Dead or alive: A simple guide to organ donation

Everyone has a vague idea about organ donation – knowing it involves a healthy organ being taken from one person (alive or dead) and given to another who needs it.

However, many don't realise people can wait months and even years for an organ that matches their blood and tissue type. More donors would mean shorter waits. Here, we look how you can become an organ donor, what happens when an organ becomes available, and what organs are most in demand in Ireland.

How can you become an organ donor?

Becoming a potential donor is the easy part. You can pick up an organ donor card from your local pharmacy and keep it in your wallet. You can download the digital donor card on to your smartphone, or request an organ donor card from the Irish Kidney Association by texting "Donor" to the freetext number 50050, phoning 1890 543 639 (lo-call) or via ika.ie/card. You can also sign up when you get or renew your driver's licence (the code 115 will be printed on the back of your driver's licence card).

However, in spite of all these ways to express your desire for your organs to be donated when you die, your next-of-kin will make the final decision. Consent is never presumed – even if the deceased carried a signed donor card. For this reason, the Irish Kidney Association (which manages the organ donor card system) stresses the importance of informing your family that you want your organs donated when you die.

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The Human Tissue Bill, which is currently being drafted by the Government,plans to introduce an "opt-out" register for people who don't want to be organ donors – in the hope that family members will be more inclined to donate organs of their loved ones once they are not on this register. Currently, an estimated one third of people asked to donate the organs of their deceased relative refuse to do so. Prof Jim Egan, medical director of Organ Donation and Transplant Ireland (ODTI) says he believes "everyone has a right to refuse and we absolutely respect that, but our task is to create an environment that people think about organ donation and are supported to make the organ donation process easier".

Are most organ donations from dead people?

Yes, most organ donations are from people who have died from a head injury, stroke or brain haemorrhage. This is called deceased brain donations or heart-beating donations and accounts for about 90 per cent of all organs donated from deceased donors in Ireland. In these cases, two separate teams of doctors define the time of death and artificial ventilation keeps the heart beating to allow the organs to continue functioning until they are removed for donation. Organs can also be donated from people who die from cardiac death (when the heart stops beating) – which is how the vast majority of people die.

However, it is more complex to manage organ donation from people who die in this way because firstly, it’s a less predictable way to die (and less likely patients are in an intensive care unit) and secondly, once the heart stops beating, the organs stop functioning so artificial ventilation is also needed to keep the kidneys, liver, pancreas and lungs functioning until they are removed for donation. Recent technological advances in medicine can now sustain organs removed from the body for a period of time until they are transplanted. Organ donation currently only occurs in about 0.5 per cent (150 deaths) of the 30,000 deaths annually in Ireland.

What happens when organs become available for donation?

Once a death occurs in circumstances that make organ donation possible, the family is asked whether they would like to donate the organs of their deceased relative. If they say yes, the donor coordinator from Organ Donation and Transplant Ireland (ODTI) is contacted. The organ donor coordinator then travels to the hospital to support the family and the hospital staff.

The organ donor coordinator also contacts the transplant centres to find matched recipients for the heart, lungs, kidneys, liver and pancreas and manage the donation process. There are 40 donating hospitals in Ireland and three transplant centres – St Vincent's Hospital Dublin for liver and pancreas, The Mater Hospital, Dublin for heart and lungs and Beaumont Hospital for kidneys. Some paediatric transplants take place in Temple Street Children's Hospital, while others are referred to the UK.

How quickly do organs have to be removed for donation?

Hearts are the most vulnerable organ following death and must be removed first. “The heart copes least when out of the body and four hours is the specified time from when it’s taken from the deceased donor and put into a recipient’s body,” explains Prof Egan. A pancreas must be removed and put into a recipient’s body within four to six hours. Kidneys can be kept up to 18 hours; lungs and liver can be kept up to 24 hours. Tissues can be donated up to 48 hours after the heart has stopped beating.

Are there circumstances in which organs from deceased donors cannot be donated?

Yes. If the person has a recent history of cancer or treatment for cancer, there is a small risk that the cancer might be transmitted through the organs. Similarly, if there is evidence of viral infections such as HIV, the organs might not be donated. “With new treatments for viral infections, we can sometimes proceed to organ donation,” says Prof Egan. He is keen to point out that age is not a barrier for organ donation and people in their eighties and nineties can be potential donors.

How can you become a live donor?

Some people opt to become a live donor when a family member requires a kidney because a healthy person can lead a normal life with only one working kidney. In such cases, the blood and tissue type of the donor has to be a match of the recipient. In some rare cases, family members can agree to become a donor for an unknown matched recipient so that their family member can receive an organ from a matched family member of that person. In Ireland about one quarter of kidney transplants come from live donors.

What organs are most in demand?

There are about 500 people waiting for a kidney donation at any one time. Fifty people are waiting for a heart and lung transplant and 30-40 people are waiting for a liver transplant. There are 15 people waiting for a pancreas transplant. No other organs are transplanted in Ireland.