Organ, Tissue and Eye Donation

1. Organ, Tissue and Eye Donation Barb Nelson-Agnew Hospital Liaison, LifeSource Sally Jacobson, Volunteer Liver Recipient LifeSource 2010

2. There are two types of donation • Tissue Donor—Occurs after cardiac death. • Tissues that can be donated: Heart valves, bone, connective tissue, veins, skin, corneas/eyes. • Organ Donor—Occurs after brain death, or withdrawal of support following grave neuro injury. • Organs that can be donated: Kidneys (2), heart, lungs (2), liver, pancreas, intestine *Tissue and eye donation can follow organ donation!

3. Fast Facts about Donation • Over 103,000 men, women and children currently need life-saving organ transplants. • Every 12 minutes another name is added to the national organ transplant waiting list, or over 100 daily. • An average of 18 people die each day from the lack of available organs for transplant. • In 2008, there were nearly 28,000 organs transplanted in the U.S. • Approximately 1,000,000 tissue transplants are performed annually and 1 in 20 people will need a tissue transplant. • Over 40,000 cornea transplants are performed in the U.S. each year. • Virtually anyone can donate their organs, tissues and eyes after death.

4. How donation agencies learn about deaths • All hospitals are required by federal law to report each hospital death to the donation agencies that they collaborate with. In our region, the donation agencies are LifeSource for organ and tissue donation, and the Lions Eye Bank for eye donation.

5. Notifying the donation agencies • Hospitals call 1 central number that reaches both agencies. • Questions about the decedent’s medical/social history are asked at that time, and if appropriate, the donation agency coordinators ask to speak to the family regarding donation. This happens via phone.

6. Donor Designation—what does it mean? • In our region, Donor Designation is the law. When you document your wishes via driver’s license, living will, advanced directive or state ID, it is legally binding. It is as powerful as your will.

7. Donor Designation, continued • When DD is present, the donation agency coordinator goes to the family disclosing what we intend to do, not asking for authorization, because the permission has already been documented in writing by the decedent.

8. Telling your family… • When you document your wishes in writing (driver’s license, living will, advanced directive or state ID), it’s very important to tell your family. • Your family is who the donation agencies speak with upon your death. Knowing your wishes will make the discussion easier for your loved ones.

9. Documenting your wishes… • To be a designated donor, check the BOX on your Driver’s License application. • Here’s what it says: • “Under the provisions of the Uniform Anatomical Gift Act, do you wish to be identified as an organ donor?” (To stay a current donor, you need to check the box each time you renew your license)

10. Screening for donation • The family answers a series of questions related to loved one’s medical history. This questionnaire is similar to the questions one would be asked if donating blood. This may take some time, but it’s well worth the gift that is being shared. • Some of the history may be obtained from the hospital and the patient chart.

11. Does it cost money to donate? • There is no cost to the donor’s family for organ, tissue or eye donation. • The donation agencies do not pay funeral expenses. • The recipient of organs, tissues or eyes pays for the transplant through their insurance company or Medicare.

12. Appearance • An open casket funeral is still an option when a loved one has been a donor. • Prosthetics are put in where tissues are taken out. • Family is informed that if upper arm bone is removed, there is an incision that may show; long sleeves may be the best option. • There is a slight risk of redness, bruising or swelling following an eye recovery, but funeral directors can normally correct imperfections with cosmetics.

13. Timing… • Eye Bank recovery staff are locally based most often, and can perform the procedure usually within several hours after family discussion. The procedure can take approximately 2 hours. • Tissue recovery staff fly from St. Paul to various hospital locations; they arrive within several hours of family discussion; the procedure can take 4-6 hours.

14. When can organ donation occur? • In order to be an organ donor, the patient needs to be on a ventilator and must have suffered a severe neurological injury.

15. When can organ donation occur, continued… • After all efforts to save the patient’s life are exhausted, tests are done to confirm that the patient is brain dead. • If the patient does not progress to brain death but is not going to survive the injury, the family may choose to withdraw support.

16. When can organ donation occur, continued… • When situations like this occur in hospitals, they are communicating with LifeSource and establishing a plan for next steps. LifeSource will talk with the family when: • They have questions about donation • Brain death has been declared • The family has chosen to withdraw support.

17. When can organ donation occur, continued… • The hospital physicians working to save the patient are different from the ones who recover organs for transplant. • Once a donation decision has been made, LifeSource will come on site and take over management and prepare for the recovery to occur.

18. What organs can be recovered? • Heart • Liver • Pancreas • Small intestine • Kidneys (2) • Lungs (2)

19. Tissue and Eye Donation • Tissue and eye donation can occur after the heart has stopped beating; whether organ donation has occurred already, or not. • LifeSource and the Lions Eye Bank work with all hospitals to facilitate tissue and eye donation, regardless of rural locations.

20. Tissue and Eye Donation , continued… • Lions Eye Bank has trained professionals (enucleators and in-situ techs) in communities to perform procedures. • LifeSource flies procurement teams in to ND hospitals to recover tissues.

21. What tissues can be used?

22. Tissue comes back to our community • Over 11,500 tissue grafts have been used in our local hospitals in the past year. • Orthopedic procedures, implants, fusions, skin-grafts for burn victims • Over 50 people can benefit from one tissue donor.

23. What eye tissue can be used? • The cornea—the clear protective lens of the eye, transplanted to two recipients • The sclera—the white, outer portion of the eye, can be sectioned and transplanted to 8 individuals.

24. Before cornea surgery… A cornea can become clouded for a number of reasons; most times it’s a congenital defect. If a patient is in need of a double cornea transplant, one eye procedure takes place at a time, so that the eye can heal before the next one occurs.

25. After cornea surgery… The sutures are used to adhere the cornea to the eye. They are removed gradually following the transplant procedure, from 3 to 18 months after surgery. This procedure means instant sight for the recipient.

26. Donor Family Services • Donation Agencies provide family support through: • Family letter and medallion, donor placard • Bereavement materials • Support group referral • Annual Donor Family Gatherings • Recipient to Donor Family Communication and • vice versa

27. Community Awareness Efforts Above: Sally Jacobson, liver recipient and Mike Blake, heart recipient volunteer to spread the positive message about donation. At right: Les Johnson, donor father with Sally. At right: The Mobile Learning Center is a large, interactive trailer with three kiosks that travels to destinations in our region to promote donation awareness.