Donation Process

The Donation Process

When it comes to recovering the incredible gifts of organ, eye, and tissue donations, our hospitals are our most important partners. We work with over 100 hospitals in our service area to treat our donor heroes with respect and to recover their gifts efficiently and safely for the hundreds of thousands of people who need them.

The Organ Procurement Organization (OPO)

In 1984, the National Organ Transplant Act (NOTA) was signed into law creating the National Organ Procurement and Transplantation Network (OPTN). OPTN works with OPOs and Transplant Centers across the United States to match donor organs to waiting recipients. The creation of the OPTN standardized the process through which organs are donated and shared across the country.  OPTN is managed by the United Network for Organ Sharing (UNOS). 

Organ procurement organizations (OPOs) are non-profit, government-certified agencies that manage the organ donation process. Many also facilitate tissue and eye recovery services. OPOs operate in designated service areas. HonorBridge is the largest OPO in North Carolina, serving 7.2 million people in 77 counties of North Carolina and Pittsylvania County in Virginia. 

HonorBridge provides the following services in our community:

• Receives all organ, eye, and tissue donor referrals in our service area
• Evaluates potential donors for eligibility
• Discusses authorization for donation with families
• Supports families through the donation process
• Coordinates surgical organ, eye, and tissue recovery procedures
• Arranges transportation or organs to transplant centers and tissues to processing centers
• Assists with importing organs from outside of our service area
• Provides public education and public policy advice
• Assists hospitals with procedures and education

The Referral Process

Hospital and emergency medical professionals always make every effort to save a person’s life, regardless of their status as a potential organ, eye, or tissue donor. They follow medical standards and their local procedures that govern how and when an official determination of death is made.  

When a patient dies or a patient’s death is imminent, federal regulations require hospitals to notify their OPO. The OPO will review the potential donor’s medical condition and history to determine medical eligibility. The OPO will search the donor registry to see if the patient is a registered donor. They will work with families to explain the donation process, offer the appropriate options, and support them throughout.

Two types of deceased organ donation

1. Donation after circulatory death (DCD)
   
   DCD is organ donation from a patient who has died of cardiac arrest. These patients are  ventilator-dependent to live but are not brain dead. Once the heart has stopped beating and the patient is no longer breathing, the patient is declared dead by a medical professional not affiliated with organ transplantation. The organ donation process takes place soon after death is declared. If cardiac arrest doesn’t happen in a certain amount of time, donation doesn’t take place. DCD donors most often donate kidneys and, sometimes, they can also donate their liver, pancreas, lungs, and heart.
2. Donation after brain death
   
   Brain death is rare, making up only 1% of hospital deaths. Brain death is the irreversible and complete cessation of all brain function including the brain stem. Brain death is final and finite; it is not the same thing as being in a coma or persistent vegetative state. It is clinical and legal death. With brain death, no blood is flowing through the brain or brain stem and the patient has stopped responding to outside stimuli. An extensive, controlled clinical exam is performed to determine brain death. A physician carefully reviews the medical history and performs a series of physical exams and tests to determine if the brain is no longer working. A ventilator provides oxygen to the organs keeping them viable until they are recovered. Brain death donation can be particularly difficult for families, because a brain dead person on a ventilator can feel warm to the touch and look as if they are breathing. There is no chance of recovery when a person is brain dead.

Authorizing Donation

If the patient is medically eligible for organ donation, family support coordinators go to the hospital to meet with the doctors and the patient care team. They are carefully trained to work with families experiencing a wide range of emotions after a loved one’s death, and to meet with family members at the appropriate and most sensitive time to discuss donation as part of what will come next.

The family support coordinator will ask the family questions about the donor’s medical condition and social history, similar to questions asked of a potential blood donor. Medical tests may be conducted to determine which organs are suitable for transplant. We’ll explain to the family that medical information about donors is sent to UNOS for matching with potential recipients.

Potential tissue donor families are approached over the phone, rather than in person.  

Donor Care

Providing care and management of an organ donor is a complex and highly specialized area of healthcare. An Organ Donation Coordinator from HonorBridge will begin the process by evaluating a potential donor for organ function and medical eligibility.

Improving organ function to maximize the gift of transplantable organs is vital. Even a single organ recovery for transplant can save a life. This makes donor management and organ optimization of the utmost importance as staff focuses on keeping the donor stable.

The donor is kept on ventilation while the necessary tests and procedures are completed. These may include electrolyte replacement, blood replacement, advanced imagery, or diagnostic procedures. Once these procedures are completed, medical management of the donor is continued while the donor is scheduled for surgery to recover organs.

Organ Allocation and Donation

Under contact with the US Department of Health and Human Services, UNOS maintains a centralized computer network called UNet to assist with organ allocation. Transplant professionals can access this computer network 24 hours a day, seven days a week. Organs are usually offered first to the sickest patients within the same region. If there are no eligible recipients in that region, the organs will be offered to candidates in other regions. UNet electronically links all transplant hospitals and organ procurement organizations in a secure, real-time environment.

Factors affecting a match may include:

• Degree of medical urgency
• Tissue match
• Blood type
• Length of time on the waiting list
• Immune status
• Distance between the potential recipient and the donor

The organ is offered to the transplant center serving the first person on the list. The transplant team considers the organ for the patient. When the transplant team is offered an organ, it bases its acceptance or refusal of the organ based on the needs of the patient at the time using various medical criteria. When a patient is selected, he or she must be available, healthy enough to undergo major surgery, and willing to be transplanted immediately. If the organ is refused for any reason by the patient or by the patient’s doctor, the transplant center of the next patient on the list is contacted. The process continues until the organ is accepted. Once all the organs are allocated, surgery is scheduled and the organ recovery takes place. The entire process can take up to 24- 36 hours. Following the recovery process, an open-casket funeral can be held. Organs are recovered in a dignified surgical environment and the body is carefully restored.

Tissue Donation

Tissue donation is more common than organ donation. Tissue recovery takes place at either the donor hospital or in a recovery suite at the OPO.

A single tissue donor can touch the lives of up to 75 people as the donated tissues are used in a variety of procedures that can save lives, repair limbs, relieve pain or enhance a patient’s quality of life. The following is a list of the types of tissue that can be donated along with recipient benefits.

• Heart valves may be used to replace valves that have been damaged or no longer function properly.
• Recovered veins may be used for aneurysm repair by strengthening the vessel walls. Those same veins may also be used for patch grafts during heart valve replacement surgeries. Veins may be used for multiple and repeat coronary artery bypass surgeries, to restore blood flow below the knee and as a vascular access for long-term hemodialysis patients.  
• Skin may be used to treat burn patients. These grafts assist the patient in fighting off infections as well as giving the patient’s own skin time to heal. The derma skin may be used in reconstructive surgeries for women who have undergone mastectomies due to breast cancer. The skin may also be used in certain oral surgeries, gynecologic-obstetric surgeries, and orthopedic surgeries.
• Bone grafts may be used in numerous surgical procedures, such as replacement for bone deficits for victims of cancer, trauma, and other conditions, which require bone to facilitate recovery. In some cases, the graft means the difference between amputation of a limb or maintaining the ability to walk. 
• Soft tissues such as tendons, ligaments, and fascia may be used for corrective knee and ankle surgeries, gynecologic-obstetric surgeries and many other reconstructive surgeries.  

Once the tissue donation process is complete, the donor is prepared for transport to the funeral home. Just as in organ recovery, an open-casket funeral can be held. Tissues are recovered using dignified surgical procedures, and our funeral home partners are skilled in preparing donors for viewing and memorial services.