Organ Donation and Transplantation
Organ transplantation is the act of taking an organ from a living or deceased donor and using it to replace a dysfunctional or damaged organ in a recipient’s body. The surgical techniques required for this procedure have been around for a long time, however the problem has always been rejection of the new organ by the body receiving it.
The first successful organ transplant was in 1954, and it involved a kidney between living twin brothers. After drugs that help the body not reject the new organ (immunosuppressants) were developed, a large number of transplantations occurred, all having much more success than their earlier counterparts. Now transplantations can extend a patient’s life by several years with proper immunosuppressive (drug) therapy.
Some other interesting facts about organ transplantation:
- Hearts, intestines, kidneys, livers, lungs, and pancreata can all be transplanted. Other promising initial transplants have included trachea and face transplantation.
- Between January 1 and May 31, 2013, 77 people received an organ transplant in the U.S. (UNOS.org)
- In 2012, more than 28,000 patients began new lives thanks to an organ transplant. (UNOS.org)
- Living donors can donate a kidney or parts of their liver or lung.
Matching Donated Organs to Patients
When a potential organ donor is identified a transplant coordinator from an organ procurement organization enters medical information about the donor into the United Network for Organ Sharing (UNOS) computer system.
The system then matches the donor\”s medical characteristics with the medical information of candidates awaiting a transplant. The computer generated a ranked list of patients for each organ recovered from the donor. These “matches” are based on many things which may include:
- Level of illness
- Medical urgency of the transplant candidate
- Time spent on the waiting list for some organs
- Biological similarities between the donor and the candidates (such as organ size, blood type, and genetic makeup)
- Candidate’s availability to be transplanted immediately
Waiting For an Organ – How Long it Takes
Patients added to the national organ transplant waiting list may receive an organ that day, or they may wait years. Factors affecting waiting time include:
- How well the donor and recipient “match”
- How ill the patient is
- Availability of donors compared to the number of patients waiting
To gauge waiting time, UNOS publishes waiting time statistics by geographic region, sex, age, blood type and ethnicity.
Can a patient from another country receive a transplant in the U.S.?
Yes. Patients can travel from other countries to the U.S. to receive transplants. Once accepted by a transplant center, international patients receive organs based on the same policies as those that apply to U.S. citizens. These types of transplants are limited in number.
Preventing Organ Rejection
Once a donated organ has been surgically implanted, the focus of the medical teams is to insure organ function and prevent rejection of the new organ by the body receiving it.
Why the Body Rejects Organ Transplants
Because of the body’s natural function to eliminate foreign substances, the first successful organ transplant was not completed until 1954, and it involved a kidney between living twin brothers. Because their DNA was identical, the body didn’t reject the transplanted kidney. This however is a rare situation. Needless to say, essentially all donors are not identical twins. The differences then identify the transplanted organ as a “foreign” entity which without special medicines, would be attacked as part of natural body defense mechanisms.
Eventually, drugs that help the body not reject the new organ (immunosuppressants) were developed, a large number of transplantations occurred, all having much more success than their earlier counterparts. Now transplantations can extend a patient’s life significantly with proper immunosuppressive (drug) therapy.
Types of Drug (Immunosuppressive) Therapy
There are three types of immunosuppression involved with organ transplants:
- Induction immunsuppression
- Maintenance immunosuppresion
- Anti-rejection immunosuppresion
Induction immunosuppresion – These drugs are given right after transplantation and the doses are very high; this serves to prevent immediate rejections. The medications could be continued for up to the first 30 days after discharge, but are not used for long term maintenance.
Maintenance immunosuppression – These are the drugs given before, during, and after transplantation with the intention to maintain the organ transplant for the long term. Maintenance immunosuppression does not include any medications given to treat rejection episodes, or for induction.
Anti-rejection immunosuppression – These drugs are given for the purpose of treating an acute rejection episode during the initial period after a transplant or during a specific follow-up period, usually up to 30 days after the diagnosis of acute rejection.
