Stroke Survivors: Organ Donation Possibilities And Limitations

Organ donation and transplantation is a complex process that requires the collaboration of many people. People most frequently become organ donors after a stroke, heart attack, or severe head injury. Brain death is diagnosed as an irreversible loss of blood flow to the brain, and after brain death, the donor's body is kept functioning by artificial means such as a ventilator. In the case of stroke patients, brain death may occur due to the irreversible loss of blood flow to the brain caused by the stroke. However, it is important to note that a person must be pronounced dead, either by brain death or cardiac death, for organ donation to be an option.

Brain death diagnosis

Brain death is diagnosed as the irreversible loss of blood flow to the brain, causing the brain to die. This diagnosis must be made by two doctors, one of whom must be a senior doctor, and neither can be involved with the hospital's transplant team.

Before testing for brain death, doctors must rule out other factors that could be causing the symptoms, such as an overdose of drugs, poisons, or other chemical agents, abnormally low body temperature (hypothermia), or severe underactivity of the thyroid gland.

The following tests are then carried out twice to confirm brain death:

• A torch is shone into both eyes to see if they react to light.
• The eye is stroked with a tissue or piece of cotton wool to observe any reaction.
• Pressure is applied to the forehead and the nose is pinched to check for any movement in response.
• Ice-cold water is inserted into each ear, which would usually cause the eyes to move.
• A thin plastic tube is placed down the windpipe to observe if it provokes gagging or coughing.
• The person is disconnected from the ventilator for a short time to see if they can breathe on their own.

A person is declared brain dead if they fail to respond to all of these tests.

Brain Death vs Coma

It is important to distinguish between "brain death" and "coma". Coma may imply a limited form of life, whereas brain death is equivalent to death and helps guide decision-making for both physicians and patients' families regarding the withdrawal of care.

Brain Death and Organ Donation

According to the "dead donor rule", organ procurement can occur only after death has been declared. Therefore, for patients who are brain dead, organ procurement is allowed, even if the patient still has some circulatory and/or pulmonary function.

Organ procurement process

Organ donation is a complex process that requires the collaboration of many people. The process can be broadly divided into the following steps:

Identification of Potential Donor

The nature of the injury leads a physician to determine if the patient is brain dead or a potential donation after circulatory death (DCD) candidate. This is the first step in the organ procurement process.

Evaluation of Donor Eligibility

The patient's medical and social history, as well as a physical examination, will be evaluated by a recovery coordinator to determine if the patient is a suitable candidate for donation.

Authorization for Organ Recovery

If the patient is deemed a suitable candidate, the legal next-of-kin will be approached for consent. If the patient is a registered donor, this process is smoother, and the family will be informed of the patient's wishes. If the patient is not a registered donor, the family will need to give consent for the donation to proceed.

Medical Maintenance of the Patient

Once consent is obtained, the patient is maintained medically, with physician support if necessary, until organ recovery.

Matching Organs to Potential Recipients

Information about the organs available, the donor's blood type and body size, is entered into a national computer system, which then matches the organs to potential recipients based on blood type, body size, medical urgency, and length of time on the waiting list.

Offering Organs Regionally and Nationally

A list of potential recipients in the matching blood group is generated, and efforts are made to match organs with recipients regionally before offering them nationally.

Surgical Recovery of Organs

Once recipient matches have been found, the donor is taken to the operating room, where the organs are surgically removed. The donor is treated with honour and respect throughout the process.

Preparing Recipients for Surgery

As the organ recovery process is happening, identified recipients are contacted by their transplant surgeons for final pre-operative preparations.

Distribution of Organs

The organs are then sent to the transplant hospitals, where the transplants are performed.

Funeral and Burial Plans

After organ recovery, the donor's family can proceed with funeral or burial plans, which are not affected by organ donation.

Follow-up with Family and Hospital

As a final step, the organ procurement organisation sends letters to the donor's family, hospital staff, physicians, and nurses, informing them of the organs and tissues that were recovered.

The process of organ donation and transplantation is a complex and intricate one, requiring the expertise and collaboration of many individuals. It begins with the generous decision of the donor and their family and ends with the hope of saving lives.

Patient's wishes and family consent

Organ donation and transplantation is a complex process that requires the collaboration of many people. It is important to respect the wishes of the patient and obtain consent from the family.

