ORGAN AND TISSUE DONATION FOR TRANSPLANTATION

FREQUENTLY
ASKED QUESTIONS


The decision to donate

Who can donate organs and tissue?

Anyone can donate organs and tissue. A person’s age and medical history will be
considered as part of the donation process, but people shouldn’t exclude themselves by
thinking they are too young, too old or not healthy enough.

If you want to become an organ or tissue donor upon your death, the most important
thing to do is tell your family as they will be asked by hospital staff to confirm your
wishes.

If so many people already support organ donation, what difference can my

decision make?

For people with a serious or life-threatening illness, an organ or tissue transplant may be
the only option for a second chance at life.

Only one per cent of all deaths in hospital occur in such a way that organ donation is
possible – so every donation is very important.

Many more people are able to donate tissue for transplant. Unlike organs, tissue may be
stored for a period of time and successful tissue donation and transplants can take place
in more varied circumstances than is possible with organ donation.

Do certain religions object to organ and tissue donation?

All the major religious denominations in Australia support organ and tissue donation.

What can be donated?

The organs that can be donated for transplant in Australia include the heart, lungs, liver,
kidneys and pancreas.

Tissue can also be donated, from heart valves to bone, skin, eye and pancreatic tissue.

What if I only want some of my organs to be donated, not all of them?

You can specify which organs or tissue you would like to donate by telling your family,
friends and loved ones about your wishes.

You can also specify the organs and tissue you want to donate on the Australian Organ
Donor Register (www.donorregister.gov.au). But registering alone is not enough and you
don’t need to be registered to become an organ donor. The most important thing you
need to do is to make your wishes clear to your family because it is your family who will
be asked by hospital staff and who give the written consent for donation to go ahead.


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Is registering the best way to ensure my wishes are respected?


The best way to ensure your wishes are carried out is to have the conversation with your
family, friends and loved ones about organ donation because your family will be the ones
asked to confirm your wishes.

Registration is a useful way for some people to demonstrate their commitment – and
formalise in their own mind their wishes – to donate their organs and tissue.

But people don’t have to register to become a donor.


The experience of donor patients

Will the fact that I want to be a donor mean that I receive less attentive care in
hospital?

No. In caring for a patient, the most important consideration for clinicians is to help save
life. The fact that you are a potential organ or tissue donor will in no way compromise
your treatment.

How do they know I am dead, not just in a coma?

Medical tests clearly distinguish between death and coma. A patient in a coma is
unconscious because their brain is injured in some way, but it can continue to function
and their condition may improve.

When someone dies, their brain stops functioning and will never function again. There is
no blood flow to the brain, and there is no chance of recovery, even though other organs
may be able to continue to function with medical support.

Strict protocols in Australia ensure that organ and tissue donation processes are not
initiated until a potential donor has been certified as dead. A series of tests is carried out
by two independent and appropriately qualified senior clinicians to establish brain death of
a patient. These doctors are not involved in the organ and/or tissue donation and
transplantation processes.

Will donation disfigure my body?

The removal of organs and tissue for donation is no different to any other surgical
operation and is performed by highly skilled health professionals who treat the body with
respect and integrity.

The donor’s body is always treated with dignity and respect. The donation of organs and
tissue does not alter the physical appearance of the body. Many donor families have open
casket funerals.



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After donation

Does my family have any control on whether my organs are actually transplanted,
rather than being used for medical research?

The law requires that a person’s remains are treated with the utmost respect and care.

There is no possibility that the remains of a deceased person may be used for research
purposes without the written agreement of the family. Donated organs and tissue may only
be used for research purposes if specific consent has been given for this purpose by the
individual or their family.

Surgeons will only retrieve organs and/or tissues that the family has agreed to, based on
your wishes, and that are medically suitable for transplant and for which a suitable recipient
has been found.

Could my organs go to someone who doesn’t deserve a second chance?

