Organ donation - the gift of a lifetime
I have just received a letter informing me that my driver's licence is up for renewal. Along with the letter came a leaflet asking me to consider becoming an organ donor. Having cared for several transplant patients over the years, I am a huge advocate of organ donation, so this is an easy decision for me. However, I know that for many this is a difficult issue, often complicated by cultural beliefs.
Organ donation is the process by which organs or tissue are removed from one person, and donated to another.
Successful donations have been performed with heart, lungs, liver, kidneys, pancreas, corneas (a small part of the eye) and skin.
In some instances, for example kidney transplants, it is possible to have live donors, who go on to live healthy lives with only one remaining kidney. However, organ donation is most commonly done when the donor is pronounced "brain dead" – for example, after a massive head injury or stroke.
At that stage, when the organs are still "alive" and working, but there is no hope of recovery, the doctors may discuss organ donation with the patient's family.
Transplantation began in New Zealand in the 1940s, when the first corneal graftings took place. Twenty years later, the first organ transplants were performed using kidneys and heart valves. The first total heart transplant occurred at Greenlane Hospital in 1987, and the 1990s saw liver, lung and pancreas transplants join the list.
Since the early days of transplantation, medical and surgical techniques have advanced hugely, making successful recovery and long-term survival for the recipient a far more likely outcome. Survival rates for heart transplant patients are now around 80 per cent at the five year point, and liver transplants are even more successful with around 90 per cent after five years.
Around 400 New Zealanders a year benefit from transplant surgery that restores sight, saves lives and improves health for the patients affected. However, many more people than this remain on the waiting list, hoping for a donor. In 2014, the numbers of transplants performed included:
★ 17 heart transplants
★ 17 lung tranplants
★·42 liver transplants
★·2 pancreas transplants
★·139 kidney transplants (including both live and deceased donors).
Without the possibility of a transplant, many of these patients would have died – and sadly lots still do, as they sit on the waiting list, hoping for a donor to become available.
Unfortunately, not all patients will be suitable candidates for transplant surgery. Before a decision is made about who will receive the donated organs, several things have to be taken into account by the transplant unit:
★ Blood group and tissue typing – these have to be compatible, or the recipient's body will "reject" the transplanted organ
★ Height and weight compatibility
★ Time spent on the waiting list
★ Degree of "medical urgency" around the recipients state of health
★ Other health conditions that may make transplantation too risky.
If there is no suitable recipient on the waiting list, organs will not be retrieved from a potential donor.
Who can donate?
Almost anyone can be considered as a donor, even children and elderly people. Although age and general medical condition need to be taken into account when deciding which organs can be donated, actually very few people are considered not suitable at all. A patient with severe asthma, for example, will not be able to donate their lungs, but could well be able to donate other organs such as heart, kidney or liver.
To become a donor, you need to tell your family. They are the ones who need to consent to the surgery at the time of your death. Registering your intent on your driver's licence isn't enough, unfortunately, as your family's consent will still have to be obtained. I would encourage you, if you are considering this as an option, to have the conversation, difficult as it may seem, so that your wishes can be respected by those who love you.
Organ Donation New Zealand (donor.co.nz ) provides information and support for those who are considering this process. They also help with contact between donor families and recipients if requested, allowing those who have received such an incredible gift the opportunity to say thank you.
Cathy Stephenson is a GP and medical forensic examiner.
- Have you ticked 'yes' to being an organ donor on your license?