organ & tissue donation and transplantation. presentation prepared by corinne weernink, london...

Organ & Tissue Donation Organ & Tissue Donation and Transplantationand Transplantation

Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada 2

TransplantationTransplantation

Transplantation has a long history of fascinating the public – as is evident in Transplantation has a long history of fascinating the public – as is evident in fiction (Mary Shelley’s Frankenstein, 1816) and various tabloid reports. fiction (Mary Shelley’s Frankenstein, 1816) and various tabloid reports. Transplantation in fact has a long, successful history and is an accepted Transplantation in fact has a long, successful history and is an accepted

treatment for end-stage organ failure.treatment for end-stage organ failure.


1682 - bone

1881 - skin

1906 - corneal

1908 - knee joint

1954 - kidney transplant

1966 - pancreas transplant

1967 - liver transplant

1967 - heart transplant

History of TransplantationHistory of Transplantation

The1The1stst recorded transplants occurred in recorded transplants occurred in the 17the 17thth century. The 1 century. The 1stst successful successful

organ transplant, a kidney, was organ transplant, a kidney, was performed by a team led by Dr. Joseph performed by a team led by Dr. Joseph Murray on December 23, 1954 between Murray on December 23, 1954 between

identical twin brothers in Boston. Dr. identical twin brothers in Boston. Dr. Murray went on to receive the Nobel Murray went on to receive the Nobel

Prize in Medicine for this Prize in Medicine for this accomplishment.accomplishment.


Perhaps the most well known Perhaps the most well known of all transplant firsts, Dr. of all transplant firsts, Dr.

Christian Bernard became a Christian Bernard became a household name when in household name when in 1967 he performed the 1967 he performed the

world’s 1world’s 1stst successful heart successful heart transplant in Capetown, transplant in Capetown,

South Africa.South Africa.

Unfortunately, early results Unfortunately, early results were not as successful as were not as successful as

initially hoped as was pointed initially hoped as was pointed out a mere four years later on out a mere four years later on

yet another LIFE cover.yet another LIFE cover.


revolutionized transplantation

increased survival rates

1st in a new generation of anti-rejection drugs

Introduced in 1978, the drug Introduced in 1978, the drug cyclosporine revolutionized cyclosporine revolutionized

transplantation by depressing transplantation by depressing T cell activation and reducing T cell activation and reducing

organ rejection.organ rejection.


1981 - heart-lung transplant

1986 - lung transplant

1988 - liver/bowel transplant

1988 - split liver transplant

1989 - living related liver transplant

1995 - cluster (liver,bowel,stomach,pancreas &

kidney) transplant

Further Successful Firsts Further Successful Firsts in Transplantationin Transplantation


Survival after TransplantSurvival after Transplant

varies greatly among organ groups

depends on the patient’s condition before transplant

depends on the presence of other illness

0

20

40

60

80

100

survival

kidney liver heart lung


Transplant SuccessesTransplant Successes

Snowboarder, Chris Klug, won a Snowboarder, Chris Klug, won a bronze medal at the 2002 Olympics, bronze medal at the 2002 Olympics, two years after his liver transplant.two years after his liver transplant.

Now 22 years post liver Now 22 years post liver transplant, London ON success transplant, London ON success

story Heather Fisher climbed story Heather Fisher climbed Mount Kilimanjaro after her Mount Kilimanjaro after her

surgery.surgery.

Transplanted with a Transplanted with a liver, bowel, stomach liver, bowel, stomach and pancreas at age and pancreas at age

5.5 months, Sarah has 5.5 months, Sarah has a spot in the Guiness a spot in the Guiness

Book of World Records Book of World Records as the youngest multi-as the youngest multi-

organ recipient.organ recipient.


Who Needs a Transplant?Who Needs a Transplant?

Transplantation is offered to patients who:are in end-stage organ failurehave no other surgical or medical option available to themhave a limited life expectancy without a transplanthave undergone a rigorous and thorough assessment process and meet all necessary criteria

Baby Jane was listed for a liver Baby Jane was listed for a liver transplant when no other life-saving transplant when no other life-saving

options were available.options were available.


