Organ & Tissue Donation and Transplantation

1. Organ & Tissue Donation and Transplantation

2. Transplantation Transplantation has a long history of fascinating the public – as is evident in fiction (Mary Shelley’s Frankenstein, 1816) and various tabloid reports. Transplantation in fact has a long, successful history and is an accepted treatment for end-stage organ failure. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

3. History of Transplantation The1st recorded transplants occurred in the 17th century. The 1st successful organ transplant, a kidney, was performed by a team led by Dr. Joseph Murray on December 23, 1954 between identical twin brothers in Boston. Dr. Murray went on to receive the Nobel Prize in Medicine for this accomplishment. • 1682 - bone • 1881 - skin • 1906 - corneal • 1908 - knee joint • 1954 - kidney transplant • 1966 - pancreas transplant • 1967 - liver transplant • 1967 - heart transplant Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

4. Perhaps the most well known of all transplant firsts, Dr. Christian Bernard became a household name when in 1967 he performed the world’s 1st successful heart transplant in Capetown, South Africa. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

5. Unfortunately, early results were not as successful as initially hoped as was pointed out a mere four years later on yet another LIFE cover.

6. revolutionized transplantation • increased survival rates • 1st in a new generation of anti-rejection drugs Introduced in 1978, the drug cyclosporine revolutionized transplantation by depressing T cell activation and reducing organ rejection. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

7. Further Successful Firsts in Transplantation • 1981 - heart-lung transplant • 1986 - lung transplant • 1988 - liver/bowel transplant • 1988 - split liver transplant • 1989 - living related liver transplant • 1995 - cluster (liver,bowel,stomach,pancreas & kidney) transplant Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

8. Survival after Transplant • varies greatly among organ groups • depends on the patient’s condition before transplant • depends on the presence of other illness Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

9. Now 22 years post liver transplant, London ON success story Heather Fisher climbed Mount Kilimanjaro after her surgery. Transplanted with a liver, bowel, stomach and pancreas at age 5.5 months, Sarah has a spot in the Guiness Book of World Records as the youngest multi-organ recipient. Snowboarder, Chris Klug, won a bronze medal at the 2002 Olympics, two years after his liver transplant. Transplant Successes Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

10. Transplantation is offered to patients who: are in end-stage organ failure have no other surgical or medical option available to them have a limited life expectancy without a transplant have undergone a rigorous and thorough assessment process and meet all necessary criteria Who Needs a Transplant? Baby Jane was listed for a liver transplant when no other life-saving options were available. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

11. Canadian Transplant Numbers(1994 – 2003) statistics provided by the Canadian Institute for Health Information Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

12. Canadian Donor Numbers(1999 - 2003) statistics provided by the Canadian Institute for Health Information Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

13. Donation two types of donors: deceased (dead) donors • donor has been declared dead by two physicians independent of the transplant team • usually occurs only in cases of neurologically determined death (the brain stops working 1st but the donor is still on artificial support such as a ventilator to allow the other organs to maintain a blood supply and remain suitable for transplant) live donors • patient chooses to donate one or part of an organ to someone on a transplant waiting list • can only occur with organs when removal will NOT cause grave harm to the donor Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

14. Deceased Donation neurologically determined death • usual case • also referred to as brain death • intact heartbeat & circulation • on ventilator • less than 3% of all deaths One the reasons that there are so few organ donors in Canada is that very few people die under circumstances that allow them to donate their organs. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

15. Deceased Donation donation after cardiac death • currently being explored in Canada • common in countries such as Spain and the Netherlands • occurs in hopeless cases in the hospital where the decision to withdraw life-support is made (decision is independent of the decision to donate) • organ donation occurs immediately once the heart has stopped and the patient is declared dead Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

16. Tissue Donation • tissues include eyes, heart valves, bone, tendons and skin • tissues do NOT need oxygen to remain suitable for transplant – do NOT need to have an active blood supply • can occur following death regardless of whether death was determined by neurological (brain death) or cardiac (heart stops) assessment • almost everyone can be considered for tissue donation after death Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

17. The Most Common Causes of Death Leading to Organ Donation The most common cause of death in adult organ donors is an infarction or bleed to the brain; in those less than 18 years old, the most common cause of death is trauma. • cerebral bleed • cerebral infarction • primary brain tumour • trauma (i.e. motor vehicle accidents or a severe fall) • anoxia, hypoxia (a condition in which blood flow to the brain has been stopped leading to no or poor oxygen supply to the brain) Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

18. Who can donate? Can … • an 85 year old … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

19. YES! the oldest organ donor on record was a 92-year old woman whose liver was successfully transplanted by surgeons in London, ON the age of the organ donor does not dictate who gets the organ – as long as the organ is healthy, it is offered to the patient next on the list eye donation can occur in individuals up to 100 years of age Can an 85 year old person still be a donor? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

20. Who can donate? Can … • an 85 year old … • someone with diabetes … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

