Organ donation is defined as the process of transplanting human organs from one person to another (“Organ donation,” 2017). As of November 2018, there are more than 114,600 people on the national waiting list for a donor organ, and a new person is added to the list every 10 minutes (“Organ Procurement and Transplantation Network,” n.d.). So far in 2018, over 30,400 transplants have been performed from more than 14,500 donors (“Organ Procurement and Transplantation Network,” n.d.).
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The most commonly transplanted organs are kidneys, as they can come from living or deceased donors (“Organ donation,” 2017). The process of organ donation is rather complex, and so are the perspectives of the people involved.
There are many elements to the organ donation process. The Organ Procurement and Transplantation Network (OPTN) is the database in the United States responsible for matching potential transplant recipients to identified organ donors (“Transplantation, Medical,” 2017). The organization in charge of running the OPTN is the United Network for Organ Sharing (UNOS), a non-profit that is based in Richmond, VA (“Transplantation, Medical,” 2017). This network takes a variety of factors into account when matching donors and recipients to increase the probability of a successful transplant.
The U.S. and the U.K. use a consent system called “informed consent,” meaning that the donor or family of the donor has to approve the donation (“Organ donation,” 2017). One can register to become a donor by marking a space on their driver’s license or registering online; however, most hospitals will still consult the donor’s family and get their final approval even if the patient is a registered donor (“Organ donation,” 2017). Other countries use a system called “presumed consent,” meaning that healthy organs are removed for transplant in any patient, unless there is written evidence that the person did not want to become a donor (“Organ donation,” 2017).. This system does increase the number of available organs and transplants, but it does some people who may not have wanted to donate will be organ donors. A majority of donor organs come from deceased/brain dead donors, which are usually young and healthy patients that have sustained a fatal head injury and no longer have brain activity (“Organ donation,” 2017). These deceased or “brain dead” donors can donate both kidneys, both lungs, a heart, pancreas, and intestines. Living organ donors can give one kidney, one lung, and portions of the liver, pancreas, or intestines (“How Organ Donation Works,” n.d.).
When the UNOS list is matching donors to recipients, it considers the blood type, body size, severity of potential recipients’ condition, how long he or she has been on the waiting list, and the distance between the two to find the closest match (“How Organ Donation Works,” n.d.). One of the biggest problems facing the actual donation is the possibility of rejection. Each person’s tissues bear a distinctive set of antigens, and scientists now know the closer the human-leukocyte-antigens are between the donor and the recipient, the higher chance for a successful transplant (“Transplantation, Medical,” 2017). If the antigens are not a close enough match, the recipient’s immune system will attack the antigens of the new organ thinking that they are foreign, which makes the body reject the transplanted organ (“Transplantation, Medical,” 2017). There are two types of rejection; acute rejection happens very quickly after the transplant, while chronic rejection involves the organ slowly failing (“How Organ Donation Works,” n.d.). To combat this rejection, the recipient will be prescribed immunosuppressive drugs for the rest of his or her life (“Transplantation, Medical,” 2017). However, the result of a suppressed immune system can cause other issues; is that it cannot fight off germs and bacteria as easily and make the body more susceptible to illness and unable to recover as quickly, especially in the first few months after the transplant (“How Organ Donation Works,” n.d.).
Organ donation affects many lives, well beyond just those physically involved in the process. Whether it be the potential donors, people on the waiting list, or the donor’s family, each has their own unique opinion about their experience or how they feel about certain aspects of the donation. Taking these perspectives into account makes one understand just how complex the process is and why it is still a somewhat controversial topic.
A study conducted in Northern France by Munoz Sastre et al. (2012) interviewed 200 people on their willingness to be organ donors in a variety of theoretical situations. The factors included in the possible scenarios included: the donor’s relation to the recipient (a stranger versus a family member), the possible surgical complications/long-term health issues for the donor, the likelihood of success, and the probability of matching to a potential recipient (Munoz Sastre et al., 2012). The study resulted in three categories of responses. The first group, which consisted of 49% of the participants, had a high willingness to donate for a family member versus a low willingness to donate to a stranger (Munoz Sastre et al., 2012). The second category was comprised of 37% of participants who were highly inclined to donate to a family member, but also moderately inclined to donate to a stranger (Munoz Sastre et al., 2012). The third category included 14% of participants, who had a low willingness to donate to a family member as well as an unfamiliar person (Munoz Sastre et al., 2012). This study gives helpful insight into what makes people want to become organ donors.
This study, conducted by Merola et al. (2016), surveyed 225 people who are currently on the UNOS transplant list on their willingness to be donors as well as their attitudes about the process as a whole. The results were that 32% of participants were registered donors, 28% had no interest in becoming donors, 38 % felt that their medical condition disqualified them from as potential donors, and 18% felt that they should be prioritized on the list if they agreed to donate (Merola et al., 2016). According to Merola et al. (2016), only 28% of these participants reported discussing the possibility of donating with their doctor. If the 68% of waitlisted patients were not registered did so, 9,500 new people would be added to the potential donor pool which could increase the number of transplants each year by 19,000 or more (Merola et al., 2016). Merola et al. (2016) also noted that more than half of the participants of this study confirmed misconceptions regarding organ allocation and eligibility, indicating that these waitlisted patients need to be more informed on the topic in order for more transplants to take place.
A study performed by Marck et al. (2016) in four Melbourne hospitals interviewed forty-nine families of deceased organ/tissue donors to evaluate their experiences after they consented (or did not consent) to organ donation. The results revealed that the families were highly satisfied with the care received from health professionals, noting that they felt like they were well-informed of their loved one’s status and the prospective outcomes of the donation process (Marck et al., 2016). Also, according to Marck et al. (2016), most of the families suggested that they found comfort in the fact that their loved one was able to save other people’s lives, even though the process was difficult and somewhat stressful. The only families in the study that regretted their choices were some of those who did not consent to organ donation (Marck et al., 2016). It is important to understand the family’s outlook because they ultimately make the final decision as to whether or not their loved becomes an organ donor, making them just as involved in the process as the donor or the recipient.
For those waiting on the UNOS list, receiving a donor organ is literally a matter of life and death. Medicine is continuing to evolve and every year more and more selfless donors give the ultimate gift. Names are always being added to the UNOS list, but more donors allow for more people to have the opportunity for a healthy life. The whole process of organ donation has several moving parts and complex outlooks of those involved.
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