Deceased Organ Donation

The surgery used to recover a donated organ after the donor dies is typically covered by the organ procurement organization or OPO. This organization assumes responsibility for the costs to recover and process donated organs and tissues after the donor’s death. If an OPO does not cover this cost, the recipient of the donated organs or tissues may pay for the surgery. The donor’s family or estate is not charged for any medical expenses associated with donation, but is responsible for the cost of end-of-life care prior to the donor’s death and final arrangements for funerals, burials or cremations after death. 

When an OPO is responsible for the cost of procurement, it is later reimbursed by the transplant center or hospital that will receive the organ for the upcoming procedure. If tissues are donated instead of organs, the OPO is reimbursed by the tissue processor instead. The transplant center or hospital will then bill the recipient for the cost of the procedure after the transplant has occurred, which is usually either covered by the recipient’s insurance or alternative financial arrangements that the recipient has made. Organ donation recipients often have to provide financial proof establishing that they are able to uphold their portion of the financial responsibility for any medical expenses associated with the donation and subsequent transplant. 

Sources

“Get the Facts: Are My Family or My Estate Ever Charged for Donation?”. Donor Alliance. https://www.donoralliance.org/newsroom/donation-essentials/get-facts-family-estate-ever-charged-donation/ 

“Organ donation: Don’t let these myths confuse you”. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529 

When a loved one’s organs are donated after death, a series of steps is taken to ensure that the organs are suitable and will remain viable for successful transplantation. In accordance with federal regulations, the hospital will reach out to a local Organ Procurement Organization (OPO) to notify them that your loved one is near death or has died. A physician will be present to conduct a brief test to confirm brain death and will also note the time of death per the requirements for organ donation. 

Before the OPO can move forward with organ donation, consent must be acquired. If your loved one’s name is listed in the state’s organ donor registry, it is considered legal consent. Other methods to determine consent include reviewing your loved one’s driver’s license or other documentation. Sometimes the OPO may need to contact the next of kin as well. After approval is granted, the OPO will gather your loved one’s medical and social history for a medical evaluation. This evaluation determines whether your loved one’s organs can be donated. 

The OPO official and a medical team will review the overall condition of your loved one’s organs and a transplant surgical team will begin removal if the organs are in suitable condition. The surgical team is responsible for removing organs and approved tissues. Any incisions or cuts that are made during the procedure will be closed to ensure that an open-casket funeral can be held if it is the patient’s or family’s preference. The OPO often works with the funeral director at the funeral home to ensure that these wishes are honored. 

Assuming the evaluation reflects that the organs are suitable for donation, the OPO will contact the Organ Procurement and Transplantation Network (OPTN), which is the national transplant database that houses information about patients on the waitlist in need of a transplant. The OPO will input your loved one’s information into the system to identify patients that match your loved one’s donation per organ. Each organ is offered to the transplant team of the patient that is deemed to be the most suitable match and then the transplant surgeon from that team determines whether it is appropriate to proceed with the transplant.  

In the weeks that follow, the OPO conducts follow-up outreach to the donor’s family to let them know which organs were transplanted. The names of the recipients are kept private, although there are communication guidelines in place if the donor’s family and the recipients wish to interact with each other. As time progresses, the OPO may provide additional support to the donor family, such as resources for bereavement counseling or assistance with memorial events. 

Sources

“Deceased Donation”. United Network for Organ Sharing. https://unos.org/transplant/deceased-donation/ 

“Donation After Life”. Health Resources & Services Administration. https://www.organdonor.gov/learn/process/donation-after-life 

Donation after cardiac death (sometimes called donation after circulatory death) or DCD is organ donation that occurs when a person is in an irreversible coma but doesn’t meet the strict criteria for brain death. When organ transplantation first became a reality in the 1950s and 1960s, all organ transplants were donations after cardiac death because the criteria for brain death [link to What is brain death?] were not developed until 1968. First presented in a landmark paper “A definition of irreversible coma, the Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” those criteria are credited with laying the groundwork for deceased donor organ transplantation as it exists today. 

Prior to donation after cardiac death, the next of kin or healthcare agent is first consulted to discuss the possibility of removing a person who doctors have determined has no hope of survival from ventilator support. This discussion should happen independently of any discussion about organ donation unless the family mentions the option to the physician first. If the family agrees, the hospital contacts the Organ Procurement Organization, which will work to find a suitable recipient or recipients. Once suitable candidates are located, the person is taken to the operating room, and preparations to remove the organs are made. 

Once the OR team is ready, the patient is taken off ventilator support and observed. When the heart stops beating (which usually happens fairly quickly), doctors wait an additional 5 minutes to ensure that a spontaneous heartbeat doesn’t return. At that time, a team of specialists removes the abdominal organs, such as the liver, kidneys, pancreas, and intestines. 

Advances in technology and evolving organ donation guidelines have made it possible for the heart and lungs to be transplanted following cardiac death. Because organ viability depends on the circumstances of death, rigorous evaluations and strict criteria must be met before transplantation can proceed. Despite these challenges, donation after cardiac death (DCD) is growing more frequent, providing a vital lifeline for patients awaiting transplants.

Sources

“‘Donation after cardiac death’: New heart transplant method being tested for the first time in the U.S.”. Stat News. https://www.statnews.com/2020/01/16/heart-transplant-donation-after-cardiac-death/ 

“How Donation after Cardiac Death is Changing the Transplant Landscape”. Emory Healthcare. https://www.emoryhealthcare.org/stories/heart-health/donation-after-cardiac-death-is-changing-the-transplant-landscape 

“Critical Pathway for Donation After Cardiac Death”. United Network for Organ Sharing. https://unos.org/wp-content/uploads/Critical_Pathway_DCD_Donor.pdf 

The term “brain death” confuses many people because it implies that a person who has died is actually alive. However, a person who is brain dead has no brain function, and without brain function, the rest of the body cannot survive. They cannot breathe or maintain a heartbeat without the aid of a ventilator. 

Brain death typically occurs after a severe head injury, bleeding in the brain, or an event that deprives the brain of oxygen, such as drowning or prolonged cardiac arrest. It can occur almost immediately, or it can happen over a period of hours or days as injured brain tissue swells. 

In accordance with the Uniform Determination of Death Act, doctors determine brain death through a series of physical examinations and diagnostic tests. They check for spontaneous breathing, response to painful stimuli, and whether or not the pupils respond to light. They also perform an electroencephalogram, or EEG, and another test that shows if there is any blood circulating in the brain. If the EEG shows no activity, there is no blood flow to the brain, and the person can no longer breathe or move on their own, the person is declared dead. In most states, two doctors must certify the death.

After death has been determined, a potential organ donor will be kept in the ICU on a ventilator and receive specialized care to ensure organ function is maintained. At the same time, the Organ Procurement Organization in the region is notified and supplied with relevant details about the patient, such as age, sex, blood type, height and weight. When the OPO identifies a suitable recipient(s)[link to How are donors and recipients matched?] the patient is taken to the operating room and the organs to be donated are removed by a specially trained surgical team. 

Sources

“What is the Uniform Determination of Death Act (UDDA)?” FindLaw. https://www.findlaw.com/healthcare/patient-rights/what-is-the-uniform-declaration-of-death-act-or-udda.html 

“The diagnosis of brain death”. Indian Journal of Critical Care Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC2772257/