What Happens To Your Body When You’re An Organ Donor?

August 28, 2020

With organ donation, the death of one person can lead to the survival of many others. But when a donor dies, how do doctors save their organs for transplant?

In order to be an organ donor, “you have to be in the hospital, on a ventilator and have some type of devastating neurological injury,” said Heather Mekesa, chief operating officer of Lifebanc, an organ procurement organization in northeast Ohio.

There are two ways this can happen: brain death and heart death. Cardiac death occurs when a patient’s brain is so damaged that they never fully recover. This damage can occur in different parts of the brain. They may have a small amount of brain function, but doctors believe they will never recover. The donor can only be kept alive on a ventilator, and their family may choose to remove them from the ventilator. When the person’s heart stops beating, they will be considered legally dead.

According to a 2020 study in the journal BMJ Open, most donated organs come from cases of brain death, where the donor has no brain function. Such patients have irreversible loss of function in all areas of the brain, including the brain stem. When a person is in a coma, has no brainstem reflexes, and fails an apnea test, doctors diagnose “brain death,” which serves to show whether all brainstem function has been lost. A brain dead person is legally dead, even if they are still breathing on a ventilator. It is up to the doctors, not the organ transplant team, to decide.

When a donor’s body is kept alive by life support, the organ procurement team tests to see if their organs are safe for transplant. If the donor has cancer or an infection (such as COVID-19), their organs may not be usable, but not all diseases prevent the organs from being used. For example, an HIV-positive donor can donate to an HIV-positive recipient.” They often transplant organs that are positive for hepatitis A, B and C,” adds Mekesa.

Routine blood tests can reveal the health of organs such as the liver and kidneys. The organ procurement team sometimes checks to see if a donor’s heart is damaged or blocked by inserting a thin tube into an artery or vein and threading it through its vessels to the heart. The team may also use chest X-rays to assess the size of the lungs and signs of infection or disease. They may do further tests by inserting a thin tube into the lung to further assess the infection and determine if antibiotics are needed. According to the 2020 study, the brain will never be transplanted, but in the case of brain death, all other organs can be donated; in the case of heart death, the heart is likely to be damaged and cannot be donated, according to the 2020 study.

After testing the organ, the organ procurement team will find and identify a matching recipient from the national transplant waiting list. The recipient’s surgeon will set up a meeting time and fly to the donor. Depending on the number of donated organs, “you might organize three or four state surgeons,” Mekesa told Live Science.

In cases of brain death, doctors begin to recover the organs by clamping down on the circulatory system to stop the ventilator from pumping blood around the body.In cases of heart death, Mekesa said, they remove the ventilator and wait until the heart stops beating, which can take about half an hour to two hours, then an additional five minutes to ensure the donor’s heart doesn’t spontaneously restart. If the heart stops beating too long and other organs begin to die, the surgeon may decide not to restore the organs. For both types of organ donors, the surgeon drains the blood from the donor organ, refills it with cold preservation fluid, and then removes the organ.

Surgeons fly the organ back to the recipient and begin the transplant. They must act quickly, and according to the Health Resources and Services Administration (HRSA), the heart and lungs last four to six hours outside the body, the pancreas 12 to 24 hours, the liver 24 hours, and the kidneys 48 to 72 hours. Meanwhile, the donor’s body, after the organs are removed, is prepared for a funeral or other memorial service.

Organ donation saves lives, but it’s not enough. According to the HRSA, 20 people die every day in the United States waiting for a transplant. While 90 percent of adults nationwide support organ donation, only 60 percent are registered to donate. Even those who are registered may experience problems donating if they don’t make their wishes clear to their families.” When we meet with families, the biggest challenge we face is when they say, ‘I don’t know what they want to do.’ We’ve never had that conversation before,'” says Mekesa.