Organ Donation

Organ donation is when a person allows an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive or dead with the assent of the next of kin.

Donation may be for research or, more commonly, healthy transplantable organs and tissues may be donated to be transplanted into another person.

Common transplantations include kidneys, heart, liver, pancreas, intestines, lungs, bones, bone marrow, skin, and corneas. Some organs and tissues can be donated by living donors, such as a kidney or part of the liver, part of the pancreas, part of the lungs or part of the intestines, but most donations occur after the donor has died.

In 2017 Spain had the highest donor rate in the world at 46.9 per million people, followed by Portugal (34.0 per million), Belgium (33.6 per million), Croatia (33.0 per million) and the US (32.0 per million).

As of February 2, 2018, there were 115,085 people waiting for life-saving organ transplants in the US. Of these, 74,897 people were active candidates waiting for a donor. While views of organ donation are positive, there is a large gap between the numbers of registered donors compared to those awaiting organ donations on a global level.

Organ donors are usually dead at the time of donation, but may be living. For living donors, organ donation typically involves extensive testing before the donation, including psychological evaluation to determine whether the would-be donor understands and consents to the donation. On the day of the donation, the donor and the recipient arrive at the hospital, just like they would for any other major surgery. For dead donors, the process begins with verifying that the person is undoubtedly deceased, determining whether any organs could be donated, and obtaining consent for the donation of any usable organs.

Normally, nothing is done until the person has already died, although if death is inevitable, it is possible to check for consent and to do some simple medical tests shortly beforehand, to help find a matching recipient. The verification of death is normally done by a neurologist (a physician specializing in brain function) that is not involved in the previous attempts to save the patient's life. This physician has nothing to do with the transplantation process.Verification of death is often done multiple times, to prevent doctors from overlooking any remaining sign of life, however small.

After death, the hospital may keep the body on a mechanical ventilator and use other methods to keep the organs in good condition.[7] Donors and their families are not charged for any expenses related to the donation.

The surgical process depends upon which organs are being donated. After the surgeons remove the organs, they are transported as quickly as possible to the recipient, for immediate transplantation. Most organs only survive outside the body for a few hours, so recipients in the same region are usually chosen. In the case of a dead donor, after the organs are removed, the body is normally restored to as normal an appearance as possible, so that the family can proceed with funeral rites and either cremation or burial.

The Ten Major ideal donor management goals (DMGs):

- MAP 60–120 mm

- HgCVP 4–12 (or < 12)

- Final Na ≤ 155, or 135-160 mmol/L

- Pressors < 1 ideal, or low dose pressor

- PaO2/FiO2 ratio > 300 (PaO2 > 300 on 100%

- FiO2, 5 PEEP)pH on ABG 7.25–7.5Glucose < 150

- Urine Output 0.5-3 mL/kg/h

- LV EF (%) > 50

-Hgb > 10 mg/dL

The lungs are highly vulnerable to injury and thus the most difficult to preserve, with only 15–25% of donated organs utilized. Suggested management includes ARDS goals; low tidal volume ventilation (6–8 mL/kg), low FiO2, and relatively high PEEP. PaO2 ratio should be > 300 in preparation for organ donation and/or a PaO2 > 300 on 100% FiO2 and 5 cm H2O PEEP. While a lower PaO2/FiO2 will not always result in exclusion, this should still be the goal.

Please think about donating your organs as you will save lives.

Thank you guys for reading x