Organ Donation

Diagram 1

The brain and brainstem control many of the body's vital functions, including breathing. When a person has suffered a brain injury, they are connected to a machine called a ventilator, which artificially circulates oxygen into the lungs (ventilation). The oxygen is then pumped around the body by the heart. The heartbeat does not rely on the brain, but is controlled by a natural pacemaker in the heart that functions when it is receiving oxygen.

 

While a ventilator is providing oxygen to the body, the person's chest will continue to rise and fall giving them the appearance of breathing, their heart will continue to beat and they will feel warm to touch. This can make it difficult to accept that brain death has occurred. However, even with continued artificial ventilation, the heart will eventually deteriorate and stop functioning.

 

How do doctors know that a person's brain has died?

People who are critically ill in hospital are under constant observation by the specialist medical and nursing teams caring for them and are closely monitored for changes in their condition. There are a number of physical changes that take place when the brain dies. These include loss of the normal constriction of the pupils to light, ability to cough, inability to breathe without the ventilator, and reduced blood pressure and body temperature.

 

When the medical team observes these changes they will perform clinical brain death testing to confirm whether the brain has stopped functioning or not.

 

Two senior doctors will independently conduct the same set of clinical tests at the bedside. The doctors performing the brain death testing will be looking to see if the person has any:

• response to a painful stimulus;

• pupil constriction when a bright is shone in the eye;

• blinking response when the eye is touched;

• eye movement when ice cold water is put into the ear canal;

• gag reaction when the back of the throat is touched;

• cough when a suction tube is put down the breathing tube; and

• ability to breathe when the ventilator is temporarily disconnected.

 

If a person shows no response to these tests, it means that their brain has stopped functioning and the person has died. Although they have died the heart will still be beating because oxygen is still getting to the heart with the assistance of the ventilator.

 

There are times when the person's injury or illness means that clinical brain death testing cannot be done. For example, facial injuries may limit examination of the eyes or ears. In these circumstances, medical imaging tests are done to determine if there is any blood flow to the brain. The hospital staff will provide further information if such a test is necessary.

 

What happens after brain death has been confirmed?

Once brain death has been confirmed, the person will remain connected to the ventilator while members of the healthcare team speak with the person's family about the next steps. These will include the person's end-of-life wishes, the opportunity for organ and tissue donation and timing of removing the ventilator.

 

If the family supports donation, everything possible will be done to make sure those wishes are fulfilled. Timeframes can vary as every circumstance is different. It can take an extended period of time for necessary arrangements for donation to be made. The person will remain connected to the ventilator and medications provided to support the blood pressure and keep oxygen circulating to the organs. Increased medical activity may be seen around the person, due to the need for further tests. If it becomes clear that organs are not suitable for donation, the senior next of kin will be notified and it may still be possible for the donation of tissue including eye, heart, bone and skin to occur.

 

When the arrangements for donation have been made, the person will be transferred to the operating theatre for the organ and tissue retrieval surgery. The ventilator will be removed during the operation.

If donation is not supported, the doctor will speak with the family about removing the ventilator. When the ventilator is removed, the person's heart will stop beating due to a lack of oxygen, and their skin will become cold and pale because blood is no longer being circulated around the body.

 

Care, dignity and respect are always maintained during end of life care, whether or not donation proceeds.

 

Understanding circulatory death confirmed?

Circulatory death occurs when a person stops breathing and their heart stops beating (there is no blood flow in the body). This can occur after a sudden illness or accident, or can be the final stage of a long illness.

 

Organ donation is sometimes possible after circulatory death although only in particular situations, as organs quickly deteriorate once blood flow to them stops. The usual circumstance is when a person is in an intensive care unit following a severe illness from which they cannot recover and the doctors and family agree it is in the person's best interests to remove artificial ventilation and any other life supports. This may occur when a very severe brain injury resulting in a permanent severe disability, people with terminal heart or lung failure, or people who have suffered a very severe spinal injury where they cannot move or breathe unassisted.

 

The priority is then to support the person with care, comfort and compassion at the end of their life. The withdrawal of life support is always discussed with and agreed by the family (and patient if possible). Only when this decision has been made, is there any consideration of donation.

What happens after the doctors believe the patient's heart is going to stop beating?

 

When the family and the doctors have agreed that continuing treatment is not in the person's best interest, they will speak with the person's family about the next steps. This will include discussion on the person's end-of-life wishes and removal of the ventilator and other treatments, with a focus on providing comfort and pain relief. 

 

If the doctors expect that the person will stop breathing and circulatory death will occur within 90 minutes after taking away the ventilator and any other life supports, there may be the opportunity for organ and tissue donation to occur.

