Healthcare Professionals

Top 10 things every healthcare professional should know

How many people are in need of organ, eye or tissue transplantation?

Approximately 110,000 men, women and children await lifesaving organ transplants. Sadly, more than 8,000 people die each year because the organs they need are not donated in time.

A cornea donor can restore the sight of two individuals among the more than 40,000 Americans who suffer with corneal blindness. A tissue donor can heal more than 75 individuals in need.

What can be transplanted?

Organs that can be donated include the heart, lungs, kidneys, liver, intestines and pancreas. Tissues include corneas, islet cells, connective tissue (bones, tendons, cartilage, ligaments) bone marrow, blood vessels and blood.

Organ preservation times:

Heart 4-6 hours
Liver 12-18 hours
Kidney 24-48 hours
Heart-lung 2-4 hours
Lung 2-4 hours
Pancreas 12-18 hours

How does the donation process work?

A person who has died that has consented to donation prior to their death is referred to an organ procurement organization (OPO). If the patient has not previously consented (registered) to be a donor, the family will be asked to authorize donation. An extensive evaluation and testing performed by the OPO matches available organs with patients on the national waiting list.

Transplant centers are notified of the results of the match. The transplant team considers the organ offered for their patient that has been evaluated and listed at their center. The organ is accepted or declined. If declined, the organ donated will be offered to the next patient on the national waiting list.

How are organs allocated?

National rules have been established to determine priority for receiving an organ. Characteristics of both the donor and transplant candidate are considered to ensure that allocation proceeds efficiently and effectively. A combination of factors working together determines who receives which organ.

These factors can include: length of time spent on the waiting list, whether the potential organ candidate is a child, patient urgency, body size of both donor and candidate, tissue match between donor and candidate, blood type and blood antibody levels.

What are the criteria for donors and recipients?

The recipient must first undergo an evaluation by a transplant center to determine if they are healthy enough to go through a major surgery and that the transplant has the greatest chance of success.

The evaluation can take weeks, months or longer to complete, depending on the health of the recipient and how quickly the tests can be scheduled. To make sure there is a match, the medical team compares the blood type of the donor and recipient.

Information is collected about the donor from the donor’s medical record and next of kin.

Describe the medical definition of death.

Cardiac death is the irreversible cessation of circulatory and respiratory function. Death on a neurological basis is the irreversible cessation of all brain function, including the brain stem.

Most organ donors are people who suffer from head injuries that result in brain death. These are people who may have had a stroke, traumatic head injury due to a car accident or fall, or a brain tumor that has not metastasized (spread to another part of the body).

There are two legal ways to pronounce death. Death may be pronounced when a person’s heart stops beating (cardiac death) or when the person’s brain stops functioning (brain death). Brain death occurs when blood and the oxygen it carries cannot flow to the brain. The person’s heart is still beating and providing blood and oxygen to the rest of the body because he or she is on a ventilator (breathing machine). In brain death, the organs and tissues remain viable (healthy) and can be removed for transplantation. The organs and tissues are only removed after brain death has been declared by a physician. This physician is never part of the transplant team.

In certain situations, organs can be recovered for transplantation after the person’s breathing and heartbeat have stopped. This is called donation after cardiac death.

Where are the transplant programs in Virginia?

Transplant centers must apply and meet regulatory criteria to perform transplants. Centers are designated by the age (adult or pediatric) and organ they are authorized to transplant. Several people are designated to support patients prior to, during and after transplantation. Every transplant center must identify a social worker, financial coordinator, pharmacist and dietitian, in addition to the surgeon, transplant physician and transplant coordinator.

Other disciplines which support patients and families during the transplant experience include chaplains, child life, physical therapists and occupational therapists.

The transplant centers in Virginia are listed below.

Where can data be accessed?

National, regional, state and center data can be found by visiting:

Organ Procurement and Transplantation Network (OPTN)

Scientific Registry of Transplant Recipients (SRTR)

UNOS

How is authorization for donation determined?

There are two ways authorization for donation may be given:

Adult individuals can give authorization by designating themselves as a donor at any time prior to their death. This is commonly known as “first-person authorization” or “donor designation.” When an individual designates themselves as a donor, they are documenting that they want to make an anatomical gift after their death. This document of gift is legal authorization for donation and cannot be revoked by anyone other than the individual.

In the absence of first-person authorization, the individual’s legal next-of-kin makes the decision about donation after the individual’s death.

There are several ways an individual can document their intent to be a donor. The most common way is through their local Department of Motor Vehicles when they obtain or renew their driver’s license. Individuals can also document their intent to be a donor through the Donate Life Virginia online registry.

