Living donors
Living donors volunteer to donate full or partial organs. The most common organs that are donated are a single kidney, a liver segment or a small lobe of the lung. As with any major surgery, there are risks involved, including pain and discomfort as well as emotional and psychological responses.
Types of living donation:
- Directed donor – a donor specifically chooses who will receive their donation
- Non-directed/altruistic donor – donor is neither related to nor known by the person in need
- Paired donation – involves at least 2 pairs of transplant candidates who do not have matching blood types or are cross-matched incompatible
To qualify as a living donor, you must be:
- At least 18 years old
- Medically cleared for surgery
- Free of significant hypertension
- Free from diabetes
- Compatible with the blood type of the recipient
To determine if you can qualify to become a living donor, you’ll need to take certain tests such as:
- Tissue typing of the white blood cells
- Crossmatching to see how the recipient will react
- Screening antibodies and antigens
- Urine samples
- A chest X-ray and an EKG
- Arteriogram
- Psychiatric and/or psychological evaluation
Usually, living donation doesn’t cost the donor anything. Most recipients’ private insurance policies pay 100% of the donor’s expenses. If the recipient is covered by Medicare’s End-Stage Renal Program, either all or partial medical expenses of the donor will be covered. The only costs a donor might incur include some lost wages or sick leave depending on their employer’s policy.
Donors after brain death
According to the American Academy of Neurology, brain death is “the irreversible loss of function of the brain, including the brainstem.” It’s different from a coma because a person can’t recover from brain death. In order to remove organs from a body, organ recovery agencies must verify that brain death has been declared on a death certificate in accordance with state laws.
Brain death can result from:
- A severe head injury
- A neurological event with massive bleeding or blood clot
- A loss of oxygen to the brain
Brain death is determined by:
- An extensive examination under controlled conditions, conducted by a physician who is a neuro specialist or critical care specialist and is not involved in the donation process
- Clinical test results that show no brain reflexes and that the donor cannot breathe on his or her own
- A cerebral angiogram or an EEG to confirm the absence of blood flow to the brain
Donors after cardiac death
Donation after Cardiac Death (DCD) is an option for families of patients who have non-survivable injuries and/or illnesses but are not brain dead. Prior to the introduction of brain death laws, DCD was the only way in which organs were recovered for transplant.
Doctors can typically recover both kidneys, the liver and pancreas; in rare cases, the lungs and/or heart are also recovered.
DCD is presented as an option to the family only after they have decided to withdraw ventilator support once a physician unrelated to the donation process has determined the patient will not recover.
Cardiac death is determined by:
- Checking the pulse and detecting nothing after five minutes
- An evaluation that shows the heart will cease functioning within 90
minutes of removal of support - Monitoring the patient’s heart*
*If the heart does not stop beating in that time frame, the organs are not recovered.
Costs associated with DCD:
- The family of the donor is not charged for Donation after Cardiac Death and the organ procurement organization (OPO) assumes financial responsibility for the donation costs
- If the patient does not die within 90 minutes after the ventilator is removed or if the patient is taken back to their room for end-of-life care, their family then resumes financial responsibility for the hospital care