Professional Documents
Culture Documents
9.1 Organ Donation and Brain Death
9.1 Organ Donation and Brain Death
GENERAL SURGERY
In China there is concern over the use In South Africa organs are allocated
of organs from executed prisoners. within each province. This helps to
Due to this ethical concern no limit cold ischaemic time. Recipients
publications from China are published must be an ABO blood group match to
in the international literature and receive a solid organ. The recipients
speakers are not invited to have blood taken every 3 months
international conferences. which is kept at the tissue typing
laboratory - this is used to screen for
DONOR OPERATION preformed antibodies as their
presence would preclude
The brain dead donor is taken to transplantation. The recipients are
theatre, cleaned and draped for a full selected based on a combination of
sternotomy and laparotomy. The how good the match is and how long
they have been waiting for a from just above the iliac crest to the
transplant. Race and socio-economic symphysis pubis. This position is easy
status do not come into the equation. to access, provides good exposure of
In South Africa the average waiting the vessels and is close to the bladder
time on dialysis before transplantation for the ureteric anastomosis. The vein
is 5 – 6 years. The mortality rate while is done before the artery and the
waiting for a kidney transplant is 5% kidney is reperfused prior to
per year and a further 2% of patients connecting the transplanted ureter
will become too ill to transplant. The onto the bladder.
waiting list for heart and liver
transplantation is much shorter as Post-operative stay varies but patients
these patients die while waiting due to require very close monitoring of their
the lack of a method of long term fluid status and may need temporary
organ support. Donors for these organ support in the ICU to help them
organs also need to be matched for recover. They were until quite recently
height and weight. If there is no ideal dying. Initially very strong
recipient locally (within the province) immunosuppression is given to
the organs are allocated nationally. prevent acute rejection but this places
patients at increased risk of infection.
The Declaration of Istanbul provides Immunosuppression is lifelong but is
ethical guidelines regarding the tapered over time to balance the risk
practice of organ donation and of rejection and against infection.
transplantation. It states that organ
trafficking and transplant tourism In Pittsburgh, a major pioneering
should be prohibited because they centre in transplantation, the operation
violate the principles of equity, justice would be done the same way every
and respect for human dignity. time in order to standardize it and
Recipient Operations allow Professor Thomas Starzl
Heart and liver transplants require the (famous for the first liver transplant) to
removal of the existing organ prior to walk into theatre at any stage and
replacement. A cardiac transplant know immediately what had been
recipient is placed on bypass prior to done and what still needed to be done.
removal of the heart and the heart is
anastomosed directly in place of the LIVING DONATION
old heart - donors and recipients are
size matched. Donating a kidney carries a mortality
risk of 0.03% and is widely practiced.
The liver is unique in that it has the Living donor liver transplants are also
ability to regenerate and hence can be performed but the risk to the donor is
altered in size during back table more substantial, carrying a mortality
preparation to fit a child or split to of 0.6% and a morbidity of 10%. Living
supply two recipients (usually a child related liver donation is possible
and an adult). First the new liver is because the liver is the only organ with
connected to the IVC and portal vein. the ability to regenerate and 30% of a
The liver is then reperfused - it gets good liver is enough to prevent acute
70% of its blood supply from the portal liver failure.
vein. The hepatic artery is next
followed by the bile duct which is Living donors are extensively
anastomosed to the remnant bile duct investigated to ensure that all risks are
or to the bowel with a hepatico- minimized and that the transplant will
jejenostomy. have every chance of success. Initial
workup entails determining that the
Kidneys are transplanted in the extra- blood group is a match and screening
peritoneal space onto the external iliac for factors that would preclude
vessels. An oblique incision is made donation. Criteria are stringent as
these patients are unique in medicine, Thank you for helping to turn the loss
in that they do not have any indication of a patient into an opportunity for new
for the surgery themselves. Any co- life in others. Not an easy thing.
morbid disease, end organ damage or
lifestyle that may put the potential FAMOUS ORGAN TRANSPLANTS -
donor at future risk of organ failure WITHOUT THE UNSUNG DONORS,
would result in them being turned DOCTORS AND NURSES THE
away and referred to the appropriate FOLLOWING WOULD NOT BE
medical team. The work-up includes a POSSIBLE…
full social and psychological
assessment. In cases where multiple Jonah Lomu – New Zealand rugby
donors come forward the lowest risk player – received a living unrelated
patient with the best HLA match is kidney transplant in 2003 for nephrotic
used. syndrome. The kidney was
transplanted in a deeper position than
In Iran there is a formal system of paid normal to allow him to play contact
living unrelated donation. This is the sports.
only country with such a system. Other
countries do not practice this due to Dick Cheney – US Vice president
ethical concerns regarding perverse under George Bush – received a heart
incentives and that the net flow of transplant in 2012 for ischaemic
organs will be from poor to rich. In cardiomyopathy having been on
South Africa all living unrelated waiting list for 20 months. He had
transplants have to be approved by previously had 5 heart attacks related
the Minister of Health. e.g. Husband to his 60 pack year history.
donating to wife. There is evidence to
support that transplants between Evil Knievel – motorcycle stunt rider –
emotionally linked individuals have a contracted Hepatitis C from a
better long term outcome than cases contaminated blood transfusion. He
where there is no link. received a liver transplant in 1999 but
died from idiopathic pulmonary fibrosis
SUMMARY in 2005
Alonzo Mourning – Miami Heat Stay alert to any opportunity for organ
basketball player – developed renal donation and always consult rather
failure from focal segmental than not. The effort is always
glomerulosclerosis and received a appreciated.
kidney transplant in 2003. He won the
NBA championship in 2005 with the
Miami Heat and Shaquille O’Neal.
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