For Donors

  • Who Can Donate?
  • Advantages and Disadvantages of Being a Donor
  • How to Approach Discussion with Family
  • Living Donors
  • Donation after Death

For Patients

  • Who is Eligible for a Transplant?
  • Waiting Lists
  • Success Rates
  • Living after Transplant

 For Donors

  • Who Can Donate?

Almost any Australian has the potential to be an organ donor. At the age of 16, you can register your interest to become a donor, and once over 18 years of age, you can provide your legal consent. If under 18 years old, you must have the consent of your parent or guardian before being able to become a donor. This all is governed by the Organ and Tissue Authority of the Australian government.

Despite the misconceptions prevalent in society, you do not have to be in perfect health to be an organ donor. Although your age and medical history will be considered, people who either currently or have previously smoked cigarettes, drunk alcohol, used recreational drugs, eaten unhealthily or lived sedentary lives, are still possible donors. This is because of the vast number of organs that can be possibly donated due to advances in modern medicine. For example, a person may not be considered as a viable donor of their liver if it has been damaged by chronic alcohol abuse, yet they may still have many perfectly functioning bones that can be donated. The circumstances of an individual’s death, such as where and how, as well as the condition of the organ or tissue in question, are the crucial determining factors of eligibility.

The conditions that generally make a person unable to be a donor include HIV, malignancy, diabetes, heart disease, chronic kidney disease, or severe infection. Importantly, for Australians who lived in the UK for at least six consecutive months between the years of 1980 and 1996 can still donate their organs, but are ineligible to be blood or tissue donors due to the risk of transmitting Creutzfeldt-Jakob disease.  This is known more colloquially as “Mad Cow” disease.

Most importantly, if you are interested in becoming an organ donor but are still unsure about your eligibility, there is no harm in registering your interest and discussing the idea with your family. Your eligibility will then be ultimately decided further along in the process.

https://www.donatelife.gov.au/about-donation/myths-and-misconceptions

https://www.donatelife.gov.au/about-donation/who-can-donate#accordion-0-0

  • Advantages and Disadvantages of Being a Donor

The biggest advantage of being an organ donor is knowing that you have either saved another person’s life or significantly enhanced their quality of life. In fact, a single person with multiple healthy organs can be a donor for up to 10 patients in need. Not only does this transform the lives of those seven patients, but brings joy and happiness to their family and friends. Further, being a tissue donor allows you to change the lives of up to 75 patients. In reality, you have the power to positively impact hundreds of lives through being an organ or tissue donor. This is a tremendously generous, selfless, compassionate act in which you can always take pride and honour. The decision to become an organ donor is one of the highest forms of true altruism. On a broader scale, organ donation has the potential to save millions of dollars per year on healthcare, as it is significantly more cost-efficient in the long-term than managing millions of chronic health conditions, such as the dialysis machines needed for chronic kidney disease. Organ donation also contributes to medical research and expands our knowledge of human anatomy, physiology and biochemistry through the process of matching donors to patients and the surgery required for a successful transplant.

The disadvantage of being an organ donor are mostly associated with living donors due to donation requiring major surgery. Any surgery comes with risks of complications, such as bleeding, infection, allergic reactions and blood clots. Despite the use of anaesthesia, it is also common to experience post-operative pain and discomfort. It is also not guaranteed that every transplant will be successful, as the patient may reject the transplant for many different reasons. Further, if you register to be a donor after death, you do not get a choice in deciding which patient receives your organs, and your organ therefore may be donated to someone who may not align with your values or beliefs. It is important to understand these aspects of organ donation when considering your registration.

https://www.ama.com.au/media/organ-donation-can-transform-lives

https://www.giftoflifemichigan.org/about-donation/benefits-organ-donation

https://vittana.org/15-organ-donation-pros-and-cons

  • How to Approach Discussion with Family

It is important to tell your family and close friends about your decision to become an organ donor, preferably prior to your registration but certainty once you have registered. This is crucial as, after a person passes away, it is their family that must give consent to proceed with the donation process. Families who are already aware of the person’s decision are far more likely to proceed with donation (90%) compared to those who were never told (40%). Organ donation can be a difficult topic to raise, predominantly because it relates to death, and potentially can cause anxiety, fear and grief. This is particularly the case if the person intending to become a donor wishes to do so based on having a terminal illness, as it can cause their loved ones even more sadness.

When starting the discussion, it is wise to indicate that you are wanting to discuss something sensitive that may be emotionally triggering, but emphasise the importance of having the discussion. People generally do not like to be caught off-guard so will respond better if prepared by being warned in this way. Do not shy away from the topic of dying, which is common in society, but instead approach death as an important aspect of life itself and the journey of life that we are all on together. If you show that you are comfortable having the discussion, it will put others at ease too.

Explain to your family members why you have chosen to become a donor, showing them that you have thoroughly thought about both the pros and cons. Emphasise that you have done the required research to fully understand the meaning of your decision and that you can provide your family with more information and resources if they need more clarification.  Many hospitals also have a Specialist Donation Nurse who is well trained to support potential donor families through the process and understanding their loved ones position. There is also the Donate Life Family Support Coordinator available to provide as much support as necessary to family members. If you are choosing to become a living donor, tell your family this means you could have the opportunity to save one of their lives one day, and how privileged you would feel to have that opportunity.

