Deceased Donor Transplant Process

The lifesaving process of donating organs for transplantation is very complex. The process begins with the decision to become a donor after death to help save a life or many of the more than 100,000 people on the waiting list. After the decision to become a donor has been made, the process to complete the organ transplant includes these steps:

1. The patient is deemed a potential donor and a donor referral is made to our Organ Procurement Organization (OPO) LiveOnNY
2. A LiveOnNY transplant coordinator completes a medical evaluation
3. The consent for organ donation is obtained by a trained requestor, from the patient’s family or authorized party.
4. A patient from the transplant wait list is identified as a good match with the donor
5. The donor’s death will be determined by cardiac or neurological criteria
6. The Donor is taken to the operating room where The organ(s) are recovered and preserved for transportation
7. After the organ transplants are completed, follow-up communication is provided to the donor family and care team

Donor referral

All patients meeting criteria for organ and tissue donation are referred to LiveOnNY by submission of an electronic referral through the electronic medical record or by telephone at 1-800-GIFT-4-NY (1-800-443-8469). The clinicianprovides confidential information to determine if the patient is a potential donor.

Medical Evaluation

A LiveOnNY transplant coordinator travels to the hospital to evaluate each potential donor and to determine the medical suitability of each organ. The transplant coordinator obtains detailed medical information about the patient's current medical condition as well as any past medical history.

Declaration of Death

Organ donation may proceed after the Donor has been declared dead by Cardiac or Neurologic criteria.

Cardiac death

In the circumstance of devastating neurological injury or terminal illness, some patients and/or families may opt to limit or withdraw artificial life supporting medications or devices. When a family decides to take a patient off life support, the patient may be eligible to donate his or her organs once the heart stops beating. This type of donation is called donation after cardiac death (DCD).

When a family or patient is initiation discussion about withdrawal life sustaining treatment, a physician will contact the organ donor network (it is mandatory federal law that the organ donor network is called). The Liveon NY will screen the patient for eligibility. A representative will speak to the family if the network believes that the patient is a suitable candidate, the patient is a registered organ donor, or the family has indicated a desire to donate.

If the family consents for donation, time will be arranged for the patient to be transported to the Operating room where the life sustaining machines will be disconnected. The family is encouraged but not required to accompany the patient to the operating room and be present during withdrawal of artificial life support. Certain medications will be given to the patient before removal of the life support. These are to facilitate the donation process. Once the machines are disconnected, the patient’s heart beat is monitored. If the patient's heart stops beating within 60 (minutes Cardiac Death), the organs can be recovered for transplant. Family will be escorted from the Operating room before any organ recovery Typically, heart, liver, kidneys, lungs, intestines, pancreas and tissues can be recovered for transplant after DCD.

Neurological death

Donation after neurological death refers to organs that are recovered after a patient has been declared brain dead.

Declaration of Brain Death:

• Brain death is irreversible loss of brain and brainstem function. In order to determine a patient brain dead, a attending intensivist, neurologist, neurosurgeon or neuro intensivist must perform a single neurological exam that demonstrates a complete absence of brain function. In cases of organ donation, NYS law requires a second neurologic exam by another physician that corroborates the initial exam
• Additionally, a single apnea test must be performed. During this test, the patient is briefly disconnected from the ventilator (breathing machine) for 8-10 minutes to see if the patient is able to initiate breaths without the help of a machine. If the patient does not make any attempts to breathe, the apnea test supports the diagnosis of brain death.
• It is most important to understand that brain death is death.
• Organs that can be donated after neurological death include heart, lung, kidneys, liver, pancreas, and intestines. Tissue and eyes can also be donated.

Consent for organ donation is obtained

The transplant coordinator or family services coordinator meets with the potential donor's next of kin, or other authorized party, to offer the opportunity for donation. This conversation is carefully timed and takes place only after the next of kin is given time to understand their loved one is brain dead. Detailed information is provided about the organ donation process including which organs and/or tissues may be donated, how and when the recovery will take place, testing that will be required to determine the medical suitability of the donations, and how the organs and/or tissues will be distributed to the patients’ needing transplants.

After making the decision to donate, the next of kin will be asked to sign a consent form documenting which organs and/or tissues they wish to donate. After obtaining consent, the transplant coordinator also conducts a detailed interview with the next of kin and completes a medical and social history questionnaire about the donor. Many of these questions are similar to those asked when someone donates blood.

Medical Examiner/Coroner

Prior to the recovery of any organs or tissues, the transplant coordinator must also contact the appropriate county medical examiner or coroner if the death is under their jurisdiction.

Organ allocations and recipient identification

Each patient awaiting an organ transplant is listed on a national computerized waiting list that is maintained by the United Network for Organ Sharing (UNOS) in Richmond, Virginia. This registry contains detailed information about each patient including blood type, degree of medical urgency and other data important for matching donors to recipients. This registry changes constantly as new patients are added to the list, and as other patients either receive a transplant, die waiting, or due to a change in medical condition, are removed from the list.

Specific information about each donor, including his or her blood type and body size, are entered into the national computer system. An individualized list is generated for each donor that identifies patients who match for those particular organs. There is a different list generated for each and every donor.

Each available organ is allocated according to medical urgency, degree of match to the donor and time waiting. The transplant coordinator then contacts the transplant center where each potential recipient is waiting and provides detailed, confidential information about the donor. The transplant surgeon always makes the final decision about whether or not the donor and intended recipient are a good match.

Organ recovery procedure

The recovery of the organs is performed in the operating room where the organ donor is being cared for. The transplant coordinator oversees the arrival and departure of the surgical recovery team. This will determine when the patient may be transported to the Operating Room. Family may accompany patient to the operating, but will not be allowed into the operating room The recovery team consists of surgeons, nurses, the transplant coordinator and an organ preservation technician.

Organ preservation

Just prior to being removed from the donor, each organ is flushed free of blood with a specially prepared ice-cold preservation solution that contains electrolytes and nutrients. The organs are then placed in sterile containers, packaged in wet ice, and transported to the recipient's transplant center. It is important to transport the organs from the donor to each intended recipient as quickly as possible. Hearts and lungs must be transplanted within approximately four hours after being removed from the donor. Livers can be preserved between 12 - 18 hours; a pancreas can be preserved 8 - 12 hours; intestines can be preserved approximately 8 hours; kidneys can be preserved 24 - 48 hours.

Costs

All costs directly relating to the recovery of the organs, including laboratory tests, use of the operating room, surgeon's fees, transportation, etc., are billed to LiveOnNY. The recipient's transplant hospital then reimburses LiveOnNY for the recovery costs. In turn, the transplant hospital is reimbursed by the recipient's insurance company or through Medicare.