Donation is completely anonymous and under law a donor cannot choose who should
receive their organs or tissue. It is important to remember that an organ or tissue
transplant may be the only option for a second chance at life for many Australians on the
organ transplant waiting list. Thousands of Australians benefit every year from tissue
transplants.

Could my organs end up on the black market?

There is no chance that any donor’s organs or tissue removed in an Australian hospital
would end up on the black market. The donation of organs and tissue for transplant in
Australia adheres to very strict guidelines.

Will recipients contact my family after my donation?


Donation is completely anonymous. Records of who donates organs and tissue and who
receives them are confidential and protected by law. The organ donation agency can
facilitate limited communication between the donor’s family and transplant recipients
through an exchange of letters. These letters maintain the anonymity of both parties and
are strictly confidential.

What happens to organs and tissue that can’t be used for medical reasons?

Depending on the circumstances, any unused organs that have been retrieved will be
reunited with the person’s remains or cremated at the hospital.




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HOW THE
PROCESS WORKS


How can I become a donor?

To become an organ or tissue donor, you need to have a conversation with your family,
friends and loved ones, because your family will be asked to confirm your wishes upon
your death.

Anyone can donate organs and tissue. A person’s age and medical history will be
considered as part of the donation process, but people shouldn’t exclude themselves by
thinking they are too young, too old or not healthy enough.

What organs and tissues can be donated?

Transplants using deceased donor organs are well established for kidneys, liver, heart,
lungs and pancreas.

Eye and tissue transplants are available in Australia for corneas, sclera, heart valves,
musculoskeletal tissue (bone, tendon and ligaments) and skin.

When can organ and tissue donation occur?

The way in which a person dies determines whether they are able to donate organs and/or
tissue. Organ and tissue donation can occur in the case of brain death or cardiac death.

A person may donate organs where they have been declared ‘brain dead’ in an intensive
care unit in hospital. The majority of organ donations occur after brain death. Less than
one per cent of all people who die in hospital each year die in this way.

Organ donation may also be possible after a person’s heart has stopped beating, referred
to as ‘cardiac death’, but this is less common.

Many more people are able to donate tissue for transplant. Unlike organs, tissue may be
stored for a period of time and successful tissue donation and transplants can take place
in more varied circumstances than is possible with organ donation.

When is the issue of donation first raised with my family?


A specially trained clinician will approach the family about the possibility of donation once
medical assessment indicates that there is no chance of recovery. This may occur in the
emergency department or in the intensive care unit.

Australian protocols ensure that a decision on donation is not made and organ donation
processes do not begin until a patient has been certified as brain dead.

A series of tests is carried out by two independent and appropriately qualified senior
clinicians to establish brain death of a patient. These doctors are not involved in the organ
and/or tissue donation process.


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Who makes the final decision about donation?


Your family will ultimately give final consent, which is why it is important that you have
made your wishes clear to them. You can use these conversations to find out what your
family, friends and loved ones want too.

What happens next?

If your family confirms your wishes to donate, and if you want to be a donor upon your
death, your family will then be asked to complete a form giving formal consent to the
organ and/or tissue donation.

Once your family has agreed in writing to donation, a dedicated and trained donor
coordinator will work with specialist teams to help assess your medical suitability. They
will also keep your family up to date with what is happening and support them.

All potential donors are screened through a review of medical records and completion of a
questionnaire by your family.

If you meet initial suitability criteria, you would then undergo a thorough medical testing
process to ensure that transplant recipients receive as safe a transplant as possible.

How do they decide who benefits from my organs and/or tissues?

Screening information from the rigorous testing phase is used to identify potential organ
or tissue recipients from waiting lists.

Allocation of organs is a complex process that depends on a range of factors including

medical need, urgency and capacity of the recipient to benefit from a transplant.

Will it be my original doctors and nurses who oversee the donation?

Organ retrieval is generally undertaken by organ-specific transplant teams.

The transplant units accepting the donated organs are largely responsible for arranging
the retrieval procedure: either using a surgical team from their hospital or by
arrangement with a suitably qualified surgeon from elsewhere. The organ transplant team
will attend the hospital where the donor is located to retrieve the organ and then return to
the transplant unit where it is based to perform the transplant.

