Organ donation is when a person gives their organs after they die to someone in need of new organs. Transplantation is the process of transplanting the organs donated into another person. This process extends the life expectancy of a person suffering from organ failure. The number of patients requiring organ transplants outweighs the number of donor organs available.
History of organ transplantation Australia's first organ transplants were corneal transplants in the early 1940s. Following in chronological order are monumental first in Australia's organ transplantation history.
Early 1940s Australia began corneal transplants in Sydney and Melbourne 1965 Australia's first successful (living) kidney transplant 1984 Australia's first successful heart transplant 1985 Australia's first successful liver transplant 1985 Australia's first successful kidney transplant from a deceased donor 1986 The Brisbane Technique for splitting livers to benefit three recipients initiated 1986 Australia's first successful heart/lung transplant 1987 Australia's first successful kidney/pancreas transplant 1987 First segmental liver transplant (for children) (Australia) 1989 First successful living liver transplant (Australia) 1990 Australia's first successful single lung transplant 2002 First single segment liver transplant on a baby (24 days old) (Australia) 2003 Australia's first triple transplant (heart, lung, liver) 2006 World's first kidney/liver/pancreas transplant (Australia) 2012 Australia's first pediatric intestinal transplant (liver), (small bowel), (duodenum), (pancreas) The following table (Table 1.1) shows the global transplantation milestones in chronological order.
Table 1.1. Global transplant milestones
Table 1.1 Source: Australian Government Tissue Donation and Transplantation Authority. http://www.donatelife.gov.au
Donor types There are two types of donors; living donors and deceased donors.
Living donors In Australia the most common living donations not including blood donations are kidneys and bone marrow. The tissues and organs that are able to be donated by a living donor are:
Bone marrow Kidney Part of the liver Lung (this requires two living donors. One donates a lobe from their left lung and the other donates a lobe from their right lung) Part of the intestine Part of the pancreas
Eligibility for donation The minimum age for living donation is 18 years of age. A person may be eligible to be a donor if they are free from HIV, cancer, systemic infection, sickle cell anaemia, Creutzfeldt–Jakob disease and they are not a previous IV drug user.
Motives for living donation Donation to a family member is a common scenario. The reasons for a family member to want to be a living donor to their relatives are; a desire to help, self benefit (from loved ones improved health), a feeling of moral duty, pressure identification with the recipient, increased self-esteem from doing a good deed. It is the health professional's role to understand the difficulty of these situations involving relationships of loved friends or relatives and they are to determine whether or not the offer of donation is genuine or the living donor feels pressured into donating because of the seriousness of their loved ones organ failure. However most donations result in a positive psychological benefit to both the donor and recipient. If a donor is wanting to donate to someone who is not a relative or friend they are intensively psychologically tested to determine their motives and suitability for donation as there can occasionally be harmful motives such as attention seeking or mental illness.
Deceased donors (non-heart beating donors) Deceased donors have been declared dead and are maintained in ICU on ventilators so tissue oxygenation continues until the procedure of organ retrieval and cold preservation. Deceased donors are divided into two sub-classes.
Donation after brain death. A person is declared brain dead if there is complete loss of all brain function Donation after cardiac death. A person is declared cardiac dead if there is complete loss of all cardiac function Both types of deceased donors have complete and irreversible damage and returning to life is impossible. Thorough testing is carried out prior to confirming a person brain dead or cardiac dead. One deceased donor is able to save up to ten lives by donating the following:
Organs: Kidneys, pancreas, liver, lungs, heart and intestines Tissues: Bones, skin, heart valves, veins and corneas
Whole body donation After death some people choose to donate their bodies to science. These bodies are used in many teaching facilities and aid in teaching anatomy, surgical techniques or research. Whole body donation involves the deceased person contacting the university or teaching institution prior to death to obtain consent and cover the legalities involved. After death it is up to the family of the deceased to contact the chosen facility and arrange donation.
Opt in versus opt out Currently Australia's organ donation system is 'opt-in'. This means a person had to give consent (opt-in) to be a donor prior to their death, or their family can make the decision for them if they are considered a viable donor. The 'opt-out' system is used in several countries around the world. For this system everyone is placed on the donor list and must 'opt-out' if they do not wish to donate their organs. Whether Australia changes to the 'opt-out' system is constantly coming into question. In a discussion paper compiled in 2011 it was stated 35% of family members of a potential donor would refuse donation if they were unsure of the family members intentions on donating. However, if an 'opt-out' system was put into place and the potential donor did not opt-out prior to death, it was estimated only 20% of families would refuse donation. A study carried out in 2002 investigated donor rates of countries with 'opt-in' and 'opt-out' systems. The countries chosen for the study were ones that had relatively similar backgrounds and health systems. After the donation rates were calculated to match the mortality rates it concluded the difference in donor rates between the two systems were marginal. The results as follows (Table 1.2).
Table 1.2. Three year mean organ donation and mortality rates for 10 European countries. Reference:
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