Brain death

The irreversible and permanent cessation of all brain function.

Clinical trigger

A mutually agreed upon referral criteria established between the hospital and the organ procurement organization (OPO) which prompts a hospital provider to make referrals to their OPO. This ensures that each family is offered the option of organ, eye and tissue donation and/or the donor designation is honored.

Conversion rate

All recovered organ donors divided by eligible deaths. The national benchmark is 75%.

Crossmatch

A complex blood test that is performed prior to the transplant to determine if the donor organ is compatible with the intended recipient. If the crossmatch is “positive“, then the donor and recipient are incompatible. If the cross match is “negative," the transplant may proceed.

Deceased donor

A person who has been declared dead and whose organ or organs and/or tissues are used for transplantation.

Donation after Circulatory Death/DCD

Donation after circulatory death is the recovery of organs after circulation has ceased. DCD occurs when a patient’s care is futile, and the patient is to be removed from all medical life-sustaining measures and supports.

Donor hospital

A hospital from which patients are monitored by trained staff to recover organs, eyes or tissue for donation.

Donor Service Area

Each Organ Procurement Organization (OPO) provides services to the transplant programs inits area. An OPO’s donation service area can include a portion of a city, a portion of a state or an entire state, or more than one state. Presently, when most organs become available, a list of candidates is generated from the OPO’s local service area. If a patient match is not made in that local area, a wider, regional list of potential candidates is generated, followed by a national list.

Eye Bank

An eye bank is an organization that obtains, medically evaluates and distributes donated eyes for corneal transplantation and research.

First person consent

State laws ensuring legal authority to proceed with organ procurement without consent from the family based on a legal indication of the deceased's consent for donation, such as on a driver's license or other official document.

Graft

A transplanted organ or tissue.

Health Resources and Services Administration (HRSA)

The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services. It is the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable. HRSA oversees organ, bone marrow and cord blood donation and various other programs to help those in need of high quality health care.

Histocompatibility Antigens

Markers found on cells in the body that are unique to each individual. Known also as human leukocyte antigens (HLAs), these are inherited from one’s parents. A person’s immune system uses HLA markers to differentiate self from non-self.

Immunosuppression

The use of drugs to reduce the body’s ability to recognize the transplanted organ as a foreign body and reject the transplanted organ. A combination of immunosuppressant medications is individual to the patient, as determined by their transplant team.

Infection

A condition that occurs when a foreign substance enters the body, causing the immune system to fight the intruder. Transplant recipients can get infections more easily because their immune systems are suppressed.

Ischemic time

The time the transplanted organ is without blood circulation.

Living donor

A person that donates a kidney or part of a lung, liver or pancreas to another person. A living donor may be related or unrelated, if consent is provided and matching of organs is acceptable.

Non-directed donation

Non-directed living donors are not related to or known by the recipient, but donate purely from selfless motives. This type of donation is also called anonymous or altruistic donation.

Organ Procurement Organization (OPO)

The organization responsible for the recovery, preservation and transportation of organs for transplantation. As a resource to their communities, OPOs educate the public about the critical need for organ donation.

Organ Procurement and Transplantation Network (OPTN)

The OPTN operates the national network for organ procurement and allocation and works to promote organ donation. Through its policies, the OPTN works to ensure that all patients have a fair chance at receiving the organ they need, regardless of age, sex, race, lifestyle, religion or financial or social status. The current OPTN contractor is the United Network of Organ Sharing (UNOS).

Organ Donation

Donation of solid vascular organs, including heart, right and left lung, liver (can potentially be split for two recipients), left and right kidney, pancreas and intestine.

Organ recovery

The act of surgically removing an organ from a donor for transplantation.

Paired exchange donation

This donation consists of two or more kidney donor/recipient pairs whose blood types are not compatible. The two recipients trade donors so that each recipient can receive a kidney with a compatible blood type.

Preservation

The process of keeping organs viable between procurement and transplantation.

Rejection

The body’s attempt to destroy the transplanted organ or tissue because it is foreign. Immunosuppressive medications help prevent rejection, and may reverse this process, if identified quickly.

Scientific Registry of Transplant Recipients (SRTR)

The purpose of this registry is to provide ongoing research to evaluate information about donors, transplant candidates and recipients, as well as patient and graft survival rates. The SRTR operates under Federal Contract.

Tissue Bank

An establishment that collects and recovers human cadaver tissue for the purpose of medical research, education and transplantation.

Tissue Donation

Donation of human tissue is taken from a deceased donor that is processed and ultimately transplanted into another person to enhance their quality of life. Tissue includes bone, cartilage, fascia, heart valves, pericardium, skin, veins, tendons, joints and nerves.