Meanwhile, the donor coordinator organises the operating theatre for the retrieval,
ensures that the strict legal, ethical and procedural guidelines are followed, and completes
the required documentation.




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What organs and/or tissue are retrieved and what happens during the operation?

Surgeons will only retrieve organs and/or tissues that the family has agreed to, based on
your wishes, and that are suitable for transplant and for which a suitable match has been
found.

The removal of organs and tissue for donation is no different to any other surgical operation
and is performed by highly skilled health professionals. Donors are always treated with
respect and dignity.

How long does it take for the organs and tissues to reach their intended
recipient(s)?

There is a limited timeframe, particularly for organs, to be transplanted into the recipient:

x hearts and lungs must be transplanted within approximately six hours after being
retrieved from the donor;

x livers and pancreas must be transplanted within 12 hours; and

x kidneys must be transplanted within 24 hours.


Many more people are able to donate tissue for transplant. Following processing, tissues
such as heart valves, skin and musculoskeletal tissue can be stored in defined conditions for
up to five years before being used for transplantation.

Will my family get updates on how the transplant procedures went?

The donor coordinator will get in touch with your family to let them know which organs
and/or tissues were transplanted, how the transplants went, and which tissue (if any) has
been stored for later use. The coordinator will stay in touch with your family, ensuring that
they receive the bereavement and any other ongoing support they may need.




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HOW THE WAITING

LISTS OPERATE


Who is on the organ transplant waiting lists?

There were 1,716 people on the official organ transplant waiting lists at 1 January 2009.
A patient’s doctor will put an individual on a transplant waiting list based on medical and
other criteria.

In 2008, 846 recipients received donated organs from 259 deceased donors.

Three quarters of patients (76 per cent) on the organ transplant waiting lists are between
40 and 69 years of age. There are 164 people under the age of 30 years on the list, 29
per cent of whom are children or teenagers (under 18).

More than two thirds of people on the list need a kidney transplant. The average time
waiting for a kidney transplant is more than three years.

How is it decided who will get a transplant?

Allocation of organs is a complex process that depends on a range of factors including

medical need, urgency and the capacity of the recipient to benefit. In Australia, allocation
systems are underpinned by the principles of utility, equity and fairness.

Criteria that are used in considering potential organ transplant recipients include:

x Length of time waiting for a transplant

x Important medical factors such as tissue matching and matching of organ quality
with the patient’s medical status
x The urgency of a transplant given the likely deterioration of health without
transplant therapy
x Need in terms of how sick the patient is without transplant therapy
x Logistical factors involved in making a donated organ available to a recipient within
an appropriate timeframe

Who manages the organ transplant waiting lists?

Transplant waiting lists are managed by different groups according to both the organ
involved and the state/territory that the recipient is in, guided by protocols developed by
the Transplantation Society of Australia and New Zealand (TSANZ) and the Australasian
Transplant Coordinators Association (ATCA).

The new Authority will lead the development and implementation of a national framework
for organ and tissue allocation.

How does waiting for an organ transplant differ from a tissue transplant?

There are no formal waiting lists for tissues and hence it is not possible to determine the
true extent of demand.

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Many more people are able to donate tissue for transplant. Following processing, tissues
such
 as heart valves, skin and musculoskeletal tissue can be stored in defined conditions
for up to five years before being used for transplantation.

Nevertheless, shortage of some kinds of tissue can occur, especially in the case of skin.

How long on average are people on the organ transplant waiting list?

Waiting list times vary. The reason for delays may be based on finding an appropriate
donor, on urgency or on medical matching.

How many people on the organ transplant waiting list can a donor help?

The organs that can be donated for transplant in Australia include the heart, lungs, liver,
kidneys and pancreas.

Tissue can also be donated, from heart valves to bone, skin, eye and pancreatic tissue.

Many lives can be saved or significantly improved from each donor.




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