ORGAN DONATION: AN IMPORTANT DECISION

Organ transplants are the last resort of medicine, when a patients condition deteriorates to such an extent that only a replacement of the deficient organ can save him or her. The number of people waiting for a transplant has increased in recent years. In Europe, the waiting list has some 60 000 names on it. Each day, 12 of those people die because a donor could not be found in time. The European Union and individual countries are increasingly encouraging people to think about the problem. It is up to each one of us individually to reflect on the important issue of organ donation. Some historical facts Transplanting organs has been a human dream for a long time; the subject even appears in ancient mythology. The first attempts to transplant organs were made at the dawn of the modern age, but it was not until the end of the 19th century that research on modern transplant techniques was begun. FROM THE DONOR Who can be a donor? There are two types of organ donation: posthumous donation, which may involve cells, tissues or organs; and donation by people while they are still alive. In most cases, organs are donated by people who have died in hospital following a head injury or a stroke, or after suffering a heart attack. The feasibility of removing organs is investigated once death has been certified, following the irreversible cessation of brain activity. Donation by a living person (most commonly a kidney) is associated with a number of risks. The law prohibits it except from members of the potential recipients family. Prospective organ donors are required to undergo an in-depth medical and psychological examination. There is no age limit for becoming a donor, the important thing being the donors state of health. Organ donations must always be entirely voluntary and are anonymous and unremunerated. TO THE RECIPIENT. To whom do the organs go? The beneficiaries of organ donations are people who are so ill that the only remaining remedy is to replace the deficient organ with a healthy one. This includes people suffering from cystic fibrosis, heart defects, terminal kidney failure and cirrhosis of the liver. Transplants of the heart, lung and liver are a matter of life and death, as without them the patient will die. Kidney transplants are normally less urgent, but they have an enormous effect on the quality of life and life expectancy for patients who are dependent on dialysis.

Today, people who have had an organ transplant can go back to living a practically normal life. They are able to work, have children, do sport and travel. However, they have to undergo lifelong treatment to prevent organ rejection. Why is there a shortage of donated organs? Removal of organs for donation is potentially feasible in less than 1% of deaths in hospital, and in one out of three cases where it is feasible organs cannot be removed either because the deceased person while still alive explicitly refused to donate organs or because the next of kin refuse to allow organs to be removed on the grounds that they are unaware of what the person would have wanted. State your intention to be an organ donor European countries have different rules regarding consent to organ donation. On 16 March 2010 the European Parliament announced a series of measures that would give every citizen a chance to register in a list of all donors. In addition, the identity card could include a special sign allowing rapid identification of a potential organ donor. Until these measures are implemented across Europe, each country continues to apply its own legislation. Some countries, namely Switzerland, Denmark, the Netherlands, the United Kingdom, Ireland and Germany, stipulate that organs may not be removed unless the person concerned has given explicit consent to organ removal after death. Other countries, i.e. Austria, Belgium, Spain, Finland, France, Greece, Italy, Luxembourg, Portugal and Sweden, apply the principle of presumed consent which allows organs to be removed unless the person concerned has explicitly refused to allow organs to be removed after death. The organ donors card is valid in other countries and should be carried even when travelling abroad, otherwise the laws of the country you are in will apply. Next of kin are always informed. In practice: Anyone who wishes to be a donor of cells, tissues or organs should state that intention, either in writing or verbally, thereby taking the burden of deciding off the next of kin. Organ donor cards are available from the Medical Service, or you can download them from these URLs: www.swisstransplant.org/l4/ www.uktransplant.org.uk/ukt/default.jsp www.dso.de/ www.agence-biomedecine.fr/index.php/ For more information: www.who.int/transplantation/en/ www.fairtransplant.org/home/index.php www.bag.admin.ch/transplantation/ Dr Vronique Fassnacht and Dolors Richard, nurse CERN Medical Service