went no where. Carry your paper card in your wallet.

So on the cadaveric sides of things, until we get an opt-out policy, carry your donor card and tell your family. If you are really serious, you might put a clause in your will to disinherit your family if they go against your wishes. If you need a card, click here. If you need a form to inform your family, click here.

The other type of donation is a live donation. Live donations are becoming more common. A National Kidney Foundation survey stated one in four Americans say they would consider donating a kidney to a stranger. I have been very fortunate because many friends have offered to donate a kidney to me. Some were eliminated from the process because our blood types do not match, others because they have had a disease that would harm me post-transplant because of the immune suppressant drugs. Others have discovered it would be harmful for them to donate.

I only know the process for living donation at Memorial Hermann Hospital in Houston. Their process has four stages. A potential donor must make the initial contact to the transplant clinic. There can be no coercion or exchange of money in a donation and the clinic cannot make the first contact.

Stage one is to call the Transplant Coordinator and make an appointment for an initial evaluation. Once the appointment is made the donor has to face “the door” into the clinic. It is one thing to talk about donating, but to actually walk through the door brings up all sorts of emotions. In this stage, blood pressure is checked and initial labs are done. This includes basic blood work and urinalysis. (My friends have joined me in hauling jugs of urine to the clinic.) All along the process is a psychological evaluation and reality check for the donor so they know what they are doing and what they are getting into.

Stage two involves more blood. The lab draws about 12 vials for testing. The major test this go round is a tissue typing. In this test, the donor’s blood and recipient’s blood are mixed together. This test takes about a week to return and you are looking for a negative cross match. If there is a negative cross match and the other blood work comes back in good standing, then it is on to stage three.

Stage three is a thorough battery of exams. It is like your annual physical on steroids. Every part of the donor’s body is examined; inside and out. The evaluation is to make sure the donor is healthy enough to survive donating a kidney. Stage four is when the medical review board compiles all the data and makes a final decision whether or not to schedule a transplant. Before the transplant, there is one final cross match just to make sure.

The transplant proceeds if the final cross match returns favorable. The transplant requires two operating rooms across from each other. The donor goes into surgery before the recipient. The nephrectomy (kidney removal) takes a couple of hours and then the recipient is taken to surgery to receive the kidney. It makes for a long day. Recovery for the donor can take up to eight weeks. Most folks do well after a couple of weeks. Fortunately, for the donors, the nephrectomy can be done laparoscopic with a small incision. In former days the donor would be cracked open from the back, ribs broken and recovery would take a couple of months.

For the donor, life progresses with one kidney. For the recipient, life has a new lease. There are new ordinances to observe with anti-rejection and immune suppressant drugs, but the sacraments of dialysis are sequestered.

posted by Jeff Waldo @ 11:07 PM