Side Effects of Immunosppressive Drug Therapy
The following are some of the more common side effects associated with some immunosuppressive drugs. Side effects can include:
- Gum overgrowth
- Hair loss
- High blood pressure
- High cholesterol
- Increased appetite
- Increased blood sugar
- Mood swings
- Nausea, diarrhea and/or vomiting
- Swelling of feet, hands, abdomen or face
- Trouble sleeping
- Unwanted hair growth
- Weight gain
It may be possible to control these effects by changing doses or drugs. If there is any question, ask your doctor about the various choices in immunosuppressive drugs.
Myths and Facts About Organ Donation
It is important to have all the facts in order to make a fully informed decision about whether or you or a loved one wants to be an organ donor. There are many misconceptions about organ and tissue donation.
Getting the Facts Straight
A number of myths surrounding organ donation often create an inaccurate picture of what happens if you choose to be an organ donor. The following myths and facts are from the Organ Procurement and Transplant Network web page on organ donation.(http://www.optn.org/about/myths.asp)
Myth: If emergency room doctors know you’re an organ donor, they won’t work as hard to save you.
Fact: If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ donation can only be considered after brain death has been declared by a physician. Many states have adopted legislation allowing individuals to legally designate their wish to be a donor should brain death occur, although in many states Organ Procurement Organizations also require consent from the donor’s family.
Myth: When you’re waiting for a transplant, your financial or celebrity status is as important as your medical status.
Fact: When you are on the transplant waiting list for a donor organ, the only factors which determine organ allocation are medical factors specific for that organ and includes measure like the severity of your illness, time spent waiting and blood type among others.
Myth: Having “organ donor” noted on your driver’s license or carrying a donor card is all you have to do to become a donor.
Fact: While a signed donor card and a driver’s license with an “organ donor” designation are legal documents, organ and tissue donation is usually discussed with family members prior to the donation. To ensure that your family understands your wishes, it is important that you tell your family about your decision to donate LIFE.
Myth: Only hearts, livers, and kidneys can be transplanted.
Fact: Needed organs include the heart, kidneys, pancreas, lungs, liver, and intestines. Tissue that can be donated include the eyes, skin, bone, heart valves and tendons.
Myth: Your history of medical illness means your organs or tissues are unfit for donation.
Fact: At the time of death, the appropriate medical professionals will review your medical and social histories to determine whether or not you can be a donor. With recent advances in transplantation, many more people than ever before can be donors. It’s best to tell your family your wishes and sign up to be an organ and tissue donor on your driver’s license or an official donor document.
Myth: You are too old to be a donor.
Fact: People of all ages and medical histories should consider themselves potential donors. Your medical condition at the time of death will determine what organs and tissue can be donated.
Myth: If you agree to donate your organs, your family will be charged for the costs.
Fact: There is no cost to the donor’s family or estate for organ and tissue donation. Funeral costs remain the responsibility of the family.
Myth: Organ donation disfigures the body and changes the way it looks in a casket.
Fact: Donated organs are removed surgically, in a routine operation similar to gallbladder or appendix removal. Donation does not change the appearance of the body for the funeral service.
Myth: Your religion prohibits organ donation.
Fact: All major organized religions approve of organ and tissue donation and consider it an act of charity.
Myth: Patients are not really dead when their organs are removed.
Fact: Organs are not removed until an independent physician pronounces the patient dead.
Myth: Medications are given to organ donors that will cause their death.
Fact: No medications are given to cause a patient’s death. Patients may be given medications while they are on the ventilator to keep them comfortable.
Myth: Families cannot be with their loved one when he or she dies
Fact: Families can request to be with their loved one until death is pronounced. Most hospitals have mechanisms to respond to these requests.
How to become an Organ, Eye and Tissue Donor
There is an urgent need for registered organ, eye and tissue donors in Ohio and across the United States. One organ donor can save eight lives, while one tissue donor can enhance the lives of more than 50 people. Unfortunately, 107,000+ men, women and children nationwide are currently waiting for life-saving organ transplants. Thousands on that waiting list live in Ohio.(LifeBanc.org)
To become a registered organ, eye and tissue donor, do one of the following:
- Say yes to donation at the BMV when renewing your driver license
- Register online at LifeBanc.org or call for a registration form at 216-752-5433
- Include donation in your living will
- Inform your family about your decision
For more information about organ donation, please contact:
For more information:
Go to the Kidney Diseases health topic.