Organ Donation Process
The organ recovery process involves a series of events coordinated by hospitals and organ procurement organizations.
The National Organ Transplant Act of 1984 (NOTA) was enacted to help ensure the process is carried out in a fair and efficient way, leading to equitable distribution of donated organs.
The act established the national Organ Procurement and Transplant Network (OPTN) for matching donor organs to waiting recipients. The OPTN is managed through the United Network for Organ Sharing (UNOS) located in Richmond, Virginia. UNOS works with 58 federally designated OPOs across the country to place organs locally, regionally and nationally.
Identification of the Potential Donor by the Hospital
Medical professionals at a hospital identify a potential candidate for donation that has a GCS of five or less, ventilated and has suffered a devastating disease process/neurological/brain insult. Due to the absence of brain stem reflexes, this would lead a physician to determine the patient is brain dead or give the option to withdraw support in the face of ineffective therapy.
Evaluation of Donor Eligibility
CORE is called on all patient deaths and imminent patient deaths. Information is provided on the patient’s medical status and the CORE recovery coordinator evaluates the patient. The evaluation includes a medical and social history and physical examination of the patient. This determines whether or not the patient is a suitable candidate for donation.
Authorization for Organ Recovery
If the patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached and notified of the decedent’s decision to donate. If a donor designation or individual authorization by the decedent cannot be identified, the family must give their authorization in order for the donation process to proceed. If the family authorizes donation, the legal next-of-kin signs a donor authorization form.
Medical Maintenance of the Patient
Once the family authorizes donation or donor designation has been provided, the CORE coordinator, in concert with the hospital staff, maintains the patient medically. In some cases physician support is requested on a consultation basis.
Matching Organs to Potential Recipients
Information on the organs available for donation, the donor’s blood type and body size is provided to UNOS by the CORE coordinator. The UNOS computer then matches the donated organs to potential recipients. Recipient selection is based on blood type, body size, medical urgency and length of time on the waiting list. The heart, liver and lungs are matched by blood type and body size. In matching the pancreas and kidneys, genetic tissue type is also considered.
Offering Organs Regionally, then Nationally
A computerized list of waiting patients in the matching blood group is provided to the CORE coordinator who seeks to match organs with recipients in the CORE donation service area. If a match cannot be made for a specific organ within this area, the organ is offered on a regional basis, then nationally, if necessary.
Placing Organs and Coordinating Recovery
When a recipient match has been found, the CORE coordinator sends an electronic message to the transplant center for the patient who matches the donated organ(s). The patient’s transplant surgeon is responsible for making the decision whether to accept the organ. If the surgeon declines the organ for that patient, the CORE coordinator contacts the transplant surgeon of the next patient on the list. This process continues for each organ until all of the organs have been appropriately matched with recipients. The CORE coordinator then arranges for the operating room (for the recovery of the organs) and the arrival and departure times of the transplant surgery teams.
Surgical Recovery of Organs
When the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure. In accordance with federal law, physicians recovering the organs do not participate in the donor’s care prior to the determination of brain death.
Preparing Recipients for Surgery
Once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital. Upon the organs’ arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed.
Distribution of Organs
The CORE coordinator provides a sample of the lymph node tissue to the surgical teams for tissue typing and subsequent matching with recipients. Other organs are taken directly to the recipients by the surgical recovery teams.
Funeral and Burial Plans
After the recovery process has occurred, the donor family can proceed with funeral or burial plans, which are not affected by organ donation. Organ and tissue donation is a dignified and respectful process.
Follow-up with Family and Hospital
CORE follows up each donation by sending letters to the donor family, hospital staff, physicians and nurses regarding the organs and tissues that have been recovered.