Dr. Stephen Beed is Director of Critical Care at the Queen Elizabeth II Health Sciences Centre in Halifax and an associate professor of anesthesia and medicine at Dalhousie University.
Dr. Christopher Doig is an adult critical-care physician for the Calgary Health Region. He is also a bio-ethicist and advisor to the Alberta Advisory Committee on Organ and Tissue Donation and Transplantation.
RD: If medical authorities know that someone is an organ donor, would his or her medical care ever be compromised prior to removal of an organ?
Beed: Absolutely never. The health care team is focused on addressing whatever reversible medical conditions there could possibly be. Even in cases where we know that somebody will do very poorly, it doesn’t stop us from doing everything possible. If a family has been told that the prognosis is dismal, and they come to me to talk about organ and tissue donation, I try to defer it and say that we can talk about it if we get to that point. Organ transplant teams aren’t involved in providing direct care to the patient.
RD: What steps do medical specialists take to be sure someone is irreversibly brain dead and not simply in a coma from which they could wake up?
Beed: There is a very specific set of clinical requirements to be declared “brain dead.” In brain death, there is no evidence of function both in the higher structures of the brain (involved in talking, thinking) and in the brain stem, where many of the autonomic functions are handled. Not only is the patient unable to move, think or breathe, but there must be no evidence that the cranial nerves are working.
A coma is very different in that, although the patient is unconscious, most other brain functions are present. A coma may be reversible, but brain death is irreversible.
RD: Does the organ donation process increase the stress on the donor’s family in the form of additional bureaucracy?
Beed: There is a process that involves sitting down with someone on the health-care team to talk about the donation process to get consent. If the family gives consent, there is then a comprehensive screening examination that needs to be done so that people can be as clear as possible about the donor’s health status. [Healthcare staff] are very sensitive to the reality that the family is going through a rough time, and we do our best to be efficient and to respect their wishes, but it does have to be done to identify any potential risk factors in order to protect the potential recipient.
Although that can be an extra burden, in many cases it’s the only real peace families can get from what’s otherwise absolutely tragic circumstances. They know that two or five or ten families are going to benefit. It’s never a happy time, but it does give some relief, some comfort. And it’s absolutely crystal clear when you talk to the families who have given the gift of donation, months or years later, that it’s extremely comforting for them to know that other people and families have benefited from their gift.
RD: Does my religion permit organ donation?
Beed: My understanding is that none of the world’s major religions prohibit or advise against organ donation. But when families refuse on religious grounds, we don’t push it. We respect the wishes of the family.
RD: During the organ-donation process, is the body ever disfigured or made unsuitable for an open-casket funeral?
Doig: The surgeons and operating room teams use great care and respect in retrieving organs. This is not only to respect the donor, but also because ‘sloppy’ recovery of an organ will make it less likely to work when transplanted.
RD: Can someone with a medical condition, such as cancer or diabetes, still be an organ donor?
Doig: An individual who has ‘active’ cancer, with the exception of a primary brain tumour, cannot be an organ donor. A person with diabetes can be an organ donor, but there is careful assessment of the heart, kidneys and liver. (Diabetes can cause damage to the kidneys, increase fat in the liver, which damages the liver, or blood vessel disease in the heart). There is no reason why the lungs from a diabetic donor cannot be used.
RD: What is the most common type of organ transplant done?
Doig: The kidney is the most common organ transplant, followed by the liver, heart and lungs. There are two kidneys available per donor, and only one heart and liver. The kidney is least likely to be affected by the illness or injury that damaged the brain and led to the donor’s death. The kidneys and liver can be used from donors who are older than heart donors.
RD: Do organs ever come from living donors?
Beed: The rate of living-related donation is increasing, and it is almost always a family member because from a genetic standpoint, a good match is more likely to come from a relative. But also, to give this kind of a gift, you’re usually doing it for somebody that you’re pretty close to. I’ve also seen situations where by coincidence a close friend has been a good match genetically. Although kidney donation is by far the most common living-related procedure, living-related liver donation is also occurring. Doctors take a healthy donor, remove part of their liver and then transplant it into a relative. In other cases, part of a lung has been donated as well.
RD: If a person dies at home, can their organs be used?
Beed: No, their organs cannot be used, but they may still be able to give the gift of tissue donation. Tissue donation is very important, and we’re doing between 1,500 and 2,000 tissue transplants a year at this hospital. The vast majority are bone and skin transplants, but other tissues can be used as well. If you donate a cornea and someone can now see, then you’ve given that person a pretty amazing gift.
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