Organ donation

                                                                          Organ donation

Organ donation

Organ donation is the donation of biological tissue or an organ of the human body, from a living or

dead person to a living recipient in need of a transplantation.

• Transplantable organs and tissues are removed in a surgical procedure following a determination,

based on the donor's medical and social history, of which are suitable for transplantation. Such

procedures are termed allotransplantations, to distinguish them from xenotransplantation, the

transfer of animal organs into human bodies.

Xenotransplantation

• Xenotransplantation, or the transfer of animal (usually pig) organs into human bodies,

promises to eliminate many of the ethical issues, while creating many of its own.

• While xenotransplantation promises to increase the supply of organs considerably,

the threat of organ transplant rejection and the risk of xenozoonosis, coupled with general

anathema to the idea, decreases the functionality of the technique. Some animal

rights groups oppose the sacrifice of an animal for organ donation and have launched

campaigns to ban them.

• also two religions consider pigs unclean, and at least three more are vegetarians and believe

in ahimsa- do not violence to other creatures

Moving towards donation

Once a donor has been evaluated and consent obtained, provisional allocation of organs commences. UNOS developed a computer program that automatically generates donor specific match lists for suitable recipients based on the criteria that the patient was listed with. • Organ coordinators enter donor information into the program and run the respective lists. Organ offers to potential recipients are made to transplant centers to make them aware of a potential organ. The surgeon will evaluate the donor information and make a provisional determination of medical suitability to their recipient.

                                                                         Procurement

Brain death may result in legal death, but still with the heart beating, and with mechanical ventilation all other vital organs may be kept completely alive and functional,

providing optimal opportunities for organ transplantation.

• Most organ donation for organ transplantation is done in the setting of brain death. The non-living donor is kept on ventilator support until the organs have been surgically

removed. If a brain-dead individual is not an organ donor, ventilator and drug support is discontinued and cardiac death is allowed to occur.

• In the United States, where since the 1980s the Uniform

Determination of Death Act has defined death as the irreversible cessation of the function of either the brain or the heart and lungs, the 21st century has seen an order-of- magnitude increase of donation following cardiac death.

DCD Controversy

In 1995, only one out of 100 dead donors in the nation gave their organs following the declaration of cardiac death. That figure grew to almost 11 percent in 2008, according to the Scientific Registry of Transplant Recipients. • That increase has provoked ethical concerns about the interpretation of "irreversible" since "patients may still be alive five or even 10 minutes after cardiac arrest because, theoretically, their hearts could be restarted, [and thus are] clearly not dead because their condition was reversible

Transplantation

Location of a transplant center with respect to a donor hospital is given priority due to the effects of Cold Ischemic Time (CIT). Once the organ is removed from the donor, blood no longer perfuses through the vessels and begins to starve the cells of oxygen (ischemia). Each organ tolerates different ischemic times. Hearts and lungs need to be transplanted within 4–6 hours from recovery, liver about 8–10 hours and pancreas about 15 hours; kidneys are the most resilient to ischemia. • Kidneys packaged on ice can be successfully transplanted 24–36 hours after recovery. Developments in kidney preservation have yielded a device that pumps cold preservation solution through the kidneys vessels to prevent Delayed Graft Function (DGF) due to ischemia. Research and development is currently underway for heart and lung preservation devices, in an effort to increase distances procurement teams may travel to recover an organ.

                                                                    Organ shortfall

The demand for organs significantly surpasses the number of donors everywhere in the world. There are more potential recipients on organ donation waiting lists than organ donors. • In particular, due to significant advances in dialysis techniques, patients suffering from endstage renal disease (ESRD) can survive longer than ever before. Because these patients don't die as quickly as they used to, and as kidney failure increases with the rising age and prevalence of high blood pressure and diabetes in a society, the need especially for kidneys rises every year.

Wait list

In the United States, about 108,000 people are on the waiting list, although about a third of those patients are inactive and could not receive a donated organ. Wait times and success rates for organs differ significantly between organs due to demand and procedure difficulty. • Three-quarters of patients in need of an organ transplant are waiting for a kidney, and as such kidneys have much longer waiting times. At the Oregon Health and Science University, for example, the median patient who ultimately received an organ waited only three weeks for a heart and three months for a pancreas or liver — but 15 months for a kidney, because demand for kidneys substantially outstrips supply.

Reasons for discrepancies

A lists of countries ordered by organ donation ranking created by the International Register of Organ Donation and Transplantation shows Spain, Belgium, France, and Italy — which all have "presumed consent" laws on organ donation, where everyone is considered a donor unless they specify otherwise — in the top in the top five. • In contrast the USA — which practices an "opt in" consent law where their citizens provide express and informed agreement to donate organs and tissues in the event of their death — is also in the top five ahead of many other countries that are "opt in".