What is organ and tissue donation?
Organ donation is the act of donating, in life or after death, organs and tissues to help people who need a transplant as a treatment resource.
In life, people can donate bone marrow and parts of the kidney, liver and, in specific cases, part of the lung.
For organ donation from deceased persons, confirmation of brain death is required. In these cases, organs (heart, lung, kidney, liver and pancreas) and tissues (skin, bones, heart valves, bone marrow and corneas) are donated.
In addition to brain death, there is also the possibility of donation when the cause of death is cardiac arrest. In such cases, however, only the tissues are donated.
A single donor is able to benefit several patients who are on the waiting list, this queue being a unique and national list.
To be a donor, it is not necessary to leave any official documents or records. What is taken into account is family authorization. Therefore, informing loved ones of this desire is the most important.
The donation of organs and tissues is a transformative gesture in the life of those who receive the transplant and also for those who donate. It may seem strange to think so, as we often forget about giving in life, but that possibility exists.
Whether it is a donation while alive or after death, what matters is that this is certainly an action capable of changing the history of many people.
In the text below, we will describe how organ and tissue donation works.
Organ donation works in a few steps. We can consider that the first initiative to be a donor is to express this will to family members, as this will be the determining factor for this desire to be fulfilled.
From this, considering the cases of donation after brain death (potential donor), the steps are as follows:
Brain death diagnosis
The diagnosis of brain death is considered the first step towards organ donation, since, in principle, every patient with a confirmed brain death diagnosis can be a donor.
In this condition, even with brain failure, the heart continues to beat, maintaining blood circulation to the organs. It is this condition that makes the donation of practically all organs viable.
After the series of tests performed, usually performed by more than one doctor, the diagnosis is established and this circulation is preserved artificially, with the use of drugs and devices.
This artificial circulation is maintained as long as hospitals come into contact with the patient’s family and with the Transplant Center.
This notification to the Transplant Center must be made mandatorily, even when the donation does not take place.
After the diagnosis of brain death, communication with the patient’s family must be made, so that the possibility of donation is informed and clarified. Doubts about brain death must be clarified and the family is asked about the desire to donate the organs.
As in Brazil there is no requirement for any official document or registration to be a donor, authorization from the family is what will determine the donation. Therefore, it is important to emphasize that this desire to be a donor must be talked about and respected.
With the family’s authorization, an interview must be carried out so that a clinical history can be traced. This is done to investigate donor habits that can be considered at risk for the development of diseases and infections, which would prevent donation to the recipient.
The discovery of infections, injecting drug use and chronic diseases, for example, are impediments to donation, as they are conditions that can compromise the organ to be donated.
In addition to the interview and the questionnaire, tests should be carried out to assess the compatibility of the donated organ with the patients in the waiting list.
Withdrawal of organs
The removal of the organs is done through common surgery, which should not leave the donor’s body unconfigured.
There are several organs that can be donated from the same donor, which benefits many patients in the waiting list.
The order of removal of the organs must be made according to the time the organ will last without adequate blood circulation, a condition called ischemia time.
In these surgeries, the heart, pancreas, liver, intestine, lungs, kidneys, vessels, skin, bones, tendons and corneas are usually removed.
At that time, the Transplant Centers, which are integrated, must evaluate the donor data by crossing with the information of the people who are in the waiting line, so that the ideal patient is notified, in accordance with all the urgency and length of care requirements. wait.
The entire organ donation process is considered a race against time for everything to work out, especially when it comes to transport logistics.
The way it is transported also depends on the distance between the donor and the recipient, and it can be by air or by land transport.
When it comes to a donation between people from different states, the management of the organ must be done by air transport provided by the Ministry of Health.
There is also the collaboration of airlines for companies to transport organs for free on commercial flights, in addition to the Brazilian Air Force (FAB), which should also help when there is a request by the National Transplant Center.
Recovery after transplantation requires care, as in any post-operative process. In the case of transplant patients, what should be extra care is the use of immunosuppressive drugs throughout life, to avoid rejection of the new organ by the body.
When we talk about organ donation, we also discuss brain death, or brain death. This is usually a topic that generates a lot of doubt in people and that can be difficult to understand, especially at the moment of the loss of a loved one.
