Organ donation is when a person gives their organs after they die to someone in need of new organs. Transplantation is the process of transplanting the organs donated into another person. This process extends the life expectancy of a person suffering from organ failure. The number of patients requiring organ transplants outweighs the number of donor organs available.
History of organ transplantation Australia's first organ transplants were corneal transplants in the early 1940s. Following in chronological order are monumental first in Australia's organ transplantation history. Early 1940s Australia began corneal transplants in Sydney and Melbourne 1965 Australia's first successful (living) kidney transplant 1984 Australia's first successful heart transplant 1985 Australia's first successful liver transplant 1985 Australia's first successful kidney transplant from a deceased donor 1986 The Brisbane Technique for splitting livers to benefit three recipients initiated 1986 Australia's first successful heart/lung transplant 1987 Australia's first successful kidney/pancreas transplant 1987 First segmental liver transplant (for children) (Australia) 1989 First successful living liver transplant (Australia) 1990 Australia's first successful single lung transplant 2002 First single segment liver transplant on a baby (24 days old) (Australia) 2003 Australia's first triple transplant (heart, lung, liver) 2006 World's first kidney/liver/pancreas transplant (Australia) 2012 Australia's first pediatric intestinal transplant (liver), (small bowel), (duodenum), (pancreas) The following table (Table 1.1) shows the global transplantation milestones in chronological order.
Table 1.1. Global transplant milestones Year Milestone Location 1823 First skin auto graft transplantation of skin tissue from one location on an individual to another location Germany 1905 First human to human corneal transplant. This was also the first successful human to human transplant of any kind Moravia (now Czech Republic) 1908 First skin allograft-transplantation of skin from a donor to a recipient Switzerland Early 1940s Australia begins corneal transplants Sydney and Melbourne 1954 First living related kidney transplant (identical twins) US 1955 First heart valve allograft into descending aorta Canada 1962 First kidney transplant from a deceased donor US 1965 Australia's first successful (living) kidney transplant Queen Elizabeth hospital. South Australia 1967 First successful liver transplant US 1967 First heart transplant South Africa 1968 First pancreas transplant US 1979 Living related pancreas (mother to child) US 1981 First heart/lung transplant US 1983 First successful lung transplant Canada 1983 Ciclosporin approved for commercial use in the US. A revolutionary anti-rejection drug, it heralded a new era for kidney, liver and heart transplantation US 1984 First heart-liver transplant US 1984 Australia's first successful heart transplant St. Vincents hospital, NSW Australia 1985 Australia's first successful liver transplant Princess Alexandra hospital, Brisbane Australia 1985 Australia's first successful kidney transplant from a deceased donor Queen Elizabeth hospital, Adelaide Australia 1986 First successful double lung transplant Canada 1986 The 'Brisbane Technique' for splitting livers to benefit three recipients initiated Princess Alexandra hospital, Brisbane Australia 1986 Australia's first successful heart/lung transplant St Vincent's hospital, NSW Australia 1987 Australia's first successful kidney/pancreas transplant Westmead hospital, NSW Australia1987 First segmental liver transplant (for children) Princess Alexandra hospital QLD Australia 1988 First successful intestinal transplant UK 1988 First successful liver-bowel transplant UK 1988 First two in one liver transplant (one liver split for two recipients) France 1989 First successful living liver transplant Princess Alexandra hospital QLD Australia 1989 First combination heart, liver and kidney transplant US 1990 First living related lung transplant US 1990 Australia's first successful single lung transplant St. Vincent's hospital NSW Australia 1992 Xenotransplant (pig liver to human) US 1992 Xenotransplant (baboon's liver to human) US 1995 World's first laparoscopic live donor nephrectomy in which a patient's kidney is removed through a 5–6 cm incision US 1995 Transplantation of all abdominal organs US 1998 First successful human hand transplant (later removed) France 2002 First single segment liver transplant on a baby (24 days) Princess Alexandra hospital, QLD Australia 2003 Australia's first triple transplant (heart, lung, liver) Princess Alexandra hospital, QLD Australia 2005 First successful partial face transplant France 2005 First living donor islet transplant Japan 2006 World's first kidney/liver/pancreas transplant Royal Prince Alfred hospital NSW Australia 2009 Paediatric transplant for small bowel, liver, pancreas and two kidneys US Table 1.1 Source: Australian Government Tissue Donation and Transplantation Authority. http://www.donatelife.gov.au
Donor types There are two types of donors; living donors and deceased donors.
Living donors In Australia the most common living donations not including blood donations are kidneys and bone marrow. The tissues and organs that are able to be donated by a living donor are: Bone marrow Kidney Part of the liver Lung (this requires two living donors. One donates a lobe from their left lung and the other donates a lobe from their right lung) Part of the intestine Part of the pancreas
Eligibility for donation The minimum age for living donation is 18 years of age. A person may be eligible to be a donor if they are free from HIV, cancer, systemic infection, sickle cell anaemia, Creutzfeldt–Jakob disease and they are not a previous IV drug user.
