Any person can be a possible organ and tissue donor. All tests to see if you are eligible to be a donor are done at the time of your death, once your family has given consent for your organs and tissue to be donated. There is no age limit, because there is no age limit for people who need organs!
Co-morbidities such as obesity, diabetes, and hypertension do not disqualify potential organ donors. Each organ is individually assessed for suitability for donation.
Yes! In South Africa it is possible (in specific cases) to donate a kidney, or a part of your liver, to a person in need should you be a blood group and tissue type match. You can also donate the femoral head when you go for a hip replacement.
The organs that can be donated are as follows: 2 lungs, 2 kidneys, heart, liver (can be split between 2 recipients in some cases), and pancreas. You can also help between 50 and 100 people through the donation of your tissues. For example, your skin can be used to help burn victims and your corneas can be used for cornea transplants to restore a person’s sight. You can also donate bone, heart valves and tendons.
Healthcare professionals will try and save your life first, only after all attempts have failed and two independent doctors declare brain death, will the option of organ donation be explored.
Important to note that there is only one definition of death, accompanied by two ways of determining death, cardiac death and brain death. Research has shown that some of the nursing staff in the ICU unit feel that the donor has not really passed away when they are sent to the theater to have the organs removed. As stated before, if they approach your family for organ donation, you have died, no one has ever recovered when they were declared brain dead by medical doctors. The process of recovering organs and tissue is like any operation. The recovery is done with the utmost respect for the donor.
The law in South Africa states that you need to make your intentions to donate known by either specifying it in your will, or in a legal document, or by making it known with at least 2 witnesses present. It is important to note that hospitals tend to follow the practice where the family is consulted concerning a person’s final wishes. This makes it even more important for you to tell your tribe, tell your team and make it known that you want to be a donor.
Your family still needs to give consent before your organs are donated, even if you have registered! So be sure to let your family know of your intentions. Should you only want certain organs and tissues to be donated please also relay this information to your family.
Without enough organ donors, many people awaiting their second chance at life remain on the list for years. Even worse, a lot of people on the list end up dying due to a lack of donors. In the case of patients waiting for a kidney transplant, the average waiting time for the O blood group is 12-15 years.
There is no conclusive list of the number of patients currently awaiting a lifesaving organ transplant in South Africa.
Being an organ/tissue donor is a selfless act which saves and improves the lives of countless grateful recipients. No financial compensation is received, and trading or selling organs and tissue is illegal. There is also no cost involved in becoming a donor, and also no further medical expenses are incurred by the family once brain death is diagnosed and the family has given consent for donation.
Allocation of organs, heart, liver and lungs is done on the assessment of the patient’s health. Kidneys are allocated according to tissue type and usually one goes to the private and one to the public sector. Financial/celebrity status does not have any influence on allocation of organs.
The most important part of organ and tissue donation is conversation. The only way we can end the waiting list is for people to make it known that they intend to donate. Have the conversation with your family, your friends and even with your family doctor. The more people know, the easier it will be when the time comes.
There is no policy or regulations that exclude a member of the LGBT community from donating organs. The only consideration is that the organs are healthy.
Most religions endorse organ donation to some extent and none absolutely condemn it as long as organ donation does not hasten or cause death. Statements by spiritual and religious leaders focus on the saving of a life of another wherever possible. Donation across various cultures is seen as a charitable gift of life and as a means of saving a life.
Negative attitudes towards organ donation may stem from uncertainty rather than due to interpretation of religious teaching. For example Jehovah’s Witnesses are often assumed to be opposed to donation because of their belief against blood transfusion, this merely means that blood must be removed from organs and tissue before being transplanted. Culture is not static and does evolve as the circumstances change, here organ and tissue donation gives us the opportunity to bring various cultures and religious beliefs together to a common goal of saving lives and helping each other.
Your family needs to discuss any cultural religious practices/customs with the transplant coordinator. Your funeral will not be delayed due to organ donation and you can still have an open casket.
Transplant Landscape in South Africa
When a donor passes away, the organs such as the heart, liver and lungs are allocated nationally according to urgency. The kidneys stay in the province where the donor passed away. One kidney goes to a private patient and one to a public patient. Kidneys get allocated to the person on the facilities list according to HLA match and not necessarily based on when they joined the waiting list. Celebrity status and wealth does not play a role in the allocation of an organ. Seven solid organs from a single donor add on average 53 life-years gained. Only 1% of all people who pass away are able to donate their organs. (1 in a 100 people die in such a way to make it possible that they can become organ donors).
The timing of the request as well as by whom it is made play a very important role in the request for organ donation. The Transplant Coordinator is a skilled individual with years of experience and has acquired specific skills on how to approach the family as well as management of the donor. Therefore organ donor management is a highly specialised area of healthcare.
