Organ Donation

Organ transplantation has evolved from an experimental treatment to the treatment of choice for thousands of Ontarians who await the gift of life. Unfortunately the supply of solid organs for transplantation has not met the demand and has remained relatively unchanged over the past decade. The numbers tell the story:

Organs for Transplantation

There are hundreds of diseases that could affect an organ to the point that a transplant is required. Here is a list of organs that can be donated:

Criteria for Organ Donation

Historically organ donation has only occurred after brain death and only a small percentage of all hospital deaths result from a determination of neurological death (brain death). Some estimates are as small as 1.5-2%.

Unfortunately the supply of solid organs for transplantation has not met the demand and has, despite best efforts, remained relatively unchanged over the past decade.

The two criteria for deceased organ donation are:

• Neurological Determination of Death (NDD)
• Donation after Cardiac Death (DCD)

Neurological Determination of Death

Deceased organ donation can take place when someone has been declared brain dead, a doctor has determined the organs can be used for transplant, and loved ones opt to artificially maintain vital organs by ventilator to keep them suitable for transplant. This type of donation is referred to as donation after neurological determination of death, when a person suffers devastating brain injury, such as may occur following an aneurysm, severe head injury or stroke.

"Neurological death is the final end point of any form of brain injury that results in uncontrollable intracranial hypertension and the arrest of cerebral blood flow. The most common causes of neurological death are traumatic brain injury, cerebrovascular accidents and hypoxic-ischemic injury after cardiac arrest. The time from injury to diagnosis of neurological death varies from hours to many days, depending on the severity of initial injury and the response to therapy."

Donation After Cardiac Death

Another option for donation is organ donation after cardiac death (DCD). DCD offers families the option of donation in cases where neurological criteria for death have not been met, and the decision to withdraw life-sustaining treatment has been made. A DCD patient has no hope of survival or meaningful functional status. Only after prior and independent decision by the patient or family to withdraw life support will the option of organ donation after cardiac death be considered.

In Europe and the United States, DCD has been an option for families for over thirty years. The ongoing shortage of organs for transplantation has created a renewed interest in organ donation after cardiac death in Canada. Improved medications and surgical techniques have resulted in better outcomes for recipients of DCD donated organs. These advances combined with the severe shortage of organs for transplant make organ donation after cardiac death another option for patients and families interested in giving the gift of life.