Canadian Transplant NumbersCanadian Transplant Numbers(1994 – 2003)(1994 – 2003)

2159

14

84

13

9

2522

15

30

11

4

2829

15

73

11

5

2874

16

32

17

1

3229

16

23

14

0

3514

17

46

22

5

3800

19

01

17

0

3990

18

03

19

5

4001

18

14

23

7

3966

18

36

25

0

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Waiting Transplanted Died While Waitingstatistics provided by the Canadian Institute for Health Informationstatistics provided by the Canadian Institute for Health Information


Canadian Donor NumbersCanadian Donor Numbers(1999 - 2003)(1999 - 2003)

53 33 42 9 133 132 19

55 45 38 19 165 135 13

53 41 37 9 128 136 16

53 36 30 11 137 127 11

37 36 39 12 143 142 19

0 100 200 300 400 500

1999

2000

2001

2002

2003

AB ATLANTIC BC MB ON QC SKstatistics provided by the Canadian Institute for Health Informationstatistics provided by the Canadian Institute for Health Information


DonationDonationtwo types of donors:deceased (dead) donors

• donor has been declared dead by two physicians independent of the transplant team

• usually occurs only in cases of neurologically determined death (the brain stops working 1st but the donor is still on artificial support such as a ventilator to allow the other organs to maintain a blood supply and remain suitable for transplant)

live donors• patient chooses to donate one or part of an organ to

someone on a transplant waiting list• can only occur with organs when removal will NOT cause

grave harm to the donor


Deceased DonationDeceased Donation

neurologically determined death

usual case

also referred to as brain death

intact heartbeat & circulation

on ventilator

less than 3% of all deaths

One the reasons that there One the reasons that there are so few organ donors in are so few organ donors in

Canada is that very few Canada is that very few people die under people die under

circumstances that allow circumstances that allow them to donate their organs.them to donate their organs.


Deceased DonationDeceased Donation

donation after cardiac death

currently being explored in Canada

common in countries such as Spain and the Netherlands

occurs in hopeless cases in the hospital where the decision to withdraw life-support is made (decision is independent of the decision to donate)

organ donation occurs immediately once the heart has stopped and the patient is declared dead


Tissue DonationTissue Donation

tissues include eyes, heart valves, bone, tendons and skin

tissues do NOT need oxygen to remain suitable for transplant – do NOT need to have an active blood supply

can occur following death regardless of whether death was determined by neurological (brain death) or cardiac (heart stops) assessment

almost everyone can be considered for tissue donation after death


The Most Common Causes of The Most Common Causes of Death Leading to Organ DonationDeath Leading to Organ Donation

cerebral bleed

cerebral infarction

primary brain tumour

trauma (i.e. motor vehicle accidents or a severe fall)

anoxia, hypoxia (a condition in which blood flow to the brain has been stopped leading to no or poor oxygen supply to the brain)

The most common cause of The most common cause of death in adult organ donors is death in adult organ donors is an infarction or bleed to the an infarction or bleed to the brain; in those less than 18 brain; in those less than 18

years old, the most common years old, the most common cause of death is trauma.cause of death is trauma.


an 85 year old …

… … donate their organs or tissues?donate their organs or tissues?

Who can donate?Who can donate?Can …Can …


Can an 85 year old person still Can an 85 year old person still be a donor?be a donor?

YES!the oldest organ donor on record was a 92-year old woman whose liver was successfully transplanted by surgeons in London, ONthe age of the organ donor does not dictate who gets the organ – as long as the organ is healthy, it is offered to the patient next on the listeye donation can occur in individuals up to 100 years of age


an 85 year old …

someone with diabetes …




Can someone with diabetes still Can someone with diabetes still be a donor?be a donor?

YES!diabetes is not a barrier to donation although it may limit which organs can be donated

each organ is assessed separately and its suitability for donation determined

with diabetes, the kidneys and heart often are not suitable but this is not always the case


an 85 year old …


someone who wears glasses …




Can someone who wears Can someone who wears glasses still be a donor?glasses still be a donor?

YES!

not only can you donate your organs, you can still donate your eyes as well – wearing glasses does not mean your eyes are unsuitable for transplant!


an 85 year old …



someone who has had cancer …




Can someone who has had Can someone who has had cancer still be a donor?cancer still be a donor?

YES and NOa benign, non-transmissible

cancer is not considered a contra-

indication to donation

a malignant cancer with the

possibility of transmission to

recipients is a contra-indication to

donation


an 85 year old …




someone with HIV …




Can someone with HIV still be a Can someone with HIV still be a donor?donor?

NO!

when there is any risk of

transmitting a fatal disease

from a donor to transplanted

recipients, the organs are

NEVER used


an 85 year old …





someone with hepatitis C …




Can someone with hepatitis C Can someone with hepatitis C still be a donor?still be a donor?