Brain death is declared when the individual has a complete and irreversible arrest of brain functions . When this happens, the patient is only kept “alive” with the help of devices, so the heart continues to beat and donations are possible.
Confirmation of brain death occurs only when there is a series of medical tests to confirm this diagnosis. Tests are usually redone with time intervals for exact confirmation.
The tests should prove that the patient is no longer reacting to any brain reflexes, as well as making sure that the patient is no longer able to breathe on his own.
Tests such as electroencephalogram and cerebral angiogram can be done to confirm the absence of blood flow and brain activity. In some cases, even with the brain inactive, spasms or muscle contraction can occur, due to the electrical impulses that can remain in the spine.
Brain death is only reported when the diagnosis is confirmed. Then, the individual is declared legally dead, and the time of death is recorded at that time and not at the time of removal of the devices.
It is important to know that when brain death is declared, it means that there is nothing more that can be done to recover the patient.
Finally, when a brain death diagnosis is confirmed, hospitals must notify the Central Notification, Procurement and Distribution Centers. Age, name and cause of death, in addition to the hospital where the patient is hospitalized, must be informed.
Even when there is no family consent or when the patient’s condition is not favorable for donation, this notification is mandatory.
When the patient is a possible donor, the decision belongs to the family, so it is important that during the patient’s life, inform his family of this desire.
Brain death can be caused by different causes such as head trauma, cardiopulmonary arrest, stroke, swelling in the brain, increased intracranial pressure, tumors, overdose and lack of blood glucose.
There are no major restrictions on being a donor. Healthy people who meet the established criteria can be considered potential donors, even if they are not of all organs and tissues.
In addition, it is also possible to be a living donor, as in the case of bone marrow transplantation and part of organs such as kidney and liver, for example.
Among the criteria for donation is also the need for documentation, being over 18 years of age or presenting authorization from those responsible.
According to the Brazilian Organ Transplant Association, all people diagnosed with brain death should be considered as a potential donor .
In some conditions, the donation is more common or requires some different care:
Brain death, or brain death, is the most mentioned cause of death when it comes to organ donation, as in these cases all healthy organs and tissues can be donated.
In these cases, the donation of organs such as kidneys and heart cannot be done, due to the lack of circulation that occurs. However, it is still possible to donate tissues such as cornea, vessels, skin, tendons and bones.
Death at home
In these cases, the corneas can be donated within 6 hours of death, due to lack of circulation.
However, the donation of other organs cannot be made, due to the damage that the lack of blood circulation causes, offering a greater risk of death to the recipients.
To be a living donor, it is necessary to fulfill some requirements:
- Present a good health condition, in which the donation of the organ or tissue does not compromise it;
- Being over 18 years old or under emancipated minor (legally capable citizen);
- The recipient must present an indispensable therapeutic indication for transplantation;
- With the exception of cases of bone marrow donation, to be a living donor, the recipient must be a spouse or family of up to four degrees (parents, siblings, children, grandparents, uncles and cousins).
When it comes to a donation for people who do not fit this kinship requirement, it can only be made when there is a judicial authorization.
In some conditions, organ or tissue donation cannot be done, due to the risks that it would bring to the recipient’s health. Among the impediments are:
- Diseases that compromise the functions of organs or tissues, such as insufficiency of the kidneys, heart, lungs, bone marrow and liver;
- Communicable diseases such as people with HIV / AIDS, hepatitis B and C and other restrictions placed on blood donation;
- Generalized infection that cannot be cured;
- Malignant tumors, except those that affect only the central nervous system, skin and uterus;
- Insufficiency of organs and systems;
- Chronic degenerative diseases, such as rheumatism, multiple sclerosis, cancer, Alzheimer’s etc.
Organ donation can be divided between organs that can be donated after death and in life.
Donation after death usually occurs in cases of brain death and cardiac arrest.
In cases of brain death, the number of recipients that can be benefited is greater, as most organs and tissues can be donated. In the case of cardiac arrest deaths, donation is restricted to tissues only.
According to the Ministry of Health, the organs and tissues that can be donated, when there is family consent, are:
- Heart valves;
- Bone marrow;
In life, people can be donors of the following organs and tissues:
- Pancreas (partially);
- Part of the liver;
- Part of the lung (in exceptional situations);
- Bone marrow;
The donation of organs and tissues is a way of saving lives and helping to treat thousands of people who are in line for a transplant. A donor can only help many other patients, doing not only good for the recipient, but also for those close to him.
