03.Live organ donation
Kidney donations from living donors are becoming increasingly common, accounting for almost half of all kidney transplants. Transplants from living donors have a slightly higher success rate than from deceased donors. Living donor transplantation hit the headlines in 2001 when the late Kerry Packer received a kidney from his friend and helicopter pilot, Nick Ross.
In most cases, the donor is related to the recipient and has a compatible blood and tissue type. However, if a friend, spouse or family member who’s prepared to donate a kidney isn’t compatible with the intended recipient, another option is the Australian Paired Kidney Exchange Program (AKX), which matches willing donors with compatible recipients.
After undergoing a range of medical tests, donors and recipients have their details registered in an AKX database, where a search is performed for potential matches. Sometimes a straight swap between two pairs is possible, otherwise several pairs may be involved.
If a match is found, everyone’s surgery takes place on the same day, and at the same time for kidney removal, although not at the same hospital (to protect articipants’ identities). This ensures that if one donor pulls out at the last minute, surgery on the other donor/s doesn’t take place either, so no-one is disadvantaged. The donated kidneys are transported to the recipient’s centres and transplanted the same day.
Until recently, potential organ donors had to meet the criteria for brain death. This is when the brain has received such serious trauma that blood flow to it has ceased and there is no chance it will ever recover. Sometimes, however, a person may have received serious brain trauma and possibly suffered cardiac arrest, and while the circulation can be restarted and kept going artificially, if treatment were withdrawn the patient would soon die.
In a bid to increase the potential pool of organ donors, so-called cardiac death has now been adopted as being suitable for organ donation in Australia. In 2009, 42 of the 247 donors had cardiac death declared.
Brain death is determined by a series of tests carried out by two senior doctors. After an appropriate period of observation and mechanical ventilation during which the patient has unresponsive coma, the tests examine certain reflexes, such as pupils being non-reactive to light, an absent cough or gag reflex and a lack of spontaneous breathing efforts. Medical imaging may also be used to determine lack of blood flow in the brain.
Cardiac death is declared when, after withdrawing mechanical ventilation, the patient doesn’t move, can’t breathe on their own, has a lack of blood flow to the skin and an absence of circulation as evidenced by lack of pulse for a minimum of two minutes.