[MUSIC] So who can be a donor? Well, it depends on what you want to donate and the circumstances of your death. Pretty much everyone can donate something. There are remarkably few conditions that preclude donation entirely. Corneas, skin, ligaments, and bone can be recovered for some time after death, up to 24 hours for some. And as such, are not dependent on the circumstances of a person's death. Potential organ donors must be receiving intensive medical support, at least mechanical ventilation, at the time of referral for organ donation. Organs have strict time constraints for successful transplantation. The warm ischemic time is especially critical, and this is why less organs are able to be recovered from donors after circulatory death. A brain dead donor can potentially donate heart, lungs, liver, kidneys, pancreas, and small intestine, because of the more controlled circumstances surrounding the death. The number of lives saved by an organ donor is often seen on public awareness posters around the world. The variation as to how many lives can be saved by an organ donor can be confusing. These numbers are different because you could count split lung and split liver as extra lives saved. The bottom line is, there are a large number of people who can have their lives saved by a single deceased organ donor. Even more people can have their lives improved by tissue and cornea donation. Doctors and families often say they didn't consider organ donation because they didn't think the donor would be suitable. Donor suitability should always be discussed with the transplant team before assuming donation is not possible. The boundaries for successful transplant outcomes are continually expanding. It is much better to refer and to discuss organ donation than not to refer at all. The reality is, the donor pool is much larger than everyone thinks. The donor pool has expanded greatly from what was considered to be the ideal young donor. There's a whole new category of donors, termed extended criteria donors, who can successfully donate organs. Age is no longer a limitation, there have been successful transplants from neonates into other neonates and even into adults. At the other extreme, if someone's kidneys got them to age 80 and they're still working fine, there's no reason they couldn't be successfully transplanted. Yes, the chance of finding some condition that precludes transplant is higher in an older donor. But transplant teams are happy to make this assessment in each and every case. Infection is often cited as a reason someone can't be a donor. This is true for certain infections, such as Ebola, disseminated TB, multi-drug resistant infections, and unexplained septic shock. But identified infections responding well to directed treatment, do not preclude transplantation. For example, a patient two dies from meningitis secondary to a sensitive strep pneumonia infection can be considered for organ donation. Even viral diseases such as HIV and hepatitis do not preclude transplantation. Groote Schuur Hospital and University of Cape Town pioneered transplanting HIV-positive kidneys into HIV-positive recipients, showing good results. In 2013, President Barack Obama signed a law that lifted a ban on using organs from HIV-positive donors, due in part to this research. The HIV Organ Policy Equity Act, also known as HOPE, now allows for HIV-positive organs to be transplanted into HIV-positive recipients, helping to expand the potential donor pool. Hepatitis B and C organs can similarly be allocated into already infected recipients. Donors such as prisoners and those with high risk behaviors, such as intravenous drug use, are considered as high infectious risk, even if their screening blood results come back as negative. As they may be in the window period. A patient receiving an organ from such a donor is informed of this additional risk prior to deciding whether to accept the organ offered. Active malignancies are a contraindication for transplantation. The risk is that occult cancer may have spread into the organs that we wish to transplant. The exception is patients who have primary brain tumors. These cancers typically do not cross the blood brain barrier, and are highly unlikely to metastasize or spread to other organs. A donor with a completely cured malignancy, as evidenced by a disease-free survival of more than five years, can also be assessed for potential donation. Co-morbidities such as obesity, diabetes, or hypertension do not preclude transplantation either. What is important is each organ is assessed for the target organ damages associated with these conditions. They may well be transplantable. Hearts from older donors or donors with risk factors can be assessed pre-donation with coronary angiography and echocardiography. Organ dysfunction can limit the ability of an organ to tolerate warm and cold ischemia, and if severe enough can also preclude transplantation. However, the amount of dysfunction that can be safely tolerated is increasing, as more and more centres are publishing good transplant outcomes from these so-called marginal organs. Creatinines of up to three to four times normal can recover in their recipient and give normal kidney function for many years, if the deterioration was acute. Liver biopsies can be taken during procurement to show the degree of hepatic damage caused by hypertension. In certain situations, there may be a recipient in such desperate need of an organ that a more risky transplant is justifiable. For example, a patient with acute fulminant liver failure with only hours to days left to live may be willing to accept a more badly damaged organ. The transplant teams are only able to make these decisions with the patients if potential donors are referred. To recap, the donor pool is larger than most people think. It is almost always possible for someone to donate something at the end of life. Disseminated cancer and untreated or unidentified infections do preclude organ donation. But individual assessment of organs from extended criteria of donors allows more organs to be donated and more patients to benefit from transplantation.