Understand a little more how the donation of each organ or tissue works and who needs these donations:
The donation of the heart is intended for patients with serious diseases that compromise its functioning, such as edema or heart failure, which can alter the size and strength of the organ.
Transplantation is recommended when the patient no longer responds well to other treatments or surgeries. In such cases, the transplant can only be performed from a donor with brain death.
Under certain conditions, not even in cases of brain death can the donation of the heart occur. However, the valves can be removed and taken to valve banks, where they can be maintained for years.
From there, they can be donated to people who have some pathology associated with the function of these structures (directing blood in the heart chambers). Altogether, there are four valves in the heart: mitral (bicuspid), tricuspid, aortic and pulmonary.
Recipients are those who have severe liver disease, such as those with liver tumors or liver cirrhosis caused by alcohol or hepatitis, for example.
As the liver is an organ capable of regenerating itself, the donation of part of it can be done in life.
Lung transplantation is performed in patients diagnosed with severe lung diseases, who no longer respond to other treatments available.
The donation of this organ usually occurs in cases of brain death. However, in exceptional cases, part of the lung can be donated from a living donor. In such cases, there is a need for two donors so that a recipient can receive the transplant.
This is an important organ in the digestion process and also in the production of insulin, responsible for controlling blood glucose.
Pancreatic transplantation is usually performed with kidney transplantation, when the patient has an associated kidney problem or in patients with type 1 diabetes Mellitus. The donation occurs from deceased donors or partially from living donors.
Kidney transplantation is performed in patients who have diseases such as diabetes, chronic renal failure with indication for hemodialysis (blood filtering), hypertension and other pathologies that compromise the functionality of this organ. The donation can occur in life or after death, due to the presence of two kidneys.
The intestine can be transplanted in patients who have some severe malabsorption dysfunction, which can happen due to various types of gastrointestinal or systemic disorders, and also in patients with the Small Intestine Syndrome.
This transplant is performed when the patient has a certain condition that compromises the cornea, which impairs the vision, anatomy and functionality of the eye.
Various conditions can lead to the compromise of this tissue, such as ulcers, traumas, infections, surgery, allergies and diseases such as keratoconus.
In some cases, there is treatment for these complications, but when the patient does not improve and his vision is put at risk, the transplant is a chance to normalize the condition.
The donation of the corneas, a thin tissue that controls the passage of light to the retina and allows us to see more clearly, can only be done from deceased donors.
Bone marrow is a tissue present inside the bones that acts in the formation of red blood cells (erythrocytes), white blood cells (leukocytes), platelets and stem cells.
The donation can be made in life, even by children and pregnant women. The interest in being a bone marrow donor must be made from a register in blood centers. Each state has one and they can be consulted through the Inca website .
During registration, the donor goes through the collection of a small amount of blood and fills in a form with personal information. The blood must undergo an analysis to identify characteristics that may interfere with the transplant. This test is called histocompatibility (HLA).
HLA information must be kept in the Redome, Brazilian Registry of Bone Marrow Donors.
It is from the Redome that a cross between the data of the patient waiting for the transplant and the data of the donor. When there is a match, the donor is notified.
This type of donation helps to treat people who have suffered severe burns and over a large area of the body. It is also important for patients with severe dermatological diseases that compromise the skin.
The donation of skin is performed in deceased donors or in people who have undergone cosmetic surgery with removal of parts of the skin.
Bone transplantation is an important resource for patients who need dental implants, prostheses and spine transplants, due to the presence of tumors or trauma.
The waiting list for transplants in Brazil is divided according to the specific agency, as provided by Law No. 9,434 / 1997.
Who should organize the relationship of patients with the queues is the National Transplant System (SNT), which is part of the Ministry of Health.
Although it is a queue, what determines who should be prioritized in the transplant is not just the order of arrival. There are three criteria analyzed: blood compatibility, waiting time and severity of the case .
Therefore, people who are in the queue and have a higher risk of death should be prioritized in the transplant.
Likewise, if the first patient in the queue has a different blood type than the donor, he will not receive the transplant, “passing the turn” to the next patient who best fits the criteria.
There are also more specific cases, where the queue is organized according to a score, as in the case of kidney and liver transplants.
