It is possible to transplant organs from donors that have died as a result of primary brain injury, DBD (Donation after Brain Death) and donors who have died as a result of circulatory death, DCD (Donation after Circulatory Death). Advancements in organ preservation have led to organs that were previously classed as unusable, also known as marginal organs, now being accepted for donation.
Most of the organs that are transplanted come from patients with brain damage who are treated on a ventilator and declared dead based on neurological criteria, known as brain death. The introduction of the definition of brain death has been critical to organ donation and transplantation surgery. In connection with DBD, the heart is beating to maintain circulation while a ventilator oxygenates the blood, which facilitates the donation process, and provides time to talk to relatives and take care of the organs.
The shortage of organs has meant that in recent years donation after circulatory death, DCD, has increased, with good results. This has also meant that more people have been offered the opportunity to donate organs after their death. For DCD donations, the donation process needs to be much faster from the time of death to the start of donation surgery. If the process takes too long, the organs become unusable, and the uncertainty of the function of these donated organs is greater.
Another possibility that an increasing number of clinicians are investigating is whether methods can be found to take advantage of organs that have previously been rejected due to poor function that would risk making the recipient even sicker after a transplant. Marginal organs may come from older donors, infected donors (such as Hepatitis B&C and HIV) or donors with high BMI, diabetes or high blood pressure. The inclusion of extended criteria organs in the donation process has made the decision whether or not to accept an organ more complex than before. However, for most patients waiting for an organ, the benefit outweighs the risk of an extended criteria organ.
Very few people die in a way that makes organ donation possible. To become an organ donor, the person needs to die in an intensive care unit while receiving ventilator care. This is a prerequisite for the organs to be oxygenated and maintain function after death. But many other factors also influence organ supply; see summary below.
After a donor has been identified and accepted, the organs are offered to transplant clinics. Unfortunately, all donated organs are rarely recovered for use in transplantation. The reasons for refraining from using an organ might include the donor’s medical background and age, poor organ function, insufficient time, or that no matching recipient can be found in time. The rate of utilization varies depending on the organ; see figure. Only 20 percent of donated lungs are transplanted, 30 percent of hearts, 65 percent of livers and 70 percent of kidneys (global average 2015-2021).
Donor not identified by healthcare services, brain death cannot be diagnosed (DBD), circulatory death does not occur within the right time frame (DCD), logistical problems (no surgical team available to recover organs).
Not medically suitable, unstable donor/sudden cardiac arrest, anatomy or function of organs unsatisfactory, organs damaged during removal, insufficient circulation of organs.
The individual has expressed that they do not wish to donate organs, the family objects to donation.