21. Can someone with diabetes still be a donor? • YES! • diabetes is not a barrier to donation although it may limit which organs can be donated • each organ is assessed separately and its suitability for donation determined • with diabetes, the kidneys and heart often are not suitable but this is not always the case Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

22. Who can donate? Can … • an 85 year old … • someone with diabetes … • someone who wears glasses … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

23. Can someone who wears glasses still be a donor? • YES! • not only can you donate your organs, you can still donate your eyes as well – wearing glasses does not mean your eyes are unsuitable for transplant! Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

24. Who can donate? Can … • an 85 year old … • someone with diabetes … • someone who wears glasses … • someone who has had cancer … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

25. Can someone who has had cancer still be a donor? • YES and NO • a benign, non-transmissible cancer is not considered a contra-indication to donation • a malignant cancer with the possibility of transmission to recipients is a contra-indication to donation Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

26. Who can donate? Can … • an 85 year old … • someone with diabetes … • someone who wears glasses … • someone who has had cancer … • someone with HIV … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

27. Can someone with HIV still be a donor? • NO! • when there is any risk of transmitting a fatal disease from a donor to transplanted recipients, the organs are NEVER used Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

28. Who can donate? Can … • an 85 year old … • someone with diabetes … • someone who wears glasses … • someone who has had cancer … • someone with HIV … • someone with hepatitis C … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

29. YES (conditional)! because hepatitis C can be transmitted from donor to recipient, organs have not been used in the past and still are only used in certain circumstances because there are many patients on the transplant waiting list who already have hepatitis C, many transplant teams will now accept organs from donors with hepatitis C and transplant them into a recipient who already has hepatitis C – the organ must still undergo a variety of tests to determine its suitability hepatitis C is a contra-indication to tissue donation Can someone with hepatitis C still be a donor? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

30. Who can donate? Can … • an 85 year old … • someone with diabetes … • someone who wears glasses … • someone who has had cancer … • someone with HIV … • someone with hepatitis C … • someone who died under suspicious circumstances … … donate their organs or tissues? Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

31. Can someone who died under suspicious circumstances still be a donor? • YES! • if the cause of death is known • coroner’s consent is required and may be restricted to certain organs and tissues and may involve a time limit Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

32. Who can donate? • everyone who supports organ and tissue donation and transplantation is encouraged to express their intention to do so • at the time of death and following consent to donate, transplant teams will determine the suitability of the organs and tissues for transplant Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

33. varies between provinces most provinces – donor card BC – registry Ontario – health card in all provinces, physicians will talk to your next-of-kin at the time of death talk to your family and let them know your wishes How Do I Express My Intent to Donate? The green ribbon is an international symbol of organ and tissue donation. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

34. Frequently Asked Questions • If donation occurs, is an open casket funeral still possible? • Yes – the only way people will know that donation occurs is if the family chooses to tell them. • Are any religions against donation? • All of the major religions in Canada support donation. • If I have a signed donor card, will doctors bother to try to save my life after an accident? • Definitely! – every effort will be made to first save your life – your well-being is the priority. • Is it true that the wealthy and influential get preferential treatment on transplant waiting lists? • Definitely NOT! – in Canada, all patients are treated equally while on the waiting list. • What if I’m not really dead when donation occurs? • Death is absolute and certain whether or not you become a donor. Donation can only occur if two physicians independent of the transplant team declare you dead. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

35. Who Gets the Transplant? blood type identical compatible status of recipient sickest in hospital stable at home longest waiting 1st on the waiting list last on the waiting list size Baby Jane, two weeks after receiving her liver transplant. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

36. Live Donation • due to more people on the waiting list and a severe shortage of organs for transplant – more emphasis is being put on living donation • kidney – most common • living liver donation on the rise • living lung donation – not as common Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

37. Live Donation Baby Jared, two weeks after receiving part of his mother’s liver – mother and son both continue to do well. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

38. usually occurs between related individuals (blood or emotionally) NEVER involves payment to the donor Benefits: can allow for pre-emptive transplant (before recipient requires dialysis) allows for a planned transplant procedure has improved graft survival shortens time on the waiting list for the recipient increases the total number of organs available for transplant Live Donation Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

39. Live Donation(benefits to the donor) • a complete physical assessment –identification of a possible illness • the joy and satisfaction of helping a friend or family member – of saving a life A brother and sister pair who shared the gift of life – a kidney – both continue to do very well four years later. Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

40. any patient undergoing surgery faces risks – the dilemma with living donation is that a healthy patient is undergoing surgery with no direct health benefit to themselves every attempt is made to minimize risks to the donor informed consent is required Live Donation(risks to the donor) Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

41. Conclusion Transplantation offers a second chance at life to thousands of Canadians. It has been proven over and over again to be very successful. However, transplantation can only occur if someone consents to the ultimate gift – organ and tissue donation. Ernie – heart transplant Rafe – liver transplant Susan – heart & lung transplant Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

42. the end … or the beginning for someone on a transplant waiting list consider organ and tissue donation