In the case of liver transplants, for example, the priority of the queue also takes into account a mathematical index called Model for End-Stage Liver Disease – translation for Model for End-stage Liver Disease (Meld).
This index is based on the patient’s laboratory exams, applying the test values in a mathematical formula. According to the result, there is also a corresponding percentage, which indicates the patient’s risk of mortality.
The higher the Meld result, the more advanced the patient is positioned in the queue for liver transplantation.
In the case of kidney transplants, tests are done through the donor organ. Thus, doctors are able to check the percentage of compatibility of the organ with the patients in the waiting list.
The most compatible patients earn points and become better positioned in the waiting list. The other criteria are also considered in these cases. This update of the waiting list, in the case of kidney transplantation, is always updated when there is a new donation.
About the queue, it is also important to know how the distribution happens. Even though the organ donation queue and the transplant system are nationwide, the distributions are made by regions.
Normally, the donor organ is destined for patients in the waiting list in the same state, for reasons of transport logistics and due to the time between the removal of the donor organ until the moment of the transplant (ischemia time).
The number of people on the waiting list can be consulted, according to the region and the expected body, on the website of the Ministry of Health .
How is Brazil waiting in line?
Brazil has a very consolidated organ donation system, with the public transplant program being one of the largest in the world. However, as much as there is an increase in the number of donors, there is still much to improve and waiting lines to be zeroed or reduced.
According to data collected by the Government of Brazil, the country broke its record in 2017 in the number of transplants performed, being the best donation statistics in 20 years.
In 2016, for example, it is estimated that about 25 thousand transplants were performed, while in 2017 there were approximately 26.2 thousand.
However, despite this increase, the queues are still long.
Data released by the Ministry of Health, in August 2018, show that there is still a queue of more than 33 thousand people, with the sum of patients waiting for an organ equal to 24,664 and for cornea 9,051. The kidney, the organ with the highest number of active patients awaiting, represents 22,446 of the patients.
Ischemia is the lack or decreased blood supply to an organ or tissue. The ischemia time, in the case of transplants, determines the necessary period between the removal of the donor organ until the moment of the transplant .
This time is different for each organ and it is important for the removal and transport to be done in the appropriate period, preserving the donor’s organ so that the transplant is viable.
The estimated deadlines, according to each body, are as follows:
- Heart: must be removed before cardiac arrest. The maximum extracorporeal preservation time is 4 to 6 hours;
- Lungs: must be removed before cardiac arrest. The maximum extracorporeal preservation time is 4 to 6 hours;
- Kidneys: up to 30 minutes after cardiac arrest. The maximum extracorporeal preservation time is up to 48 hours;
- Pancreas: must be removed before cardiac arrest. The maximum extracorporeal preservation time is 12 to 24 hours;
- Liver: must be removed before cardiac arrest. The maximum extracorporeal preservation time is 12 to 24 hours;
- Corneas: up to 6 hours after cardiac arrest. The maximum extracorporeal preservation time is 7 days;
- Bones: up to 6 hours after cardiac arrest. The maximum extracorporeal preservation time is up to 5 years.
Regarding the time of ischemia of tissues such as vessels and tendons, for example, what should determine the term is the way they were stored. After the removal of these tissues, they must be sent to the processing banks, which must be responsible for preservation.
There are still many people in the queue waiting for a donation, but fortunately, many lives have already been transformed by the transplant, such as that of Marcia Maluf, who received a heart 22 years ago.
When she was 35, the now retired translator, she discovered that she had edema in her heart, a condition in which swelling caused by excess fluid occurs.
In the first consultation with the cardiologist, he did not return home immediately. For two months, she remained hospitalized and left only after this period, already with a pacemaker.
“I lived from 1988 to 1996 with a pacemaker, I had a normal life and I even got married again” says Marcia. However, despite having lived well with this treatment during that period, at the end of 1995 I felt that it was no longer working.
“He grew so much, filled with water like a party bladder that, instead of air, he had water. He didn’t hit anymore, he was heavy. I lived with an implanted pacemaker that would no longer be useful in an hour ”, he recalls.
With the most complicated health condition, in February 1996 he entered the heart transplant queue. At a time when donation campaigns were not so present, Marcia believes she has been privileged. After 12 days in line, he received the transplant.