Co-morbidities such as obesity, diabetes, and hypertension do not disqualify potential organ donors. Each organ is individually assessed for suitability of donation. Doctors sometimes cite medical reasons for not notifying the transplant coordinator. The default position should always be to refer all patients at the end of life based on recognised clinical triggers and not on donor suitability. Important to note that there is one definition of death, accompanied by two ways of determining death, cardiac death and brain death. Research has shown that some of the nursing staff in the ICU unit feel that the donor is not really dead when they are sent to the theatre to have the organs removed.
Compared to other countries in the world, South Africa’s donation rate is very low, Croatia has a rate of 30.2 per million population, where South Africa has less than three per million. Brazil has a rate of 14 per million population, these countries were able to increase their transplant rate in a decade due to an integrated approach towards referrals and transplants.
The Transplant Process:
A potential donor is a patient who has been declared brain dead by two independent doctors, who do not form part of the transplant team. The Department of Health defines brain death as: “the irreversible loss of capacity for consciousness, combined with irreversible loss of the capacity to breathe”. This means that the person has no chance of recovery.
TELL plays a part by doing hospital education drives, which aim to educate health professionals on how to identify a potential organ donor.
The potential donor is referred to a transplant coordinator. It is a moral obligation for healthcare practitioners to refer potential donors to a transplant coordinator.
TELL equips healthcare professionals with the knowledge to be able to refer potential donors to transplant coordinators in a timely manner.
The transplant coordinator is required to obtain consent from the family to retrieve the organs. The transplant coordinators approach the family as grief counsellors where they approach the subject of organ donation with sensitivity. Once the conversation is had, the family must then decide if they wish to donate their loved one’s organs.
Through public awareness we aim to increase organ donation awareness; knowing the wishes of the potential donor makes the process a little easier which is why TELL encourages the public to TELL THEIR FAMILIES of their organ donation status. As part of their end-of-life decision process. Transplant coordinators do not have access to a transplant registry.
Once consent is received, the transplant procedure can take place. The donor’s organs can then be procured and sent to the various hospitals where recipients are waiting. The procurement process is done using the same care and respect as any other surgery and so, despite false myths, the body is not mutilated at all – in fact an open casket funeral can still take place. Every donor can save up to 8 lives and help between 50 and 100 people through the donation of tissues.
TELL plays our part by providing an online support group that helps give transplant recipients the support they need. We also encourage them to give back by volunteering for TELL and sharing their stories to inspire South Africa to become organ and tissue donors.
There are 2 types of donors, a living donor or a deceased donor. A living donor can only donate a
kidney or part of a liver and has to be in excellent health, the deceased donor will be assessed at the
time of death to determine which organs and tissue can be donated.
Living organ donation
You can donate a kidney or part of the liver to a patient on the waiting list, this may be someone you know or a stranger. Donating to a stranger is called an altruistic donation. Donating to someone you know either a family member or friend is known as a related (RLD) or non-related donation (NRLD). A living donor needs to be in excellent health to withstand the operation and also to lead a normal life after donation. In order to be listed for a transplant, the recipient goes through a variety of tests and are assessed on an ongoing basis by their specialist. Only once the recipient has been cleared to be listed for a transplant, will the assessment of the living donor start. The work-up process for the donor is done in phases and can be stopped at any time if the donor changes his or her mind or if it comes to light that the donor has a medical condition that will prevent a transplant.
The process for a related or unrelated donation is as follows:
Both the recipient and the potential living donor will have various tests done in order to determine if they are suitable to be a living donor or recipient.
These tests include:
For living donors and recipients: ongoing assessment by your specialist.
● Crossmatch (to determine of blood and tissue type match)
● HIV (some centres does HIV+ to HIV+ transplants)
● Other blood test to determine how well the donor’s heart, liver, kidneys and other organs are
● Past exposure to viruses -CMV, EBV etc.
● Stress ecg
● Assess social support
● Mental fitness Surgical assessment
● Assess surgical fitness Radiological test:
● Chest X-Ray
● Abdominal ultrasound
● Renal CT scan (for living kidney donor)
● Pap smear
Nuclear GFR test: check donor kidney function
Once all the tests are completed, the case will be presented at the transplant panel and once they approve the case will be referred to the Department of Health advisory committee for approval for a non-related living donation or altruistic donation. Only directly related donors are not required to get approval from the Department of Health.
Living tissue donation
Any patient undergoing hip replacement can decide to donate their femoral head to the tissue bank. The tissue bank will use a special process to remove all the damaged and/or deceased parts of the donated femoral head to expose the white porous bone underneath which is then prepared in a new application or implanted into another patient.
There is no cost involved for the patient or the medical aid in the donation or the testing of the blood specimens.
Source Centre for Tissue Engineering.
Who benefits from a femoral head donation?
Various patients benefit from the donated bone, it is used as bone cement in various surgeries such as hip and knee replacements. The donated bone can be stored up to 10 years.
It only takes a few minutes to save up to 3 lives. By donating blood on a regular basis, you are making a meaningful difference to society. Visit the SANBS for your nearest blood drive.
Bone Marrow Donation