CORE coordinates the recovery of organs, tissues and corneas for transplant. Traditional organ donation requires a person to be in a hospital and on a ventilator when they are pronounced brain dead.
If a person experiences cardiac death, which means the heart has stopped and will not work again, they will be evaluated for tissue and cornea donation. Of the 2.2 million people who die each year, only approximately 2 percent of them are able to be organ donors.
Cause of Death
The manner in which a person dies determines what organs and tissues can be donated. In most cases, people who are evaluated for organ donation have suffered fatal head injuries resulting from a car accident, stroke or a brain aneurysm.
A person is not evaluated for organ donation until all life saving measures have been attempted. For the hospital and the first responders, their sole purpose is to save the life of the patient. The doctors will do everything in their power to try to save the life of the individual. And, the hospital staff working to save the patient’s life is completely separate from the transplant team. A person must be pronounced dead in order for organ and tissue donation to proceed.
Pennsylvania & West Virginia Death Law:
Only an individual who has sustained either: (1) irreversible cessation of circulatory and respirator functions; or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.
The majority of deceased organ donations take place after a physician has declared the patient to be brain dead. According to the American Academy of Neurology, brain death is the irreversible loss of clinical function of the brain, including the brain stem, and is a legal declaration of death.
The declaration of brain death is not a subjective decision by a physician. The patient undergoes numerous tests to confirm an irreversible loss of brain function and support the pronouncement of brain death. Usually the brain-dead patient has suffered a brain injury resulting from trauma, oxygen deprivation or stroke. The person’s heart is kept beating by mechanical ventilation, which keeps blood and oxygen flowing to their organs.
As a result, a brain-dead person can look “alive,” despite having suffered an irreversible loss of brain function. This situation can be confusing for loved ones and it is essential that physicians explain the clinical certainty of brain death to help families understand and accept that the person is not coming back.
Donation After Cardiac Death
Anyone whose brain function has been determined to be incompatible with life but does not meet all criteria for brain death is a potential candidate for donation after cardiac death (DCD).
DCD may be presented as an option to families when they have accepted that their loved one cannot survive and have made the decision to remove the person from life support. If the family chooses DCD, the person will be taken off the ventilator in an operating room. When their heart stops beating, a physician declares death and organs are recovered.
This is the original method of managing organ donation and has increased donations by as much as 25 percent in some parts of the country. Organ donation after cardiac death accounts for approximately 14 percent of lifesaving donations in CORE’s region.
Hospitals are required to report each death or imminent death. State legislation known as PA Act 102 of 1994 served as the template for the federal initiative, making this referral process a nationwide requirement.
In Western Pennsylvania, most of West Virginia, and Chemung County, New York, hospital staff will notify CORE. CORE then reviews the potential donor’s medical condition and history to determine what gifts he or she would be able to donate.
If the person is a candidate for organ donation, one of CORE’s organ procurement coordinators will review the medical chart at the hospital and, if appropriate, speak with the potential donor’s next-of-kin. When there is potential for tissue donation, a donor referral coordinator will call the potential donor’s family to discuss donation options.
Evaluation of Potential Donor
During the evaluation process, information is provided about the potential donor’s medical status and past medical history. The evaluation includes a medical and social history and physical examination. This determines whether or not the person is a suitable candidate for donation.
If their medical history does not rule out donation, CORE then begins the process of working with the hospital to determine the appropriate time to approach the legal next-of-kin. If a donor designation or individual authorization by the potential donor 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. Once the family authorizes donation or donor designation has been provided, the CORE coordinator, in concert with the hospital staff, maintains the donor medically. In some cases, physician support is requested on a consultation basis.
Information on the organs available for donation, the donor’s blood type and body size is provided to UNOS (United Network for Organ Sharing) 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.
In matching the pancreas and kidneys, genetic tissue type is also considered. A computerized list of waiting patients 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 CORE’s area, the organ is offered on a regional basis, then nationally if necessary.
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.
When the transplant surgery 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, transplant surgeons recovering the organs do not participate in the donor’s care prior to the determination of brain death. Tissue recoveries such as bone, cornea and skin occur following the organ recoveries.
The appearance of the donor is not affected, and open-casket funerals are still possible. When an organ is recovered from the body, it is flushed with a cooled solution to remove the blood from the organ, which is vital to its preservation. The organ is then evaluated carefully. It is packed in a sterile solution and ice, and taken to the hospital where the transplant will take place.
In the case of kidney transplantation, additional testing is required to determine the best match for its intended recipient. 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. 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. 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.
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. About 14 days after donation, the donor’s family will receive a letter from CORE describing how the donor helped transplant recipients. One organ, tissue and cornea donor can save or enhance the lives of up to 75 recipients.
We provide aftercare for our donor families, including grief counseling and CORE’s A Special Place ceremony. Our donors and their families are important to us. Without them, there would not be recipients.