“I have recorded the most beautiful sensation in this world: that of waking up lying down breathing normally, because until about 6 months before that I only slept sitting on the bed, if I would not stop breathing”.
Today Marcia believes that she is responsible for taking care of 2 lives: her own and that of the donor. She has little information about the donor, not least because the identity should not be announced by the doctor, unless all parties involved are in agreement.
“I know some information, minus the identity that is prohibited. I know he was a 23-year-old athlete who died in an ATM robbery ”.
The donor in question had brain death and was taken to the hospital. As I had left a letter saying that I would like to donate the organs, and with the consent of the family, the donation was possible.
From that, Marcia lives well and happy, thanks to organ donation. He believes that the transplant even had a rejuvenating role in his life, when comparing the photos of himself before and after the surgery.
The procedure was performed by SUS and the drugs for which there was no rejection, which have a high cost, were also made available free of charge.
Even with the difficulties and the most rigorous care in the first year after the transplant, she feels grateful and continues to take care of herself every day as if she had recently undergone surgery. “I’m almost a fanatic for the Beatles (beatlemaniac), I go to shows, I love a ballad and I celebrate life every day”.
In order for more people to have their lives transformed, as well as hers, Marcia believes that campaigns are essential for this, as people do not have access to information about how the donation works.
“The lack of information also begins when the subject is brain death. In addition, there is no religion that prevents donation, just a lack of information and that the campaigns seek to remedy ”, he comments.
Today, at the age of 65, he gives lectures encouraging donation, showing people what the transplant means for patients on the waiting list.
In order to raise awareness among the population and encourage the practice of organ and tissue donation, there are some campaigns that are run in the country. Know more:
National Organ and Tissue Donation Day
Celebrated on September 27 , the National Organ and Tissue Donation Day reinforces the importance of donations and how this gesture can save many lives.
The date is part of a campaign launched by the Ministry of Health.
In addition to raising awareness of society, the date is also used to reach the medical community, so that brain deaths are announced to the Transplant Centers, in accordance with the mandatory law.
Having a day to reinforce the importance of this gesture is important so that the waiting lines are reduced. Clarifying how organ donation works is one of the measures to make this possible, as there is still a great lack of information about the procedures.
In addition, the campaign also aims to remember that in life it is also possible to be a donor, and that just a conversation with family members is able to change the destiny of many patients who wait for a donation.
For family members, the campaign is also important. Respecting the will of your loved one is a way of giving life to others.
September is an important month when it comes to valuing life. In addition to the Yellow September, a campaign that brings a discussion about suicide, there is also the Green September, which encourages organ donation.
Due to the National Organ and Tissue Donation Day, celebrated in September, the whole month is considered a favorable moment to intensify the campaigns and bring even more information on how to be a donor.
This is a campaign created in partnership between the Brazilian Association of Organ Transplants (ABTO), the Ministry of Health and the state health departments.
The objective is to promote actions during this period that make people aware of the importance and need for organ and tissue donation, so that more lives can be saved.
Is there an age limit for being an organ donor?
No . When it comes to organ and tissue donation, what should be taken into account is the patient’s health condition. Therefore, there is no age requirement. No one is too young or too old to be a donor.
What doctors should assess is the donor’s health condition at the time of death and check which tissues or organs can be donated in each specific case.
How is the surgery for the removal of the organs?
The removal of the organs happens through a common surgical procedure, like any other type of surgery. According to Law No. 9,434 / 1987, doctors must follow the same care to reconstitute the donor’s body.
Thus, there is no need to worry about burial, as the donor should not be left with deformities, and can be veiled normally.
Is it necessary to record in a document the desire to be an organ donor?
No . In Brazil, there is no mandatory document or registration that you want to be a donor. What is taken into account is the authorization of the family in relation to the deceased person’s desire, which is why it is so important to inform family members of this will and, mainly, to ask that this desire be respected.
However, although the final decision is family consent, there are some initiatives that register the intention to be a donor.
One of these initiatives is the Donate is Legal project , of the National Council of Justice, in which it is possible to declare the will to be a donor and print a certificate, even if it does not have legal validity.
How does the transport of donated organs take place?
