Organ Donation: what actually happens?

After a brain-dead organ donor has had brain-death certified (I’ve penned an explanation of the intensive care process here) an impressive series of events begins. In the intensive care unit, batteries of tests are performed to look at the health of each potential organ, and its suitability to be matched with a particular recipient. In some ways, it is similar to checking blood groups before a blood transfusion, looking at not only the blood group, but myriad other little “markers” in blood and tissue that could signal a good match, or rejection by the recipient’s immune system. Tests such as imaging the heart and lungs check their potential for a new lease of life in a grateful recipient.

Throughout Australia and New Zealand, the Donate Life team are busily organising potential recipients, and the transplant surgery teams from their individual states. Once a match and need is confirmed, the patient receiving a new organ proceeds to the transplant centre in their capital city, and begins preparations for surgery.

Back at the donor’s hospital, preparations are made for the brain-dead donor to go to the operating theatre for the organ retrieval. All this while, the donor may be very unstable in intensive care, requiring treatments for high or low blood pressure, body fluid abnormalities, and heart rhythm abnormalities. The ICU team manage the donor’s body in a similar way to other critically ill patients. The donor’s family usually spend time in the ICU room at this stage. Interestingly, procuring the organs usually takes place in the “home” hospital, with the transplant surgeons travelling to where the donor is, rather than the donor being transferred to a major transplant hospital in an ambulance. I can remember times where I have seen a number of jets lined up on the tarmac at Ballarat Aerodrome (a very unusual occurrence) all ready to ferry the transplant teams and donated organs to various hospitals throughout Australia.

When everything is prepared throughout the country, the donor is taken to the operating theatre and handed over from the intensive care team to the theatre team, and the (usually local) anaesthetist.

Why does a brain-dead donor need an anaesthetist?

Effectively, the intensive care treatment of the donor’s body needs to continue until the organs are removed, to ensure they are in the best shape for the recipient.

So the anaesthetist will administer medications to optimise the organ health, including:

  • heart and blood pressure medications to ensure stability.
  • intravenous fluids to ensure optimal blood flow to the organs
  • sometimes blood to keep the blood count and oxygen delivery in a healthy range
  • blood thinners to prevent clots

muscle paralysis to stop muscles tightening as a reflex to the surgery (importantly, this is NOT a reaction to pain. The patient’s brain is DEAD, but other organs, including the nerves and muscles, continue to function. Muscles can continue to react via nerve endings and the spinal cord, like when your knee flinches when the tendon is tapped with a hammer, without any thought from you. There has (reassuringly) never been a case of any return of actual brain function after brain-death has been certified, but occasionally the (still living) muscles and nerves will continue to fire in a small way) -this relaxation gives the surgeon better access to the organs.

  • a range of hormones to ensure organ health.
  • perhaps a small dose of anaesthetic (once again this is NOT to ensure a donor is asleep — they are most definitely dead, but there is research into whether the anaesthetic may soften a “stress response” — a chemical, hormanal and inflammatory reaction by the cells in the organs to any trauma or surgery)
  • other fluids that can preserve the organs when removed, including stopping and preserving the heart.

The anaesthetist also ensures good ventilation of the lungs to optimise the oxygen to the organs and gently open the airways up prior to their removal and transplant.

A range of teams all work on the various organ systems, but the whole operation is remarkable well ordered and co-ordinated. Over a period of 2–3 hours the organs, are removed from the abdomen, then the donor’s chest, packaged safely for preservation during transport, then wing their way with the transplant teams to all points of the country. The grateful recipients are by this time ready for or already in surgery, so that the time for each organ out of the body, and without blood flow and oxygen, is minimal.

The donor’s body is sutured and cleaned, and sometimes the family will spend some more time with the donor prior to funeral arrangements.

At each transplant centre, the work begins, of not just implanting the new organs, but ongoing life support for the recipients, and all of the the anti-rejection science and medicine that makes this procedure so wonderful.

To find out more about organ donation, or to register yourself as a donor, head to DonateLife

AGB - Craig Mitchell

Written by

Anaesthesia, Critical Care, Medicine and life... from a Specialist Anaesthetist and Curious Winemaker.

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