Marios Prikis, M.D., assistant professor of medicine at the Larner College of Medicine and medical director of pancreas and kidney transplant programs at the UVM Medical Center (Photo: LCOM Creative Services)

April is National Donate Life Month! Marios Prikis, M.D., assistant professor of medicine at the Larner College of Medicine at the University of Vermont and medical director of Pancreas and Kidney Transplant Programs at the University of Vermont Medical Center, recently wrote about “Organ Donation: A Modern Act of Heroism” on the UVM Medical Center blog. Below are his comments.

“Live a Legacy of Life. Be an Organ Donor”

Is there anything more heroic than saving a life? Whether, it’s saving a child from drowning or pulling a driver from car wreckage, we are fascinated and profoundly moved by people who perform selfless acts on behalf of others.

When it comes to donating an organ however, many consider this form of selflessness as somehow perverse. Yet, whether the donors are alive offering a kidney or deceased and donating all available organs, are not such acts equally heroic as rescuing a child from a raging river?Is there anything more heroic than saving a life? Whether it’s saving a child from drowning or pulling a driver from car wreckage, we are fascinated and profoundly moved by people who perform selfless acts on behalf of others.

In 2017, more than 120,000 people in the U.S. are waiting for an organ transplant. Unfortunately, many may never get the call saying that a suitable donor organ — and a second chance at life — has been found. On average, 18 people die every day while waiting for organ transplants in the U.S., and every 10 minutes, another name is added to the waiting list.

Organ donation takes healthy organs and tissues from one person for transplantation into another. There are two ways that someone can become an organ donor. Most organ and tissue donations occur after the donor has died (Deceased Donor). But some organs and tissues can be donated while the donor is still alive and well (Living Donor).

Deceased organ donation is the process of giving an organ (or a part of an organ) at the time of the donor’s death, for the purpose of transplantation to another person. People of all ages and medical histories should consider themselves potential donors. Medical condition at the time of death will determine if and what organs and tissue can be donated.

More than 125 million people have registered as organ donors, but only about 3 in 1,000 can actually become donors when they die.

In order for a person to become an organ donor, blood and oxygen must flow through the organs until the time of organ recovery to ensure viability of these organs. This requires that a person die under circumstances that have resulted in a fatal brain injury, usually from massive trauma resulting in bleeding, swelling or lack of oxygen to the brain.

Only after all efforts to save the patient’s life have been exhausted, tests have been performed to confirm the absence of brain or brainstem activity, and brain death has been declared, is donation a possibility. Organs and tissue that can be donated include: heart, kidneys, lungs, pancreas, liver, intestines, corneas, skin, tendons, bone, nerve and heart valves. Organ donation is consistent with the beliefs of most major religions. These religions include Roman Catholicism, Islam, most branches of Judaism and most Protestant faiths.

Registering as an organ donor after death is easy and may be indicated in the following ways:

• Register with the National Donate Life Registry. https://www.donatelife.net/register
• Designate his/her choice on the driver’s license.
• Tell his/her family regarding wish for donation.

Information about an organ donor is only released to the recipient if the family of the donor requests or agrees to it. Otherwise, a patient’s privacy is maintained for both donor families and recipients.

While most organ and tissue donations occur after the donor has died, some organs (including a kidney or part of a liver or lung) can be donated while the donor is alive. There are about as many living donors every year as there are deceased donors.

Living donation is an opportunity to save a life while you are still living. To spare an individual patient a long and uncertain wait, relatives, loved ones, friends, and even individuals who wish to remain anonymous may serve as living donors.

Nearly 6,000 transplants were made possible in 2016 by living donors.

The kidney is the most commonly transplanted organ from a living donor. One entire kidney is removed and transplanted. Living liver donation, where a segment of the donor’s liver is transplanted, occurs less often, and the donor is usually related to the recipient. Also, in rare cases, a segment of organs such as lung, intestine or pancreas can be transplanted from a living donor.

Generally, living donors should be physically fit, in good health, between the ages of 18 and 60. Potential living donors are evaluated by the transplant center where they intend to make the donation to determine whether they are suitable to be a donor. The evaluation is performed to make sure that no adverse physical, psychological, or emotional outcome will occur—before, during, or following the donation. Medical conditions that may prevent a living kidney donation may include uncontrolled high blood pressure, diabetes, cancer, HIV, hepatitis, acute infections, or a psychiatric condition requiring treatment.

There are three different ways that someone can become a living donor.

• In a directed donation, the donor names the specific person to receive the transplant. The donor may be a biological relative (such as a parent, brother, sister, or adult child), a biologically unrelated person who has a personal or social connection with the transplant candidate (such as a spouse or significant other, a friend or a coworker), or a biologically unrelated person who has heard about the transplant candidate’s need.
• In non-directed donation, the donor does not name the specific person to get the transplant. The match is arranged based on medical compatibility with a patient in need. Some non-directed donors choose never to meet their recipient. In other cases, the donor and recipient may meet at some time, if they both agree, and if the transplant center policy permits it.
• Paired kidney exchange involves two pairs of living kidney donors and transplant candidates who do no not have matching blood types. The two candidates “trade” donors so that each candidate receives a kidney from a donor with a compatible blood type.

The decision to be a living donor is a very personal one. The benefit of saving another person by becoming a living donor must be weighed carefully against the risks that come with any major surgical procedure, as well as financial considerations. At present, follow-up reviews of living donors by some transplant centers show that living donors, on average, have done very well over the long term. However, donors must be made aware of the physical and psychological risks involved before they consent to donate an organ. The best source of information about risks and expected donor outcomes is the transplant team. A healthy donor faces the risk of an unnecessary major surgical procedure and recovery. A small percentage of patients have had problems maintaining life, disability, or medical insurance coverage at the same level and rate as previously. There can be financial concerns due to possible delays in returning to work because of unforeseen medical problems and importantly as with any major surgical procedure, there is a small risk of complications and/or death.

On the other hand, the positive aspects of living donation are very important. The gift of an organ can save the life of a transplant candidate. The experience of providing this special gift to a person in need can serve as a very positive aspect of the donation. Some donors have reported positive emotional experiences, including feeling good about trying to improve another person’s life. Transplants can greatly improve recipients’ health and quality of life, allowing them to return to normal activities. They can spend more time with family and friends, do more physical activities, and pursue interests and hobbies they could not enjoy while ill.