The handling of the transported organ depends on some factors. Transport usually takes place by plane or car. The urgency of transport also depends on organ to organ, as the ischemia time is considered for this, a process in which the organ or tissue undergoes a suspension of blood supply.
In these cases, there is also the Brazilian Air Force (FAB), which must always keep an aircraft at its disposal for the transportation of organs that will be transplanted and which are urgent cases.
Another support happens through the control of air traffic, in which the flights that have the transport of organs must be prioritized.
What factors prevent the number of donors from being greater?
One of the reasons that still limit the number of organ donation is the issue of family authorization by the donor. According to the Ministry of Health, it is estimated that half of the interviewed families disagree with the action and do not allow the removal of organs and tissues.
The numbers of brain deaths registered in 2014, according to the Ministry of Health, were over 36 thousand, for example, higher than the number of patients on the waiting list for organ transplant, estimated at 27 thousand, and cornea, 11 thousand.
How does it work when the donor dies at home and the family wants to donate the organs?
When the donor dies at home, only the corneas can be removed for donation, as other tissues, such as skin and bones, require a favorable hospital environment.
Even so, corneal donation is only possible when performed within six hours after the circulatory arrest.
For this reason, the notification of death to the State Transplant Center needs to be made immediately. This communication can be made through the telephone numbers available on the website of the Brazilian Association for Organ Transplantation (ABTO) .
Thus, they will be able to communicate the Bank of Ocular Tissues, activating the professionals so that the procedure of the removal of the cornea can be done.
When the cause of death is not natural, the body must go to the IML, for necropsy.
Other tissues, such as bones and skins, cannot be donated due to the need for removal in a hospital environment.
Can the donor choose the recipient?
When it comes to the donation in life, yes, as long as the restrictions for this type of donation are in accordance with the law.
In donation after death, this choice is not possible . Neither the donor nor the family can choose who the organ or tissue should be destined for, as this is a decision made according to the criteria of the single waiting list, a decision belonging to the Central of Notification, Collection and Distribution of Organs and Tissues (CNCDO) of the place where the donor died.
Therefore, for ethical reasons, information about the identity of the donor and recipient is preserved.
Among the reasons for secrecy, there is the possibility of the transplant not being successful, in the sense that some organ needs to be discarded due to the possibility of causing a risk to the patient, for example.
Is there a cost to the donor’s family or the recipient?
No. The donation of organs or tissues, when carried out by the Unified Health System, has no value for the donor’s family or for the donor, just as it is for the recipient.
In addition, the donor’s family should also not receive any payment for the donation, a gesture that must always be carried out out of solidarity and good for others, without presenting financial involvement, as well as distinction between race, sex or creed.
Do health plans cover transplant surgery?
It depends . There are coverage contracts that guarantee coverage and others that do not. In contracts made up to 1998, for example, there was no obligation on the part of health plans to cover transplants.
However, due to the considerations of the Brazilian Institute for Consumer Protection (Idec), which judge these contracts as an illegal practice, there are also judicial decisions that help the patient in these situations.
In 1999, contracts began to include coverage for kidney, cornea and bone marrow transplants, in addition to providing hospital assistance, with follow-up after surgery and medications during hospitalization.
In relation to transplants of other organs and tissues, there is no mandatory coverage, according to the resolutions of the National Supplementary Health Agency (ANS).
However, even when there is no health insurance coverage, surgery can be done by the Unified Health System, free of charge.
It is worth remembering that the queue is unique , therefore, it is the same used in SUS.
How is a possible donor identified in hospitals?
The identification of a possible donor takes place based on the work of the State Central Notification, Procurement and Distribution of Organs (CNCDOs), responsible for enrolling and classifying patients in the waiting list.
The Centrals also respond to brain death notifications sent by hospitals, taking care of the forwarding and transport of tissues and organs.
This referral is made according to the established priority criteria, such as clinical risk, time in line and blood compatibility.
When there is no forwarding of the donated organ or tissue into the state, they must notify the Central Nacional, so that a redirection can be made to other states.
Organ donation is a gesture in favor of life and the National Organ and Tissue Donation Campaign aims to remind, encourage and alert people about the importance of this action, in life or after death.
Whoever has this desire must remember how essential it is to inform family members about this desire, just as family members must welcome and respect this initiative of good.
If you are a donor or have already received a donation, feel free to tell us your story in our comments. Thanks for reading!