The donation process
The donation process is complex and requires a coordinated team approach.
Mechanism of Injury
Organ donors are generally healthy people who have suffered an injury to the brain (such as bleeding into the brain, strokes, vehicle/motorbike accidents, gunshot wounds, and drowning), which can lead to a state of brain death.
Life-saving efforts begin at the scene of the brain injury before arrival to the Emergency Department (ER). In the ER, doctors and nurses are involved in the medical care required to assess the extent of the brain injury and other injuries to the patient.
Intensive Care Unit (ICU)
Once in the ICU, further testing is done to evaluate how much damage has been done to the brain. In cases where a severe injury has occurred, this testing may show that brain death has occurred.
Brain Death occurs when:
- The patient is in a state where they will never wake up.
- The patient loses all vital functions of the brain, which includes the ability to ever breathe on their own.
Brain death means that a person is dead even though their heart continues to beat and breathing is made possible by use of a breathing tube and a breathing machine. A series of tests are done by two doctors who are experts in the field of brain injury to confirm that the patient is brain dead.
There are times when this series of brain death tests cannot be performed, and a more highly specialized test is needed called a CT Angiogram. A CT Angiogram test looks to see if blood is flowing in the brain. If blood is not flowing in the brain, the person is brain dead.
Brain death may be difficult for family members to understand because their loved one is being supported by machines, and looks as if he/she is asleep. Brain death is not the same as a coma where some brain function is still present.
In the case of brain death, blood is still flowing to other body organs such as the heart, lungs, liver, kidneys, small bowel and pancreas. Once the patient’s family makes the final decision to donate, these organs may be transplanted into another person as long as the organs are working properly; and there are no serious health concerns.
In the past, death was thought to occur when the person stopped breathing and their heart also stopped. Advances in medical science now allow us to artificially support the breathing and blood pressure of a patient. This means that we now have two ways to define death:
- Cardiovascular death- which occurs when the heart stops beating and there is no breathing.
- Brain death - which occurs when the brain stops working, but the heart is still beating and the person breathes with the use of a breathing machine.
Transplant Manitoba-Gift of Life Program (TMGLP) can receive a call about a donor in one of two ways:
Early referral- is when a patient with a severe brain injury is close to brain death and the hospital staff is calling to see whether the patient would qualify to be an organ donor. This is done before approaching the family with the end-of-life care options.
The patient has already reached brain death, as confirmed by the testing, and the medical staff is calling to see if the patient would qualify to donate organs.
Medical staff will call a Donor Coordinator (a specially trained nurse) from Transplant Manitoba with the referral. If the family is in need of more information about organ donation, the Donor Coordinator can come to the hospital to talk with the family.
Once brain death has happened, the Donor Coordinator will meet with the family to provide information on organ donation in a sensitive and supportive manner. During the meeting with the family, the patient remains on a breathing machine and can be given medications while the family is making a decision. The decision can be easier and less stressful for the family if they have already talked about organ donation before.
The family may give consent for which organs they wish to donate during this meeting.
Once a decision has been made by the family, then they can go forward and make all of the funeral arrangements.
A series of tests and exams are then performed to assess the organs being offered for transplant. These tests and exams determine how stable the donor is, if the organs are working properly, and if there is any risk of diseases being transmitted from the donor to the person receiving the organ. Even if the organs were healthy and strong in life, the process of brain death can cause injury to the organs, which can make them unfit for transplant.
To ensure the health and safety of the person receiving the organ (recipient), a review of the donor’s medical and social history is carried out with the family using a detailed questionnaire. The questions asked are similar to the ones asked when someone donates blood. A physical exam and other blood and medical tests are also performed.
Donated organs are matched to recipients based on: blood type, height, weight, and how sick the recipient is, and how long they have been waiting for a transplant. The most suitable recipient for each organ is identified before that organ is removed, because organs cannot be stored for long periods of time outside the body. Finally, for the best match of an organ to a recipient, a special blood test called HLA typing (DNA/ genetic test) is done to see which recipient would have the least chance of rejection of that organ. Every attempt is made to find a recipient for each organ, and it is rare to not locate a suitable one.
The donor is taken to the operating room once all of the tests are completed, recipients have been chosen, and the transplant teams are assembled. The donor surgery takes place in the same manner as any other surgery. The donor’s organs are removed and transplanted without delay.
After Organs Have Been Recovered
The donor is kept at the hospital until he/she can be taken to the funeral home. Organ donation should not delay any funeral arrangements. However, as with all hospital deaths the Medical Examiner must review the hospital chart before making the decision to release the body. An open-casket funeral is still an option for the family.
After donation has occurred, the family is contacted by telephone to tell them which organs were recovered for transplant or research. The family will also receive a letter from the Donor Coordinator giving them general information about the recipient(s) of the organs.
Transplant recipients may write a thank you letter to the donor family. Manitoba Law requires Transplant Manitoba to be responsible for sending these letters between the recipients and donor families to ensure that the privacy of the families and the donor is maintained.