Organ donation, an invasive surgical procedure involving the removal of human body tissues from one person who has recently died or living donor, re-purposes living organs and tissues by transplantation into a needy patient. At the time of death, the recovery agency assesses which organs, soft tissues, or eyes are acceptable for transplantation. Organ donation usually happens immediately after brain death or the confirmed loss of all brain activity. Soft tissue donation usually occurs after brain death or the confirmed loss of all cardiovascular function. Different laws and regulations vary from country to country, which allow donors to either permit or refuse surgical transplantation of body organs, soft tissues or eyes upon immediate death. Popular choices for human body donation include internal organs, such as the kidneys, heart, pancreas, lungs, intestines or heart; layers of epidermis; bone and bone marrow; and the cornea.
Opt-In Versus Opt-Out
Voluntary organ donations have two different options, including the choice to opt-in or the given consent for organ donation, and opt-out or the refusal to donate organs, tissues, or eyes after death. The rate of donation has no direct correlation with the legislative system due to different variables that contributes to the rate of transplantations in a participating country, such as the living donors connectivity rate and demand. The National Organ Transplant Act of 1984, a legislative bill that allows individual states to regulate organ donation under certain stipulations, established the Organ Procurement and Transplantation Network (OPTN) to conduct organ matching through a national registry. The Uniform Anatomical Gift Act oversees organ donations to meet the final phase of transplantation, including entire carcasses used for the dissection and study in medicine. Potential donors request a note of consent on their driver's license. Once a donor registers, the individual's information disseminates into a central information system acknowledging the consent of organ donation. The voluntary system primarily rests on the individual's choice to opt-in.
The Need for Organ Donation
The organ donation national registry has over 108,000 U.S. citizens waiting for a donor; however, only one-third of those patients will receive transplantation. In fact, three-quarters of the list desperately need a kidney. This growing epidemic requires a proactive approach to help curtail the organ shortage, and create a higher success ratio to potentially save lives. Creating and maintaining donor registries and consent laws free of loopholes could relieve the burden placed on family members. Implementing monetary incentives and reversing the regulation to primarily rest on an opt-out strategy would drastically correct this shortage. A third proposition includes establishing a social incentive program that allows the organ donor to freely choose which member on the waiting list can receive transplantation. Organ network representatives assess and screen patient records to narrow down potential donors in the unfortunate wake of their deaths. The Center for Ethical Solution researches and educates the public on practical solutions to problems facing the modern medicine establishment. One study in particular called the "Solving the Organ Shortage," an Iranian research project focused on detailing the organ donation procurement system, which revealed that the Iranians did not store existing organ donor information into a central data collection agency.
Procurement and Distribution
The United Network for Organ Sharing (UNOS, a private, non-profit organization, functions as overseer of the nation's organ transplant system contracted under the federal government. The UNOS monitors matched organs to ensure the right transplantation happens at the correct time, assists the patients, family members and friends regarding an organ donor, and educates the public about the importance of organ donation and its impact on those on the waiting list. The Organ Procurement and Transplantation Network (OPTN), the unified transplantation network established under the National Organ Transplant Act of 1984 by the United States Congress, provides a database of all organ donor and transplantation professionals. The purpose of the OPTN serves to increase the overall effectiveness of organ donation, transplantation, and allocation; increase the overall supply of organ donations available for those waiting for transplantation. Organ Procurement Organizations (OPOs) recover the organs from the deceased through the careful legal stipulations that grants them the right to prepare for transplantation. OPOs are under constant regulatory forces to ensure the proper handling of organ donations.
The organ donation distribution process has different set of guidelines for each type of organ. Various factors are considered when compiling organ donation waiting lists, including the distance between the transplantation center and the organ donor hospital, the donor's blood type, medical history and urgency, the possible wait times, and the donor's tissue type and sizing. Medical urgency has a division of three brackets separated as a "Status" for all heart transplantation recipients, including "Status 1A," "Status 1B," and "Status 2." The transplantation recipients LAS score determines the medical urgency and wait time needed before carrying out the surgical procedure. The liver allocation score or MELD helps to allocate the liver for transplantation. Kidney and pancreas transplantation waiting lists have a basis centered on the specific location, blood type, and the Human Leukocyte Antigen (HLA) typing. If a kidney or pancreas transplantation recipient has no antibodies correlated to the donor's HLA, then the zero antigen mismatch (0 ABDR) provides a low-rate of rejection by the human body. This allows a transplantation recipient to take less immunosuppressive medications than the average transplantation recipient. Zero mismatches are granted priority over others on the waiting list because of their high graft survival rating.
A transplant center's location has been given higher priority in respect to a donor hospital because of the Cold Ischemic Time (CIT) effects. Ischemia, cell starvation of oxygen after organ removal, causes varying degree of organ toleration, depending on the different ischemic times. For instance, vital organs, such as the heart and lungs require transplantation within 4 to 6 hours of recovery. The liver requires about 8 to 10 hours, while the pancreas preserves until about the 15th hour mark. Kidneys can be remarkably transplanted 24 to 26 hours after recovery due to their resiliency to ischemia. Various preservation devices, such as a Delayed Graft Function (DGF) and kidney pumps allow for the extended recovery time before transplantation is required.
United Network for Organ Sharing: About Us
Organ Procurement and Transplantation Network: About Us
Association of Organ Procurement Organizations: About Us
The Center for Ethical Solutions: "Organ Shortage."
The Library of Congress: The National Organ Transplant Act 1984
University of Pennsylvania: The Uniform Anatomical Gift Act 1987
The U.S. Department of Health and Services: Organ Donor
The American Heart Association: Organ Donation