In the case of stroke patients, it is common for doctors to discuss the possibility of organ donation with the family, especially if the patient is facing a dire prognosis and has not yet been declared brain dead. However, it is crucial to remember that a person must be pronounced dead before organ and tissue donation can proceed. In the case of brain death, this means irreversible loss of blood flow to the whole brain, and in the case of cardiac death, it means the irreversible cessation of circulatory and respiratory functions.

If a patient has registered as an organ donor in their state or national registry, this information is shared with the family, and a family counsellor from the organ procurement organisation (OPO) explains the donation process and answers any questions. The OPO and hospital staff work together to support the family and honour the patient's wishes. The family's decision is made easier if they have previously discussed donation.

In the case of Jimi Fritze, a stroke patient in Sweden, doctors discussed the possibility of organ donation before he was sedated and while he was still conscious, which led to a complaint being filed against the hospital. This case highlights the importance of assuming some level of consciousness in patients who appear unresponsive and being careful about what is said in front of them.

If a patient has not registered as an organ donor, the family is given time to think and ask questions before making a decision. The family's consent is necessary for the donation process to proceed. In the case of donation after cardiac death, this option may be presented to the family when they have accepted that their loved one cannot survive and have decided to remove life support. Once consent is given, the patient is taken off the ventilator in an operating room, and when their heart stops beating, a physician declares death and organs are recovered.

Organ allocation process

Organ donation can be a life-saving procedure, with one donor having the potential to save up to eight lives. However, the demand for organs far exceeds the supply, and organs must be transplanted within hours of recovery, so the allocation process must be efficient and fair.

The United Network for Organ Sharing (UNOS) maintains a centralized computer network (UNetSM) that links all organ procurement organizations (OPOs) and transplant centres. When a patient is declared brain dead, a specially-trained nurse from the OPO goes to the hospital to see if the patient is medically suitable to be a donor. If so, the donor's physical details, including lab results, blood type, height, weight, and HLAs, are entered into UNetSM. The system then automatically matches all potential recipients and generates a ranked list of patients suitable to receive each organ, taking into account multiple factors.

The first factor is medical facts specific to the organ type, such as immune system matching for kidneys and pancreases. Geography also plays a part, with priority given to candidates at transplant hospitals closer to the donor hospital. Size is critical to a successful transplant, with children often responding better to child-sized organs and therefore given first consideration for other children's organs. The degree of immune system matching, the length of time on the waiting list, the likelihood of the recipient's body rejecting the organ, and the distance between the recipient and donor are also considered.

The transplant centre with the first matching recipient is notified of the available organ. The transplant team then has one hour to decide whether to accept or refuse the organ based on medical criteria, the condition of the organ and recipient, staff and patient availability, and transportation. If the organ is accepted, the OPO will identify a backup recipient in case the first becomes unavailable. If the organ is declined, it is offered to the next person on the waitlist.

Funeral arrangements

Organ donation and transplantation is a complex process that requires collaboration between many people. The process begins with the organ donor, who decides to help people with end-stage organ disease by donating their organs after they die. After the donor's death, a specialised team of medical professionals will evaluate the donor's organs and facilitate the donation process. The donor's family will also be involved in this process, and their wishes will be honoured and supported.

Once a person has decided to become an organ donor, their name is added to a registry. In the event of their death, a specially-trained nurse from the organ procurement organisation (OPO) will go to the hospital to determine if the donor is medically suitable. The OPO will also talk to the donor's family about the donation process and answer any questions they may have. This conversation is easier if the family has previously discussed donation.

After the donor's death, their body is taken to the hospital where the transplant will take place. The donor's organs are surgically removed and sent to the transplant hospital. The donor is treated with honour and respect throughout this process, and their body is then taken to a funeral home. The OPO works closely with the funeral director to ensure that the donor's funeral wishes are respected and that there are no delays.

In most cases, an open-casket funeral is still possible after organ donation, as the process is rarely disfiguring. The donor's family can also expect to receive a letter from the OPO a few weeks later, informing them of which organs were transplanted while maintaining the confidentiality of the recipients. The OPO may also offer ongoing support, such as bereavement counselling and memorial events.

It is important to note that organ donation can only proceed after a person has been declared dead. In the case of brain death, this means irreversible loss of blood flow to the brain or, in some states, the entire brain including the brain stem. For cardiac death, it means the permanent cessation of the heart's circulation. In both cases, all life-saving measures must be attempted first, and a declaration of death must be made according to accepted medical standards.

Frequently asked questions