There is no right time to bring up the topic but, if possible, try to find a time where the whole family is together and in a safe, supportive, and relaxed environment. Examples include sitting around the dinner table, whilst muting the television during an advertisement break, or on a car trip.

Possible conversation starters:

  • I recently heard a really interesting discussion on the radio/saw advertisement on television/read an interesting book about organ transplant. I looked into it further and was really inspired…
  • Since grandma’s death, I have been thinking about what I’d like to do in the event I ever became really sick and think that organ donation is something I’d like to do if this situation arises…
  • I have been reflecting lately on what my true values are and realised that compassion and generosity are what I’d like to be remembered for as a person. This led me to do further reading into organ donation…
  • I have a friend who has become an organ donor recently and after speaking to them I’ve decided I’d like to look into the program further…

https://www.donatelife.gov.au/sites/default/files/OTA_Discussion%20Starters_English_Final.pdf

https://www.rch.org.au/kidsinfo/fact_sheets/Organ_donation/

  • Living Donors

A living donor is a person who has decided to donate one of their kidneys, or a part of their liver, to a patient with end-stage renal or liver disease respectively. People often choose to become a living donor to save the life of one of their family members or friend. Family members make up the majority of living donors due to being blood relatives and therefore more likely to be an organ match. However, any donor can donate their organ to any patient, provided they are the right match. A match is determined primarily on blood and tissue type.

Living donors must go through thorough physical and psychological assessment before being qualified as eligible. Many medical tests are carried out to ensure the donor’s own health is suitable to undergo the transplant procedure and associated recovery. As with donors after death, almost anyone can choose to become a living donor, even if you are elderly or living with a certain health condition. However, a living donor must be over the age of 18 to give legal consent.

As with any operation, there are risks associated with transplant surgeries such as the risk of bleeding, infection, allergic reactions and blood clots. It is typical to also experience pain for a short period whilst recovering from surgery. However, all hospitals operate under the strictest guidelines to minimise all risks of any procedure. As the Hippocratic oath states, all doctors abide firstly by the philosophy to “do no harm” and your heath is their upmost priority throughout the entire process. It is possible to live a complete, full life with only one kidney, or less than an entire liver, as the remaining organ enlarges in size and can function in the exact same way as if the entire organ was still there. In fact, it has been shown that only 20% of the liver is required for normal hepatic function.

There is a wide range of support available for living donors, both within the medical system and in broader community settings, such as Transplant Australia, a charity that supports living donors, transplant patients and their families.

It is also important to be aware and acknowledge that, for various reasons outside anyone’s control, the transplant may not succeed. It is important especially important to reach out for support in these circumstances and always know that you are not to blame.

https://www.donatelife.gov.au/about-donation/living-donation#Liver

https://transplant.org.au/types-of-transplant/kidney-transplant/

  • Donation after Death

The majority of people choose to become a donor after death. There are two types of: circulatory and brain death. It is important for donors and their families to appreciate the difference because the type of death plays a role in determining the donation process. Circulatory death is the type of death with which most people would be familiar. It means that the patient’s heart and lungs have irreversibly stopped working resulting in end-organ failure. Typically, circulatory death results in relatively rapid failure of all organs, and it is only in certain circumstances that the organs will remain viable for transplant. Most often, organ donation after circulatory death occurs in the setting of an intensive care patient whereby the treating doctors collectively believe the patient will stop breathing within the next 90 minutes. The doctors discuss their prognosis with the family and, if the family are supportive, ventilatory support is removed. The time it takes for a patient to die following ventilatory removal is variable, and organ donation will only be viable if the patient dies within approximately an hour. If the patient takes several hours to die, the patient’s organs will no longer be viable but tissue donation may still be possible.

In contrast, a patient pronounced with brain death has a functioning cardiovascular and respiratory system, but the irreversible damage to their brain has caused complete loss of neurological function. Therefore, the brainstem, which is the part of the brain that controls breathing, heart rate and blood pressure, cannot send the necessary neuronal signals to their heart and lungs to function. Brain death is caused by a pathological process that impacts the brain, such as a tumour, haemorrhagic stroke, carotid artery disease or trauma. These processes all ultimately cause the brain to swell in size. As the skull is a fixed volume structure, it cannot expand to accommodate the swelling of the brain, and therefore the pressure inside the brain continues to rise. Eventually, the pressure becomes so great that blood and oxygen can no longer enter the brain. Like all cells of the body, neurons require oxygen to survive, and will subsequently die without any oxygen supply.

