One of the two kidneys, one of the two lungs and a part of liver can be donated from a healthy person. The organs that are commonly used for donation from a cadaver donor are the eyes, heart, lungs, liver, pancreas and the kidneys.
The immediate and long term outcomes are much better for the recipient with the live donation. The cadaver organ wait list becomes shorter and the donor feels emotionally satisfied and gratified by donation especially if the outcome is successful.
Live donation involves psychological stress to the donor and his family and inconvenience (time involved and absence from work) and risk of evaluation. There may be postoperative surgical site pain and abdominal discomfort and occasionally wound infection or pneumonia.
Parents, children, siblings, grandparents, and spouse can be voluntary kidney donors if their age is between 18 to 60 years and they are blood group compatible (well suited with that of the recipient).
The donor should be free from long-standing ailments that can affect kidneys in the course of the illness (diabetes mellitus, hypertension etc.) and should have two healthy normal functioning kidneys. They should not have an infection with blood-borne viruses (Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus infection) and they should be psychologically stable to make a decision on kidney donation without coercion.
Apart from the evaluation of the above-mentioned issues, tests will be done to make sure that there are no illnesses affecting other major organs. Assessment of individual kidney function by radioisotope renogram (a scanning test done following intravenous injection of radioisotope),tissue typing (blood collected from the donor and the recipient are tested for the degree of tissue level compatibility) and computed tomography (CT) angiography (contrast material is injected intravenously to see clearly the blood supply of the kidneys; location and branching of kidney blood vessels will help in surgical plan) are the other tests required for donor evaluation.
The living donor will undergo urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) in the Operating Room (OR) just before the removal of the kidney.
The kidney will be removed through an incision over the right or left side of the abdomen (open nephrectomy) or by laparoscopic technique (laparoscopic nephrectomy) under anesthesia.
Laparoscopic technique requires bloating abdomen with carbon dioxide before introducing laparoscope (an instrument that helps to visualize the interior of the abdomen through a very small incision). It is associated with less postoperative pain, faster recovery and early return to work. However, it may require additional abdominal incision to deliver the removed organ or conversion to open technique in case there are unexpected problems during laparoscopic removal of the kidney.
Organs from deceased donors are needed due to absence of voluntary living donors (small family, blood group incompatibility, family members having the same disease or some other disease that does not permit organ donation) and single number organ status in a normal human being for the organ required (heart, pancreas).
Brain dead heart beating patients who are victims of head injury, stroke and brain tumor and who have non recovery of brain function with cardiac resuscitation following cardiac arrest are the potential cadaver donors. Numerous laboratory tests will be conducted to make sure that there is no chronic illness that involves the organs to be harvested. Patients with age above 70 years, severe hypertension, advanced cancer and blood borne viral and bacterial infection will not be considered for organ harvesting.
Zonal Coordination Committee of Karnataka for Transplantation (ZCCK) is responsible for coordination of deceased donor organ donation and transplantation. It is a non-profit medical service working with centers recognized by the Government for cadaver donor transplantation.
Brain death is complete and irreversible cessation of brain activity despite the presence of heartbeat. With mechanical ventilation and medical support, the lungs and heart can be made to continue function and circulation to the tissues can be sustained.
A panel of four doctors that includes a neurologist and the Medical Superintendent of the hospital carry out a series of standard tests that are accepted medically and ethically all over the world to confirm that a patient is “brain dead”.
Once a patient is pronounced brain dead after evaluation, testing and documentation, consent is obtained from the family for organ donation if there are no contraindications for the same. Organ Procurement Organization is informed and consent is obtained from legal authorities. The organ donor is maintained on ventilator and medications and is stabilized with fluids. Recipients and their treating consultants are informed to get ready for possible organ transplantation. The surgical team harvests multiple organs from the donor in OR. They are then perfused with through special solutions kept under cold storage. Ventilator support is discontinued and donor’s body is handed over to the relatives at the end of surgery.
As the organ donor will be maintained on a ventilator and stabilized with fluids and medications and organ harvesting is done within 24 hours of diagnosis, the harvested organs are likely to have good function after transplantation.
The harvested organs will be perfused and kept in cold storage under the custody of ZCCK until the tissue cross match report is ready. They will then be transported to the center wherefrom the chosen recipient had registered with ZCCK.
Healthy living people can state their wish for organ donation after death by signing a donor card through ZCCK website and then submitting it on line. This is a legal document and doctors can remove organs from such a person after death if the close relatives do not have objection for the same. That is why it is important to let your family know your decision on organ donation after death.