 

If the person and family supports donation, everything possible will be done to make sure those wishes are fulfilled. It can be very difficult to predict the exact time it will take for a person to die following removal of the ventilator and other life supports. Some patients die within an hour or so, and donation may be possible. Others may not die until many hours later. If this occurs, organ donation will no longer be possible but donation of tissues may still be possible. If death does occur soon after removing life supports, the person will need to be moved quickly to the operating theatre so that the organ retreival surgery can occur before the organs become damaged.

 

If donation is not supported by the family, the doctor will speak with the family about removing the ventilator. When the ventilator is removed, the person's heart will stop beating due to a lack of oxygen, and their skin will become cold and pale because blood is no longer being circulated around the body.

Care, dignity and respect are always maintained during end of life care, irrespective of whether or not donation proceeds.

​

About transplantation

Transplantation can save and significantly improve the lives of many people who are sick or dying.

• Some people with heart failure, viral infection, or a congenital heart defect, require a heart transplant to survive.

• Lung transplants are often needed by people with cystic fibrosis or emphysema whose own lungs cannot provide enough oxygen to their bodies.

• People with severe kidney failure are on dialysis and will need a kidney transplant to stay alive.

• People with metabolic liver disease, Hepatitis B or C, and congenital liver defects such as Biliary Atresia can require liver transplants to stay alive.

• Intestinal transplantation can improve the lives of people with intestinal failure who can’t absorb the nutrients needed to grow or live a healthy life.

• Pancreas transplants can be an effective treatment for people with Type-1 Diabetes.

• Donation of eye tissue allows transplantation of the cornea (clear tissue covering the coloured part of the eye) and the sclera (white part that surrounds the eye).

  • Corneal transplants restore sight to people who are partially or completely blind due to corneal damage following a genetic condition, illness or injury.

  • Scleral grafts can prevent blindness due to injury or in people who have had cancer removed from their eye.

• Donated bone tissue can be grafted to replace bone which has been lost as a result of tumours or through other disease or accidents. It is also used to aid fracture healing, strengthen hip and knee joint replacements, and to repair curvatures of the spine (scoliosis) in children and teenagers.

• Skin grafts are provided to people who have suffered extensive trauma, infection damaging or destroying the skin, or severe burns. When skin is donated, only a thin layer is retrieved, somewhat like the skin that peels in sunburn.

• Donated heart tissues such as heart valves are able to repair congenital defects in young children and babies, and also used to replace diseased valves in adults.

 

Transplantation is only possible following the donation of organs and tissues from a living or deceased person. It involves the removal of an organ or tissue from one person (the donor) for transplant into another person (the recipient).

 

Both donation and transplantation happens in a surgical procedure by highly skilled surgeons and health professionals, much like any other surgical procedure.

 

At any time, there are around 1,400 Australians who are waiting for an organ transplant. Sadly some people die waiting for a transplant.

 

Please consider joining the Australian Organ Donor Register. By registering this means that one day you could save the lives of many people waiting for an organ transplant.

Organ transplant waiting list and eligibility

 

In Australia, organ transplant waiting lists are kept for each transplantable organ - heart, lungs, kidneys, liver, intestine and pancreas.

 

A person is placed on an organ transplant waiting list when they have end-stage organ failure, all other treatments have failed and their medical specialist believes they will benefit from a transplant.

 

To be wait-listed for an organ transplant, patients must be referred to a transplant unit for assessment and meet the eligibility requirements. These eligibility requirements are detailed in clinical guidelines which have developed by the responsible professional groups to ensure equitable and transparent access to transplantation:

• Clinical Guidelines for Organ Transplantation from Deceased Donors, Transplantation Society of Australia and New Zealand

 

Once a person is on a transplant waiting list they receive support from a transplant coordinator and are regularly reviewed to ensure that they remain eligible to receive a transplant.

Waiting times depend on the availability of suitable donated organs and the allocation of organs through the transplant waiting lists.

 

When a match is found, the transplant coordinator arranges for any necessary tests or scans, and coordinates the transplant process.

 

Organ allocation

The organ allocation process is designed to get the best possible outcome from available organs while ensuring equity of access to transplantation for Australians.

 

The allocation process is a complex and time-critical process influenced by a range of factors including medical need, urgency, donor/recipient suitability and logistical factors.  

 

Organ allocation takes no account of race, religion, gender, social status, disability or age (unless age is relevant to the organ matching criteria).

 

Specific criteria for the allocation of organs have developed by the responsible professional groups to ensure an equitable and transparent access to transplantation:

• Clinical Guidelines for Organ Transplantation from Deceased Donors, Transplantation Society of Australia and New Zealand

 

Organs such as the heart, lungs, liver and pancreas are matched to recipients by blood group, size, compatibility and urgency. Kidneys are matched by blood group and tissue compatibility through the computerised National Organ Matching Service (run by the Australian Red Cross Blood Service).

 

The above information is courtesy of Donate Life. For further information, or to register to become a donor, visit www.donatelife.gov.au.