HERSHEY – What happens if a daughter or son suddenly goes into nonreversible liver failure, and only a liver transplant can save them? What if an individual suddenly loses his kidney function and only realizes it when told that dialysis and transplantation may be necessary?
Contrary to popular belief, liver cirrhosis does not necessarily mean that someone has been drinking too much alcohol. Suppose a person or his loved one is suddenly diagnosed with end-stage liver disease from one of the many other causes of cirrhosis, such as primary sclerosing cholangitis or autoimmune hepatitis, or simply from a fatty liver known as nonalcoholic steatohepatitis?
Everyone assumes that this will not happen to him or a family member. However, those who have had the misfortune of being diagnosed with end-stage kidney, liver or heart disease have few options open to them other than transplantation. The problem is that although transplant procedures have emerged as very successful therapies, not everyone has the good fortune of receiving a donor organ in time. Everyone agrees that saving a life is important, so why does a continual shortage of donor organs exist?
According to the United Network for Organ Sharing Web site (www.unos.org ), 96,027 people to date are waiting for a donor organ in the United States. In 2006, a total of 28,921 patients were on waiting lists for donor organs, and only 14,754 were able to benefit from a transplant procedure last year.
There are a lot of reasons for this shortage of organ donors. Perhaps the main one relates to the tremendously difficult time at which families are approached about potential donation of organs from a loved one when they are just coming to grips with the difficult fact of that person’s death. That is why many who wish to donate should clearly indicate their wishes to their families to spare them the agony of making such an important decision at such a difficult juncture.
Many states, including Pennsylvania, indicate on the driver’s license information whether one wishes to act as an organ donor. In addition, an individual can carry an organ donor card. Still, it is important that wishes to donate are communicated ahead of time to family, because ultimately, no organ donation will proceed if a family refuses organ donation, regardless of whether one carries an organ donor card or has this information indicated in his driver’s license.
Organ donation can come from a live donor, where a person donates either one of their kidneys or part of their liver, but more commonly organs come from deceased donors. One of the limiting factors in deceased donor organ donation is a prevalent fear that if one carries a donor organ card or a driver’s license indicating one’s wish to donate, the medical staff will not carry through maximum resuscitation to keep one alive. This is a misperception.
Organ donation only proceeds in the event of brain or cardiac death which require stringent criteria, protocols and tests to diagnose. Respect of the individual’s rights is a high priority, and brain death does not equate to all comatose states. It is instead an irreversible condition where a person is clinically dead. In clinical catastrophes such as a motor vehicle accident with massive injuries or stroke, every effort is made to resuscitate the individual, and organ donation is far from the medical team’s thoughts. The request for organ donation only comes up if the resuscitative efforts are unsuccessful and brain death criteria are ultimately recognized and met.
Donor organ allocation follows stringent allocation rules, which are overseen by UNOS and do not allow illegal organ trading. Donor organs are given to those whose clinical condition and waiting time indicates they are the most in need. Directed donation is a special form of allocation which allows an organ to be directly offered to a person specifically designated by the donor’s family. Usually this occurs if the donor or their family knows someone, who is either a close relative or friend, in need of a transplant and is on a waiting list for a donor organ.
Organ donation has a depth of feeling associated with it that leaves complex concepts and emotions. It allows a second lease on life for someone who has had up until then no other hope of recovery. Transplantation is a gift of life: Through each donor, one or more individuals can live on. It is the ultimate gesture of generosity that a person can make at a time of grief and death, making it a gift of joy and hope, thus allowing others to live on through the donation.
Zakiyah Kadry is chief of the Division of Transplantation and surgical director of Liver Transplantation at Penn State Milton S. Hershey Medical Center. She also serves as a professor in the Department of Surgery at Penn State College of Medicine.