Deciding to donate your organs after your death is a gift beyond compare. The availability of organs from deceased donors is very limited. Many people on the organ waiting list to receive a donated liver or donated kidney will die before one becomes available.
After your death, you could help up to five or more people by donating multiple organs. If you suffer an accident and are declared legally dead, a member of the organ procurement organization (OPO) will ask your family for authorization to harvest your organs. The OPO is not allowed to obtain your organs without your family’s consent.
After the organs have been harvested, the OPO transports them to the transplant centers of the intended recipients. Once the donated organs have been removed, the body of the deceased donor is prepared according to the family’s wishes. The donor can still have an open-casket funeral, if so desired by the family.
In the U.S., registering as a deceased organ donor doesn’t automatically grant doctors permission to harvest your organs. In the unfortunate event of the death of a healthy person, only the surviving family can authorize donation of the deceased person’s organs. With this in mind, if you want to become a donor, you should voice these wishes to your family.
The donor (or the family) may choose which organs to donate. The most common are heart, lungs, kidneys, liver, pancreas and intestines. Some tissues can also be transplanted, most commonly corneas, skin and bone marrow.
Registering as an Organ Donor
Registering to become an organ donor is a great way to raise awareness, but it does not grant anyone the right to harvest your organs. This means that having a “Donor” sticker on your driver’s license won’t automatically give physicians the authorization to harvest your organs, nor will you receive poor medical attention because of it.
Due to the moral implications of donation, this process is very carefully monitored by the United Network for Organ Sharing (UNOS). They have ruled that to protect the donor, the only two ways to legally harvest organs are:
- Getting permission from the family of the deceased
- Getting the consent directly from the donor before he or she undergoes certain risky medical procedures, such as brain surgery, for example
Possible Organ Donor Concerns
One of the biggest misconceptions about organ donation is that donors may receive poor medical attention so that the doctors can harvest their organs. This is absolutely not true.
The physicians who are attending to the donor are not associated with organ donation in any way, and their sole objective is to help the patient survive. It is in their best interest, career-wise, to keep you alive. The organ procurement organization isn’t called into the hospital until after the donor has been officially declared dead.
The organ donor and his/her family do not pay for any donation-related costs. Obtaining organs is covered by the insurance of the recipient. The donor’s body will not be disfigured, which means that an open casket funeral can still take place after donation.
The Role of UNOS in Organ Transplant and Donation
UNOS is a nonprofit organization in charge of overseeing organ procurement and transplant across the U.S. They are contracted by the U.S. Department of Health and Human Services.
As the governing entity for all transplant activities, they perform the following roles:
- Overseeing policy compliance and development
- Maintaining the national organ waiting lists
- Matching donated organs with transplant candidates
- Collecting statistical data on all transplant recipients and donors
- Overseeing all organ procurement organizations (OPOs) and ensuring ethical practices
About Organ Procurement Organizations (OPOs)
There are 58 organ procurement organizations (OPOs) in the U.S., all under the supervision of UNOS. As their name states, they are in charge of obtaining organs, so they are the front-line contact with the deceased donor and their families.
Each OPO is a nonprofit that serves a different region in the nation. Their roles include:
- Getting permission from the family of the recently deceased donor to obtain organs
- Evaluating blood type, tissue type and condition of the organs, as well as checking for infections
- Working with UNOS to find suitable candidates for the organs
- Surgically extracting the organs that are to be donated
- Transporting the organs to their respective transplant centers
- Mediating possible communication between the recipient and the donor’s surviving family
- Performing community outreach to increase the number of registered donors
How Does Organ Donation Work After Death
The only way a deceased donor may be considered for organ donation is after he or she has been declared dead. The donor’s family must authorize the donation. Organs may not be procured without the family’s consent, even if the person is listed as a donor on his or her driver’s license.
Organ Donation After Brain Death vs. Cardiac Death
Most organ donors are people who suffer from head injuries that result in brain death. These head injuries may include a stroke, trauma after an accident or brain cancer that has not spread to other parts of the body.
Brain death occurs when blood and oxygen cannot flow to the brain, while the heart is still beating to provide blood and oxygen to other parts of the body. Patients with brain death usually require a ventilator or breathing machine to bring oxygen into the lungs.
In brain death, the organs remain functional and can be used for transplantation after a physician declares the patient dead. Because of the potential for conflict of interest, this physician may not be part of a transplant team.
Cardiac death is declared when the heart stops beating. Very few organ donations come from cardiac deaths. Lahey has chosen not to participate in cardiac death donations due to the uncertainty of their success rates, since organs begin deteriorating as soon as the heart stops delivering oxygenated blood to the body.
The Family’s Authorization
After a person has been declared brain dead, the local organ procurement organization (OPO) will ask the family for permission to harvest the organs of the deceased. Family members are the only ones who may give consent for donation, or refuse it. The OPO is legally not authorized to harvest organs without the family’s consent.
How the Organ Recipient is Chosen
To prevent illegal or immoral activities, the United Network for Organ Sharing (UNOS) typically doesn’t allow the family of the deceased donor to choose who receives the organs. Instead, they are allocated to candidates on the UNOS waiting list, based on their medical characteristics.
There are rare instances when the family of the deceased donor may already have a friend or family member on the waiting list. In this case, if they are of compatible blood type, they may take part in “direct donation.” This means the needed organ is directed specifically to that person, regardless of their status on the waiting list. The remaining organs will still follow the standard allocation process.
How the Organs are Obtained
The OPO will wait for all donated organs (liver, kidneys, pancreas, etc.) to find recipients. They will then take responsibility to carefully harvest the organs, place each in a preservative solution, and transport them to their respective transplant centers.
Once the donated organs have been removed, the body of the deceased donor will be prepared for arrangements according to the family’s wishes. The donor will still be able to have an open-casket funeral, if so desired by the family.