Organ donation: what are the logistics?

Factual Questions
1

Let’s say somebody who is an organ donor dies, perhaps in a car accident. How fast do the person’s organs have to be harvested, and what is the usual procedure? Would this happen in the emergency room of a hospital if the patient died there? What if he died on the scene (somewhere away from the hospital)? Would the doctors just check the person’s driver’s license to make sure he’s an organ donor and then just start removing what they need, or would they contact next of kin first, or what?

What if someone was slowly dying at home, or in the hospital in a deathbed, and they made their wishes known that they wanted to be an organ donor? Would the doctors just swing into action as soon as the patient died, or what would that procedure be? How do they know what to take, or do they just take everything and check a list later to see what is needed? Would all the organs go to local recipients, or is there a chance they’d be transported around the country? What if someone was still alive and wanted to donate a kidney? How would that be set up in advance?

I’m very curious because I’m a registered organ donor and I had a semi-near-death experience in traffic recently, so I wanted to know how it all works.

2

Partly a BUMP.

Partly an answer to some of it:

For the doctors to start “carving you up, and removing your bits” they MUST have signed consent from Next of Kin. Period. They might keep you alive mechanically, in a clear brain death case, while they wait for this consent, but they can’t do it in advance.

For donations, the donor must have been in reasonably good health, with no underlying complications (cancer, HIV, hepatitis, etc…) so I don’t think the person that was “slowly dying at home” would qualify under that…

I’m sure our resident doctors can answer much better than I can though. Paging QtM !!!

-Butler

3

If the organs are donated for purpose of transplant, at least. Donated organs can also be used for educational or scientific purposes, though. No matter what a person dies of, I’d think some part or parts of the body would be useful for studying that cause of death.

4

My mother was a total body donor, as am I. My mother’s body was transported to Emory University in Atlanta from Newnan. Her corneas were harvested before transport.

I do wish Emory had seen fit to tell me they were sending my mothers cremains to me, instead of me opening the box and finding them. It was quite a shock.

5

Sorry - forgot the main point of the above post (snerks at self). Reason for total body donation: those doctors to be have to have someone to carve on and do weird medical school pranks with!!

6

I can tell you what happened with my mother just a couple of months ago. She had a brain aneurysm, she was pretty much gone by the time she got to the hospital. She wanted to be a donor so that part at least was easy.

First what they did was asked me a ton of questions, like any health problems she might of had, any diseases she had, the same kinds of sex questions they ask when you give blood, how she ate. Basically a ton of personal questions, some of which I could not answer but my aunt could. The packet was a good three to four pages long.

Then they went over all the different parts that we would want donate. That included all the organs, the skin, bones, and other tissues. Then they wanted to know if we were ok with how they donated the organs, either to other people or for study.

They kept my mother on a machine for a couple of days, even though she was technically dead, so that the family could come in from around the country. I know they did a number of tests on all of the major organs to determine if they could be used. Then they pulled in all the people that they could who could use the organs then did the transplants. I know that the liver, kidneys, and lungs went to people. The heart could not be used whole because of her age, 51, but the valves could be.

After all was said and done, when the body came back you could tell a bit that things were different, the arms were not totally straight because the took the bones, but no one else seemed to notice. The company who did the work has kept us in the loop for the last couple of months, and one family has expressed an interest in meeting the children.

I did ask some questions, though I don’t remember them all, but I do know that the major organs have to go pretty quickly. They have a database of recipiants, for local, state and nationwide. They try and go local first then go out.

I’ve got to go but if you have other questions let me know, I’ll see what I can remember.

7

A couple of rather morbid questions:

  • When they have to keep the donor on life support for a bit, who pays that part of the hospital bill? Does the donor/family’s health insurance pay? Is it allocated among the recipients somehow? does the hospital just “eat” the cost?

  • If you want to donate your body for research, how would you arrange that? do you carry a card with you? Does the hospital ask (once they’ve determined the patient is not suitable for or does not want to be an organ donor)? Do you pre-arrange with the proposed recipient? and who pays the costs associated with preparing the body and shipping it?

8

In my EMT days ambulances occasionally met planes at the airport to pick up an organ courier and ran them lights and sirens to the hospital doing the transplant surgery. I dunno what the storage life of a harvested organ is but under perfect conditions I cant see them lasting more than an hour or two.

In some respects It would seem to be easier to transport whole intact patients even being paced and or manually ventilated the whole way than trying to move fast enough to keep an organ from dying.

9

I believe that the company who does the harvesting pays for the hospital stay. For my mother they had people working for them taking care of her and not people with the hospital. I’m guessing that they pass on the costs to the reciever’s insurance. I know that my mother’s insurance did send me a letter saying that organ harvesting is not covered under her insurance. I just tossed it.

10

I can answer some of your questions. I’ve worked with many organ donors. The family must sign consent for organ removal. The medical team taking care of the donor has nothing to do the harvesting. A harvesting team comes in after brain death is confirmed. They are not part of the hospital staff. They cover the given community.

Organs are not harvested until the donor has been clinically tested twice for brain death, with at least a 6 hour interval between tests. Or they have to have a brain flow study, showing no blood flow to the brain.
In the meantime, their organs must be kept viable, so the donor is intubated, on a ventilator, their blood pressure is supported with IV fluids, rather than vasopressors, since antihypotensives would cause blood vessel constriction, and possibly damage the harvestable organs.
Once brain death as been confirmed, the retrieval team takes the donor to OR.
The whole process takes several hours, so, the donor is cared for in the ICU. Donor care can be very time consuming, most ERs just wouldn’t have the resources or man power to do it.
If a potential donor dies in the field, a few things are still harvestable. Skin and bones are more forgiving as are corneas, but they are less so.
Heart, lungs, liver, pancreas and kidneys need to be oxygenated until the go on ice, so the person has to make it long enough to get onto life support.

The organs rarely go to the local community. There are national and international databases for each organ type. Blood is drawn for the donor while on life support. Tissue typing is done and checked against the databases for possible matches. Final tissue typing is done after harvesting. If they still have a viable matches within the time frame area, the different organs are shipped off to their new homes. Each organ has an time limit it can be without circulating oxygen. That time frame dictates where it can go. Hearts are IIRC 6 hours.

Living, unrelated kidney and partial liver transplants have been done. The risk is pretty high and the change of organ failure no better than a cadaver donor.
I hope this answers your questions.
Here are some US and international sites for more informatiom
1. U.S.
2. U.S.
3. International

11

God bless your mother. She’s done a great service.