ABOUT TRANSPLANTATION

Which organs and tissues can be donated?

Organ and tissue transplantation is sometimes the only way to save a patient’s life or to provide a satisfying quality of life to a patient.

Organs and tissues can be donated from a deceased (cadaveric) or living person. In the first case, the brain death has to be confirmed according to the laws practiced in the state where the potential donor lived. Conversely, a living donor can give his or her approval for organ or tissue donation but only after the prior approval of medical experts (who carry out the medical examination of the potential donor and check the donor’s and recipient’s organ and tissue compatibility).

The deceased (cadaveric) donor can donate the following organs: heart, lungs, liver, kidneys, intestine and pancreas and the following tissues: corneas, sclera, heart valves and blood vessels, bone tissue including tendons and cartilage. Living donor can donate the following organs and tissues: part of the liver, one of two lung lobes, one of two kidneys, blood, marrow and bone.

In order for the transplantation process to be successful, organs, tissues and cells have to be transplanted quickly. Special medical experts and institutions for organ preservation, transport and allocation are responsible for this.

Kidneys

Chronic kidney disease and its consequences are the most common reasons for kidney transplantation. The end-stage of chronic kidney disease leads to kidney failure and creates a need for a kidney transplant. Kidneys can be donated by deceased or ‘cadaveric’ donors as well by living donors. Living donors are often close relatives of the kidney recipient, which increases the possibility that the donor and recipient are compatible. The main advantage of a kidney transplant from a living donor is the reduction of wait time for transplantation, as well as the fact that a kidney donated by living donor may usually function better and last longer than the kidney donated by a cadaveric donor.

Heart

A heart transplant is most commonly performed when terminal heart failure is present, e.g. serious heart sicknesses such as cardiomyopathy (disease of a heart muscle), myocarditis (the inflammation of a heart muscle) or blockage and narrowing of the heart blood vessels which leads to heart failure. Heart diseases can generally be treated by medicines, although for some patients in advanced stages of the disease heart transplantation may be the only way to save their life.

Liver

Liver transplant is a widely used treatment method for acute or chronic liver failure. There are two main types of liver transplant: full liver transplant from a deceased donor and transplant of part of the liver from a living donor. When deceased donor ‘split-liver’ transplantation procedures are performed, the donor’s liver is divided into two parts and transplanted to two transplant patients.

Lungs

The lungs are the respiratory organs that provide our body with the oxygen. Depending on the needs of the patient, the transplantation of one or both lung lobes can be performed. Sometimes lung transplant surgery is performed at the same time as a heart transplant procedure. The main reasons why a lung transplant may be needed are obstructive lung disease, idiopathic lung fibrosis, cystic fibrosis and lung hypertension (high blood pressure in the lungs arteries). Lung transplant surgery lasts on average between 4 to 12 hours.

Small intestine (Small bowel)

The small intestine forms part of the gastrointestinal tract placed between the stomach and the large intestine. The transplant of this organ is not very common and it is performed when small intestine failure is evident. This failure can be caused by the appearance of extensive and advanced Crohn’s disease, some serious digestive disorders, and short bowel syndrome (which can occur as the result of partial removal of the small intestine). The first successful small intestine transplantation was performed in 1988. Today, more than 85% of patients survive a year or more with a small intestine transplant.

Pancreas

The pancreas is a long organ located in the abdominal cavity between stomach and intestine. The pancreas regulates and produces hormones, especially insulin which controls the regulation of blood sugar levels. The pancreas is often transplanted together with kidney mostly in patients with kidney failure related to type 1 diabetes.

Donors

Who can become a donor?

There are two main donor types: a living donor and a deceased (cadaveric) donor.

Living donors

Living donors are generally close relatives or individuals who are intimately and emotionally connected to the donor, such as the spouse of a transplant patient. Altruistic living organ donation from a donor not having any close connections to the (unknown) recipient is permitted in some countries. To prevent potential abuse, this type of the organ donation is strictly monitored.

Living donors can donate a part of the liver, one of two lung lobes, one of two kidneys, blood, marrow and bone.

An individual younger than 18 years of age can become a donor only in special circumstances (e.g. donation to a sibling). You can donate if you are physically and mentally healthy, generally in a good condition and if you do not have underlying health issues such as diabetes, uncontrolled high blood pressure, active cancer or infection.

The expert team and the ethical board of a transplantation center make decisions regarding organ transplantation from living donors. If there is a risk for the life and health of a living donor, transplantation cannot occur.

Deceased (Cadaveric) donors

Identifying a potential donor and their subsequent evaluation forms the foundation of a successful transplantation procedure. During the evaluation process it is very important to determine the cause of the donor’s death. There is no strict limit of age for organ donation. In general, organs may be donated by someone as young as a newborn or as old as 75, however the limit of a donor’s age can vary depending on the organ which is going to be donated.

During the evaluation process it is very important to specify all the risk factors. These include an examination of the donor’s medical history or any history of malignancy, active infection, or other diseases that may affect transplanted organ function, such as diabetes or hypertension. The health and social history of a donor is also checked with the patient’s family, if available, including a history of smoking, alcohol consumption, use of drugs, and travel history, particularly to endemic areas of transmissible parasites and viruses. Piercings and tattoos may present a risk because it increases the risk of a patient catching a hepatitis or HIV infection.

Brain death diagnosis

The largest number of organs dedicated to transplantation come from patients classified and determined as brain dead. The transplantation process may only begin after brain death diagnosis. Throughout history, the definition of the death of a human being has changed. The moment when a person stopped breathing and an individual’s heart stopped beating was traditionally considered the moment of death.

Along with the development of medical technologies and techniques such as reanimation, it has since become clear that brain function is the true border between life and death. Brain death is the crucial point from which there is no return to the world of the living.

Brain death is an irreversible cessation of the function of the brain including the brain stem. It is the most important diagnosis in medicine because of its multiple medical, ethical and legal implications. After the brain death diagnosis has been made, lung function is maintained with mechanical ventilation – in effect, artificial breathing. The heart and bloodstream function may also be artificially stimulated. It should be pointed out that in this moment there is no more life maintenance but only the organ’s functioning maintenance. The family of the deceased person sometimes have problems dealing with the brain death of their loved one, and so these matters must be handled with maximum sensibility and understanding.

There are two sequential clinical examinations. The purpose of these is to determine brain death and it is confirmed by one of the instrumental tests. Clinical examinations include the pupil’s reaction to the light (or absence thereof), the corneal reflex, pharyngeal and other reflexes (or absence thereof), as well as the absence of spontaneous breath or atony of the muscles. Instrumental tests that confirm brain death include an electroencephalogram and transcranial sonography.

What is the difference between coma and brain death?

The brain of a patient in a state of coma continues to function, so the recovery of a coma patient is possible – depending on the level of brain damage. In the case of brain death, the brain functions have irreversibly stopped. Brain death may also be confirmed by an intracranial blood flow scan. If there is no blood flow, brain cells don’t receive oxygen and nutrients and die. The patient’s brain is not able to recover from this state and the patient may be declared brain dead.