Transplant

A surgical operation to give a functioning organ to someone whose organ has stopped working or is close to failing.

Transplant hospital

A hospital that performs transplants, including evaluating patients for transplant, registering patients on the national waiting list, performing surgery and providing care before and after transplant.

Uniform Anatomical Gift Act

An act established by the federal government in the 1960s to standardized state laws on donation of organs and tissues from deceased donors. The act allows anyone 18 years of age or older to donate any or all of their organs upon death.

United Network for Organ Sharing (UNOS)

A private, non-profit organization that serves the organ procurement and transplantation network to oversee organ donation, allocation and transplantation in the United States. UNOS serves as the OPTN under contract with the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS).

Vascular Composite Allografts (VCA)

VCAs are transplantation of multiple structures that may include skin, bone, muscle, blood vessels, nerves and connective tissue. VCA transplants have restored vital function to patients with severe injuries and disfigurement, burns, malformations and illness.

Waiting List

After evaluation by the transplant team, a patient is added to the national waiting list by the transplant center. Lists are specific to organ type. Each time a donor organ becomes available, the UNOS system generates a list of candidates based on factors that include genetic similarity, organ size, medical urgency, proximity of the donor to potential recipients and time on the waiting list. Through this process, the best possible patients are matched to a donated organ.

Virginia Laws

32.1-297.1. The Virginia Transplant Council
The Virginia Transplant Council (d/b/a Donate Life Virginia) is hereby established to create, compile, maintain, and modify as necessary the Virginia Donor Registry in accordance with the regulations of the Board of Health and the administration of the Department of Health. [source]

32.1-291.14. Rights and duties of procurement organization and others.
When a hospital refers an individual who is dead or whose death is imminent to a procurement organization, the organization shall make a reasonable search of the records of the Virginia Department of Motor Vehicles and any donor registry that it knows exists for the geographical area in which the individual resides to ascertain whether the individual has made an anatomical gift. [source]

Related Partners

Virginia Department of Motor Vehicles
Virginia DMV registers more than 90% of Virginians registered on the Virginia Donor Registry.

Donate Life America
Donate Life America (DLA) is a nonprofit national organization devoted to inspiring people to save and enhance lives through organ, eye and tissue donation. DLA manages and promotes the national brand for donation, Donate Life, and assists Donate Life State Teams and national partners in facilitating high-performing donor registries.

Eye Banks
The Lions Medical Eye Bank (LMEB) and Old Dominion Eye Foundation (ODEF) provide human eye tissue for transplant, research and education in the Commonwealth of Virginia and work to register organ, eye and tissue donors.

Organ Procurement Organizations (OPO)
An organ procurement organization (OPO) is a federally-designated agency responsible for facilitating the organ, eye and tissue donation process of deceased individuals. OPOs work collaboratively with their local hospital partners, medical professionals, donor families and community members to build programs, systems and processes needed to make donation possible. There are 58 OPOs nationwide. LifeNet Health, Infinite Legacy and Tennessee Donor Services serve Virginia.

Tissue Banks
A tissue bank is an establishment that collects and recovers human cadaver tissue for the purposes of medical research, education and allograft transplantation. LifeNet Health and WRTC serve Virginia.

UNOS
United Network for Organ Sharing (UNOS) is a private organization that manages the nation’s organ transplant system under contract with the federal government. UNOS maintains the national organ waiting list.

Contact Your Nearest Transplant Center

Charlottesville

University of Virginia Transplant Center
1215 Lee Street, Charlottesville, 22903

Adult: heart, kidney, lung, pancreas, kidney/pancreas, liver
Pediatric: heart, liver, kidney

Norfolk

Sentara Norfolk General Hospital
600 Gresham Drive, Norfolk, 23507

Adult: heart, kidney, pancreas

Children’s Hospital of The King’s Daughters
601 Children’s Lane, Norfolk, 23507

Pediatric: kidney

Northern VA

Inova Fairfax Hospital
8110 Gatehouse Road, Falls Church, 22042

Adult: heart, kidney, lung, pancreas, kidney/pancreas

Richmond

Virginia Transplant Center, Henrico Doctors’ Hospital
1602 Skipwith Road, Richmond, 23229

Adult: kidney

Hunter Holmes McGuire VA Medical Center
1201 Broad Rock Boulevard, Richmond, 23249

Adult: heart

VCU Health Hume-Lee Transplant Center
1250 East Marshall Street, Richmond 23298

Adult: kidney, liver, pancreas, heart
Pediatric: kidney