Brain death is not a decision made lightly. It requires two senior clinicians to carry out the same thorough physical assessment of the patient and agree that their findings are consistent with brain death. The hallmark features of brain death are unconsciousness (coma), absence of reflexes and apnoea (lack of breathing). After a patient is deemed to be brain dead, they remained attached to ventilatory support whilst the medical team informs the family and discusses the next steps, including organ and tissue donation. The ventilator remains attached to the patient as they are surgically operated on to retrieve their organs and tissues.

https://www.kidney.org/sites/default/files/03-60-0119_FBE_CirculatoryDeath_Bro_v5.pdf

https://www.donatelife.gov.au/about-donation/donation-process#accordion-0-2

https://litfl.com/brain-death/

 For Patients 

  • Who is Eligible for a Transplant?

There is typically both inclusion criteria  and exclusion criteria a patient must meet to join the waiting list for an organ or tissue transplant. The decision is primarily driven by three elements:

  • Patient has been diagnosed with end-stage organ failure
  • All medical treatments have been tried and have failed
  • The medical specialist team believes the transplant will be successful

To join a waiting list, the patient must be referred to a transplant unit which is responsible for carrying out all necessary clinical assessments to determine eligibility. The assessment is extremely thorough and varies depending on the organ in question. All guidelines for clinical assessments have been carefully developed by practitioners in each specialty.

Every assessment takes into account four main factors:

  • Age

In and of itself, elderly age does not exclude a patient from a transplant waiting list. However, in patients over 70 years old with multiple other diseases are generally not eligible.

  • Comorbidities

Any concurrent illness that puts the patient at high risk of mortality or morbidity at any stage during the transplant process is ineligible. The most common comorbidities are heart disease, active cancer and chronic infections.

  • Behavioural risks factors

A patient’s past risk-taking behaviour is not considered when determining suitability for transplant. However, patients who continue to take part in lifestyle choices such as smoking, illicit drug use, alcohol abuse, are unlikely to be put on a waiting list due to these behaviours being linked to less successful transplants..

  • Inability to comply with medical treatment

This is usually in the setting of chronic and irreversible cognitive impairment.

A specialist transplant surgeon is required to complete the assessment, which involves thorough physical and psychological examination and investigation to determine the suitability of the patient for organ donation.

If deemed suitable, the patient will be added to the waiting list but will be required to undergo ongoing regular review by the transplant medical treating team to ensure their status as eligible does not change over time.

If a patient is not considered eligible for a referral to a transplant unit for initial assessment, the patient may seek a second opinion from another specialist in the field. If a patient is assessed by a transplant unit, and deemed ineligible, the patient can appeal the decision. If so, the transplant team will firstly thoroughly review their original decision. If their view remains that the patient is ineligible, the patient and their family can be referred to a second transplant unit for a second, impartial assessment. If the second unit also deems the patient ineligible, this is conveyed to the patient, whilst if believed to be eligible, the patient will be waitlisted for transplant.

https://www.donatelife.gov.au/about-donation/donation-process#accordion-0-3

https://transplant.org.au/types-of-transplant/kidney-transplant/

https://tsanz.com.au/storage/documents/TSANZ_Clinical_Guidelines_Version-16_11052021.pdf

  • Waiting Lists

The time spent on the waiting list for a transplant varies markedly depending on the specific organ. Once a donor organ becomes available, the transplant unit is responsible for making a clinical judgement on which patient on the waiting list receives the organ which is based primarily on urgency and the closeness of donor-patient matching.

https://tsanz.com.au/storage/documents/TSANZ_Clinical_Guidelines_Version-16_11052021.pdf

  • Success Rates

The rate of success of organ transplant varies greatly depending on the specific organ, the complexity of the surgery involved and the specific patient, such as their age and other comorbidities. In Australia, there is the most amount of data regarding kidney transplants, which show an extraordinary 91% five-year patient survival rate.

https://kidney.org.au/your-kidneys/treatment/kidney-transplants

  • Living after Transplant

An organ transplant is a major surgical operation, and will typically require 2-3 days recovering in the intensive care unit, and up to a four-week hospital stay. Following hospital, the patient will require ongoing, regular follow-up appointments with the treating medical team to assess and monitor their progress. Transplant recipients will be required to be on indefinite immunosuppressant therapy, in order to ensure their body does not reject the transplant. This does put the patient at greater risk of infections which must always be considered. Avoiding certain foods that are known to be commonly associated with contamination, such as shellfish or seafood, should be avoided. Further, practising optimal hygiene, including food practices, is also essential. As with everyone, physical activity is important to maintain good health and for transplant recipients, exercise can increase the longevity of the donated organ. Always discuss the initiating of exercise with the medical team who can best guide you in the choice of exercise type, intensity and duration based on your current level of recovery. Generally, it is best to avoid any contact sports that could risk damage to the organ. It is also possible to join transplant recipient communities and groups, which can provide social opportunities that are beneficial to your mental health and well-being. There is a vast array of support services available for transplant recipients who may be struggling with adjusting to their new life and other challenges such as returning to work. There is also the potential to be connected with your living donor, or the family of your deceased donor. This requires consent on behalf of both parties and can be a wonderful way to show your gratitude and potentially foster a special new friendship in your life.

https://transplant.org.au/living-with-your-transplant/

Authorised by Stephen Mason, CEO, APA.