YES (conditional)!because hepatitis C can be transmitted from donor to recipient, organs have not been used in the past and still are only used in certain circumstancesbecause there are many patients on the transplant waiting list who already have hepatitis C, many transplant teams will now accept organs from donors with hepatitis C and transplant them into a recipient who already has hepatitis C – the organ must still undergo a variety of tests to determine its suitabilityhepatitis C is a contra-indication to tissue donation


an 85 year old …





someone with hepatitis C …

someone who died under suspicious circumstances …




Can someone who died under Can someone who died under suspicious circumstances still suspicious circumstances still

be a donor?be a donor?

YES!

if the cause of death is known

coroner’s consent is required

and may be restricted to

certain organs and tissues and

may involve a time limit


Who can donate?Who can donate?

everyone who supports organ and tissue

donation and transplantation is encouraged to

express their intention to do so

at the time of death and following consent to

donate, transplant teams will determine the

suitability of the organs and tissues for

transplant


How Do I Express My Intent How Do I Express My Intent to Donate?to Donate?

varies between provinces

most provinces – donor card

BC – registry

Ontario – health card

in all provinces, physicians will talk to

your next-of-kin at the time of death

talk to your family and let them know

your wishes

The green ribbon is an The green ribbon is an international symbol of international symbol of

organ and tissue organ and tissue donation.donation.


Frequently Asked QuestionsFrequently Asked Questions

If donation occurs, is an open casket funeral still possible?• Yes – the only way people will know that donation occurs is if the family

chooses to tell them.

Are any religions against donation?• All of the major religions in Canada support donation.

If I have a signed donor card, will doctors bother to try to save my life after an accident?

• Definitely! – every effort will be made to first save your life – your well-being is the priority.

Is it true that the wealthy and influential get preferential treatment on transplant waiting lists?

• Definitely NOT! – in Canada, all patients are treated equally while on the waiting list.

What if I’m not really dead when donation occurs?• Death is absolute and certain whether or not you become a donor. Donation

can only occur if two physicians independent of the transplant team declare you dead.


Who Gets the Transplant?Who Gets the Transplant?

Baby Jane, two weeks after receiving Baby Jane, two weeks after receiving her liver transplant.her liver transplant.

blood typeidenticalidentical

compatiblecompatible

sickest in hospitalsickest in hospitalstatus of recipient

stable at homestable at home

longest waiting11stst on the waiting list on the waiting list

last on the waiting listlast on the waiting list

size


Live DonationLive Donation

kidney – most common

living liver donation on

the rise

living lung donation –

not as common

due to more people on the waiting list and a severe

shortage of organs for transplant – more emphasis

is being put on living donation



Baby Jared, two weeks Baby Jared, two weeks after receiving part of after receiving part of his mother’s liver – his mother’s liver –

mother and son both mother and son both continue to do well.continue to do well.



usually occurs between related individuals (blood or emotionally)NEVER involves payment to the donor

Benefits:can allow for pre-emptive transplant (before recipient requires dialysis)allows for a planned transplant procedurehas improved graft survivalshortens time on the waiting list for the recipientincreases the total number of organs available for transplant


Live DonationLive Donation(benefits to the donor)(benefits to the donor)

a complete physical assessment –identification of a possible illness

the joy and satisfaction of helping a friend or family member – of saving a life

A brother and sister pair who shared the A brother and sister pair who shared the gift of life – a kidney – both continue to gift of life – a kidney – both continue to

do very well four years later.do very well four years later.


Live DonationLive Donation(risks to the donor)(risks to the donor)

any patient undergoing surgery faces risks – the dilemma with living donation is that a healthy patient is undergoing surgery with no direct health benefit to themselves

every attempt is made to minimize risks to the donor

informed consent is required


ConclusionConclusionTransplantation offers a second chance at life to thousands of Canadians. It has been proven over and over again to be very

successful. However, transplantation can only occur if someone consents to the ultimate gift – organ and tissue donation.

Rafe – liver transplantRafe – liver transplant Susan – heart & lung Susan – heart & lung transplanttransplant

Ernie – heart Ernie – heart transplanttransplant

the end …the end …

or the beginning for someone on a or the beginning for someone on a transplant waiting listtransplant waiting list

consider organ and tissue donationconsider organ and tissue donation

organ & tissue donation and transplantation. presentation prepared by corinne weernink, london...

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