When someone dies, a life is irretrievably lost. Yet, the very tragedy of death itself can bring life to not just one, but many people. Spain is a case in point. Not only has it been the word leader in donations and transplants for 28 consecutive years, it has continued to the point that it has broken its own record donors per million population, which now stands at 48.9 p.m.p. Altogether, 2,301 donors gave 5,449 organ transplants. There was a historical record in lung and kidney transplants, raising the figure to 116 transplants p.m.p.
Yet, beyond these amazing and inspiring achievements, the general public is largely unaware of how the transplant process works. Below, we’d like to demystify this life-giving act with a simple explanation of how it all works.
First of all, it is important to point out that not all organs are transplanted from deceased individuals. Many of the most common donations – such as one kidney or one lung, or part of a liver, intestine or lung – are taken from living people whose organs are compatible with the person receiving the donation.
The options for donation from deceased donors are greater: the heart, lungs, kidneys, liver and pancreas organs can all be transplanted, together with tissues such as eye tissue (cornea and sclera). Bone tissue can be grafted to replace that lost by tumours or other diseases or accidents. Up to 10 people may benefit from a single bone donation, depending on the type of transplant needed.
Skin is another tissue that can be transplanted, helping people who have suffered extreme trauma, infections or severe burns. It takes skin from three donors, on average, for each recipient.
Hearts can be donated as a whole organ, but heart tissues may be donated separately. The most common tissue donated is heart valves, used to correct congenital defects in babies and children, and also used to replace valves in adults.
The most recent additions to the possibilities of donated organs are faces and hands. Spain is a leader in both, having carried out hand and arm transplants since 2008, and the world’s full-face transplant in 2010.
So, what does this process itself involve?
The process may vary from country to country, but the Spanish protocol is as follows when the donor is diagnosed with brain death. A diagnosis of brain death is made only following a strict protocol of clinical neurological examination, an observation period, and the possible application of instrumental tests that support the diagnosis.
The first step is the detection of donors; this is important, because detecting patients is key to quickly and correctly identifying potential donors, and it is essential to maintain the potential donor’s blood flow and oxygenisation in the organs to be transplanted.
These patients with brain death are monitored closely and continuously, with the aim of maintaining spontaneous respiration, haemostatic stability, maintenance of body temperature and changes in the donor’s hydro-electrolyte and hormonal balances.
Once the diagnosis has been made – and excepting cases that may require judicial authorisation, such as signs of violence, suicide or a medically non-certifiable cause of death, when a judge must be consulted – a family interview is carried out. This interview with the family is done by the treating physician, who then suggests the feasibility of a donation. The decision is entirely up to the family, with the main goal of the interview being to help the family who is suffering from the loss. Taken into account are socio-cultural views, the grief and anxiety the family are feeling, and any other distinguishing characteristics that may enhance communication between the physician and the family.
If the family agrees to the donation, doctors then select and assess the donor’s organs and tissues to identify those suitable for transplant. At the same time, they must coordinate the logistics in both the donating hospital and in the transplanting hospital, if not the same. This often requires more than health professionals, as airports and transportation authorities are often involved. There is a transplant coordinator who manages, oversees and facilities the tasks of all those involved in this complex chain of events, and takes any decisions necessary so that everything runs smoothly.
The next steps are the extraction of the organs and tissues and their subsequent transfer to the transplant site, where the recipient receives the transplant. The donor’s incisions are sewn up so to disguise the incisions and allow the body to be viewed in an open casket if desired.
In truth, the transplant and donation process begins in society, with a donor who, after being diagnosed as brain dead, allows their organs and tissues to be donated to those whose conditions cannot be cured with any other conventional treatment other than a transplant.
From the moment the potential donor is identified, until they are wheeled into the operating theatre, then turned over to the family, they are treated with all the dignity and respect accorded to their humanity and generosity.
Have you registered as a donor? Give it some thought… your generosity may save and improve many lives.