With organ donation, the passing of one person can lead to the survival of many others. But when a donor dies, how do doctors save their organs for transplantation?
“In order to be an organ donor, you have to be in a hospital, on a ventilator, and have some type of neurologically devastating injury,” experts explain. There are two ways that this could come about: cardiac death or brain death. Cardiac death occurs when the patient has such intense brain damage that they would never make a full recovery. This damage can be to different parts of the brain. They may have a tiny amount of functional brain capacity, but the physician must decide that you will never be able to recover.
The donor is only kept alive via a ventilator, which their family or loved ones may choose to remove. This person would be thought of as legally deceased when their heart stops beating. Most organs that are donated come from cases of brain death, in which the donor has zero brain functionality, according to a 2020 study, this patient has irreversible loss of function everywhere in his brain, including the brain stem. A doctor diagnoses a person as “brain dead” when the patient is in a coma, has no brain stem reflexes, and fails an apnea test that servers to show if all brain stem function has been lost.
A person who is brain dead is legally dead, even if they are still breathing with the aid of a ventilator. The physician, not the organ transplant team, makes this decision. While the donor’s body is kept alive through life support, the organ procurement team tests whether their organs are safe to be transplanted. If the donor has cancer or an infection like COVID-19, their organs might not be viable for transplant, but not all diseases prevent organs from being used. For example, an HIV-positive donor can donate to an HIV-positive recipient. They are transplanting organs on a regular basis that are hepatitis A-, B-, C- positive.
Regular blood tests can reveal whether organs such as the liver and kidneys are healthy. The organ procurement team occasionally inspects the donor’s heart for damage or blockage by sticking a thin tube into an artery or vein and threading it through their blood vessels to the heart. The team can also use a chest X-ray to evaluate the lungs for size, infection, or any signs of disease. They could do further testing by putting a small tube into the lungs to further assess for infection and figure out if antibiotics are required.
Brains are never transplanted, but other organs can be donated in the case of brain death; in the case of cardiac death, the heart is usually too damaged to donate, according to the 2020 study. After assessing the organs, the organ procurement team figures out and confirms recipient matches from the national transplant waiting list. The recipient’s surgeons set up a time to meet and fly to the donor. Depending on how many organs are being donated, you might be organizing surgeons from three to four states. It can get pretty elaborate when transplanting organs.
In the case of brain death, the doctors start to recover the organs by clamping the circulatory system to stop the ventilator from pumping blood around the body. In the event of cardiac death, they remove the ventilator and wait until the heart stops beating, which can take anywhere from around half an hour to two hours. Then an additional five minutes to ensure the donor’s heart does not spontaneously restart.
The surgeons might decide not to recover the organs if it takes too long for the heart to stop and the other organs begin to die. For both types of organ donors, the surgeons then drain the donor’s organs of blood, refill them with a cold preservation solution, and remove the organs. The surgeons fly the organs back to the recipients and begin the transplantation. They must be quick; the heart and lungs can only last 4 to 6 hours outside of the body, the pancreas 12 to 24 hours, the liver up to 24 hours and the kidneys 48 to 72 hours. Meanwhile, the donor’s bodies, with organs removed, are prepared to lay peacefully in their caskets ready for the funeral of other memorial service.
Overall, donating organs saves lives and with an understanding of the process, we hope more people are willing to give consent for their organs to be donated if they end up being put in a vegetative state. What you donate will save many lives if you ever end up in the situation.