Professional Perspectives: Organ Donation
For the second post in our Professional Perspectives series, Ria interviewed Sandy Andrada, Regional Director of Donor Network West. Donor Network West is a non-profit organ procurement and tissue recovery organization. Here are some great set of frequently asked questions and Sandy’s insightful answers. Since organ donation is a decision people can make in their Advance Health Care Directives that they may have questions about, we hope this post will be helpful.
By: Ria N.
Speaking with Sandy Andrada, a regional director at Donor Network West, we learn more about how organ donation works.
What is your role with Donor Network West?
My role as a regional director puts me in charge of the Santa Clara, Santa Cruz, Monterey, and San Benito areas. I have a team of 14 people: 7 are clinical coordinators, 3 are social workers, and 4 are educators.
Why should people donate organs?
I feel like it is the ultimate way of helping someone else. After passing away, you won’t need your organs or tissue anymore, and this is something that can help someone else live a better or longer life. It also helps you live on in someone else, and this concept gives many families hope. It’s almost like getting a new family when your family connects with the recipient, and I’ve seen cases where the donor and recipient families become really close.
About how many lives can potentially be saved with one organ donor?
One organ donor could potentially save 8 lives. One tissue donor could potentially save 75 lives.
In what circumstances do people need to have donated organs?
We have a lot of people affected by kidney disease in the U.S. due to our diets or other unhealthy habits. If someone experiences kidney failure after dialysis, they would need a kidney transplant. Heart transplants are for those born with a heart defect or those with a virus attacking their heart. Most lung recipients were born with cystic fibrosis. Liver recipients usually need transplants because of viruses or disease, and those who need them due to alcohol damage are the minority. Recipients actually have a psychological evaluation before receiving a donation. Substance abusers must be able to prove that they are in the condition to take care of their new organs. Many people are waiting for these, so we have to make sure that recipients will take care of themselves after the transplant.
(Shannon Liu Shair adds as a side note that her son was born with a congenital heart defect, requiring open heart surgery at 30 days old. Even babies and young children may require heart transplants for their CHD. Here is a post about Shannon’s experience with a CHD Symposium.)
Can you give an example of what each reason for organ donation means?
Transplants are the most well-known where it goes directly into the patient. Organs can also be donated to research. For example, Stanford conducts brain research for those with Alzheimer’s or seizures. Research is also used to improve the transportation of organs. Organs can be used for education, as medical schools use them to allow students to practice surgery or learn anatomy. They can also be used as therapy. The matrix from the skin of a donor can help burn victims grow their own skin with less risk of infection and scarring.
What is the process for organ donation? How long does it typically take?
Our coordinators work at hospitals where there are patients who are in critical condition or have passed away. The hospitals are required to notify them of deaths. The coordinators then review the patient's charts to see if they are viable as donors. Then, they check to see if the patient was a registered donor. If they were, and the patient is brain dead or has passed away, the coordinators can help the family with the process. If the patient was not registered they speak with the family about the option of donation. Once they receive authorization, they match the recipients with the donor and proceed to recovery. The process takes about 24-72 hours.
Who makes the decision of whether a person's organs are viable for transplant? Who makes the decision of whether a person is brain dead so that the organs can be donated? Are they different people?
They are two different people. The coordinators from Donor Network West evaluate the patient’s chart to determine whether a person’s organs are viable for transplant. Brain death testing, however, is completed by physicians at the hospitals. In California, two physicians must verify brain death, so their interests are with the family and have nothing to do with the transplant.
Is it still possible to do an open-casket funeral if someone is an organ donor?
Donors can actually have open-casket funerals, and no one would be able to tell that they are a donor. Organ recovery is a straight line, and incisions are often made where it wouldn’t show. If they donate skin, it is recovered from areas that wouldn’t be visible in an open-casket. If they donate bones or bone marrow, the bones can be replaced with wooden dowels to maintain the body’s structure.
What are the different options for what someone can request when agreeing to be an organ donor?
The first thing someone can customize is what they want to donate - most people authorize donating any organ. Through an advance health care directive or the state registry, they can limit authorization to only organs and not tissue, only research, etc. It is also possible to choose to authorize only transplants or research as well. When the transplant is completed, the organization can notify the donor family of vague information about recipients, such as age, condition, or region. The donor family can write to the recipient through the organization (or vice versa). They can both also mutually decide to meet, which would be set up by Donor Network West.
What are the requirements to be eligible as an organ donor? Ex: age, health conditions, etc.
Anybody can sign up to be an organ or tissue donor. At the time of death, the coordinators complete an evaluation to see if they are viable as a donor. Age requirements can definitely change over time as technology gets better. We can now transport a 70-year-old’s organs, which we weren’t able to do a few years ago. We can even transplant organs from those who have HIV or Hepatitis B since it goes to recipients with the same conditions. How you are today does not represent how you will be when you pass, so don’t rule yourself out for any reason.
Can organs be transported across state lines or internationally?
We match the recipients on a national database by blood type, height, weight, tissue type, how ill they are, age, etc. Only when each organ has a waiting patient do our coordinators go in and recover. Regulations require that we help patients locally first, but how far we can transport the organs depends on the type. For example, kidneys can go across the country or even to Canada, but hearts or lungs can only go a few states away. However, technology is always changing. Recently, researchers have developed a new machine that can pump air and blood into the lungs as they are transported; this allows them to go out farther.
What is the most common transplant? The rarest or hardest to find?
Most common transplant is a kidney transplant. About 70% of waiting patients need kidneys. The hardest organ to get for a transplant is the pancreas.
Can an adult’s organs help a child or vice versa?
Organs are usually placed with a patient based on height and weight. For example, a petite woman’s liver can go into a teenage boy because they might have similar measurements.
What if someone just has the "pink dot" on their driver's license that they are an organ donor? What can be donated or done with that authorization?
That dot is representative of registration at the donor registry, which gives full authorization as a donor.
What if someone puts on their health care directive that they want to be an organ donor, but their health care agent doesn't want to go through with the organ donation?
The Uniform and Anatomical Gift Act ensures that the patient’s wish cannot be revoked.
What is the likelihood that someone will want to be an organ donor and their organs will actually be used for someone else's survival (transplant)?
Less than 1% of us will die in the way that allows us to be an organ donor. We have to pass away in an ICU setting on a ventilator to be an ideal donor, but most of us will likely die cardiac deaths.
Is it possible in the future that more kind of organs than now will be possible to be transplanted?
Yes, 10 years ago we couldn’t do uterus, face, or limb transplants and we can now. There are always advancements in technology that allow us to do more.
What are the best ways to let your loved ones know that you are an organ donor?
New legislation has made the advance health care directives more specific and comprehensive so you can include all your wishes. However, the best way is to talk to your loved ones and have that conversation.
Is there anything you wish that people thinking about organ donation knew about?
I think the most important thing is that people share their donation wishes with their family members. Many families get confused about what you would have wanted, and talking about it with them makes it easier.