Motives for living donation Donation to a family member is a common scenario. The reasons for a family member to want to be a living donor to their relatives are; a desire to help, self benefit (from loved ones improved health), a feeling of moral duty, pressure identification with the recipient, increased self-esteem from doing a good deed. It is the health professional's role to understand the difficulty of these situations involving relationships of loved friends or relatives and they are to determine whether or not the offer of donation is genuine or the living donor feels pressured into donating because of the seriousness of their loved ones organ failure. However most donations result in a positive psychological benefit to both the donor and recipient.
If a donor is wanting to donate to someone who is not a relative or friend they are intensively psychologically tested to determine their motives and suitability for donation as there can occasionally be harmful motives such as attention seeking or mental illness.
Deceased donors (non-heart beating donors) Deceased donors have been declared dead and are maintained in ICU on ventilators so tissue oxygenation continues until the procedure of organ retrieval and cold preservation.
Deceased donors are divided into two sub-classes. Donation after brain death. A person is declared brain dead if there is complete loss of all brain function Donation after cardiac death. A person is declared cardiac dead if there is complete loss of all cardiac function Both types of deceased donors have complete and irreversible damage and returning to life is impossible. Thorough testing is carried out prior to confirming a person brain dead or cardiac dead.
One deceased donor is able to save up to ten lives by donating the following: Organs: Kidneys, pancreas, liver, lungs, heart and intestines Tissues: Bones, skin, heart valves, veins and corneas
Whole body donation After death some people choose to donate their bodies to science. These bodies are used in many teaching facilities and aid in teaching anatomy, surgical techniques or research. Whole body donation involves the deceased person contacting the university or teaching institution prior to death to obtain consent and cover the legalities involved. After death it is up to the family of the deceased to contact the chosen facility and arrange donation.
Opt in versus opt out Currently Australia's organ donation system is 'opt-in'. This means a person had to give consent (opt-in) to be a donor prior to their death, or their family can make the decision for them if they are considered a viable donor. The 'opt-out' system is used in several countries around the world. For this system everyone is placed on the donor list and must 'opt-out' if they do not wish to donate their organs. Whether Australia changes to the 'opt-out' system is constantly coming into question. In a discussion paper compiled in 2011 it was stated 35% of family members of a potential donor would refuse donation if they were unsure of the family members intentions on donating. However, if an 'opt-out' system was put into place and the potential donor did not opt-out prior to death, it was estimated only 20% of families would refuse donation.
A study carried out in 2002 investigated donor rates of countries with 'opt-in' and 'opt-out' systems. The countries chosen for the study were ones that had relatively similar backgrounds and health systems. After the donation rates were calculated to match the mortality rates it concluded the difference in donor rates between the two systems were marginal. The results as follows (Table 1.2).
Table 1.2. Three year mean organ donation and mortality rates for 10 European countries. Reference: Country Three year mean organ donation rates* (per million inhabitants) Three year mean mortality rates† for organ donation (per million inhabitants) Spain 33.8 309 Austria 23.5 298 Belgium 23.0 343 France 18.3 330 Italy 16.8 246 UK 13.2 243 Netherlands (I) 13.0 187 Germany (I) 12.6 240 Switzerland 12.5 195 Sweden 11.3 240 *The rates shown comply with the definition of the council of Europe: "if at least one solid organ has been retrieved for the purpose of organ donation" †Mortality rates for CVA and (traffic) accidents 0–65 years (I) indicates country has an 'opt-in' system There are many pros and cons for each of the two systems, making it a controversial topic, and as seen above some studies can be contradicting. Ultimately it is the family of the deceased who will make the final decision on organ donation. Only 57% of Australians know the wishes of their family members in regards to organ donation, which has a large impact on families giving consent for organ donation. Donation cannot go ahead without families consent even if the person is on the donor register.
Donation in religion In most cases religions support organ donation. However, there are a few aspects of each religion that can make the logistics of organ donation difficult.
Islam Most organ donations in predominately Muslim countries are live donations, for example in Iran in 2006 only 13% of renal transplants were from deceased donation. In Islam, violating the human body whether living or dead is forbidden, this includes organ donation. However, saving a life is ranked extremely highly in the Qur'an. Brain stem death (brain dead) is controversial in Islam. This, along with burial customs of Muslims being they have to be buried within 24 hours of death makes if difficult for organ donation.
Christianity Generally Christianity approves of organ donation although some Christians believe principle healing is achieved through prayer. The majority of Christians see organ donation as Christian love or an act of devotion to God and mankind.
Judaism