What is the difference between organ and tissue donation?
Organ donation received a great deal of media attention. There are often reports of the latest advances in the transplantation of hearts, livers, kidneys and lungs. Few people realise, however, that tissue can also be donated. Tissue are classed as, parts of the body that consist of “an aggregation of similarly specialised cells united in the performance of a particular function”. Examples would be bone, skin, heart valves, tendons and the cornea of the eye.
With a solid organ donation, it is vitally important that the organ is removed from the donor and transplanted into the recipient within the shortest possible time, so that the organ does not deteriorate. With tissue donation, however, it is possible to retrieve the tissue and store it over a period of time. This allows the tissues to be screened for possible infectious agents and allows a pool of available tissue to be established.
Organs can be retrieved from a donor that has been declared “brain stem dead” and is supported by a ventilator. In this way the function of the organs is maintained.
Some organs may also be retrieved from non heart beating donors. This is where, 10 minutes after a systole has taken place, and in a controlled manner, certain organs may be retrieved. Studies have shown that they are robust enough to be transplanted after a systole has occurred.
Tissues can be donated after death but must be retrieved within 24 hours.
Which tissue can I donate?
It is possible to donate several tissues following death. The most common are cornea, heart valves, tendons and skin (will be introduced late 2007), all of this tissue is used to greatly improve the quality of life for many people. It is also possible to donate before death. There is an extensive programme in Scotland where people who are to undergo primary hip replacement voluntarily donate the femoral head that is to be removed before the prosthesis is implanted.
How can I ensure that my tissues will be donated after my death?
If you wish to make a donation following your death, it is vitally important that you inform your next of kin of your wishes. Simply carrying a donor card does not guarantee that donation will occur, since it is your next of kin who must provide the information necessary in order for authorisation to be recorded. Carrying a donor card, however, will mean that family and hospital staff are aware of your wishes and this may make the decision easier for them. It will also help if you sign up for the national organ donor register. This provides a database of donors from all over the country. If you become a potential donor, and you do not have a donor card on your person then the register will be checked and your wishes made known. To join the national organ donor register telephone 0300 123 23 23 or log on to Organ Donation Scotland and register on line.
What will happen to the tissues that I have donated once they have been removed?
In Scotland, heart valves, tendons and skin are stored at the tissue bank in Edinburgh. Corneas are sent to the Manchester or Bristol eye banks. All tissues have mandatory testing carried out for viral and bacterial diseases that may be passed on to a tissue recipient. The tissues are placed in quarantine until such times as all results are known and the tissue is then suitable for release to use.
Who will benefit from my donation?
With whole organ donation a single organ is removed and transplanted into the recipient. In tissue donation, a single donated tissue can benefit more than one person.
Heart valve donation | The whole heart is removed and the aortic and pulmonary valves are dissected out. This means that two people can benefit from a single donation. The heart valves are used to repair congenital heart defects in children and young adults and to correct acquired diseases of the heart valves in adults. (i.e. Bacterial endocarditis) |
Tendons | Patellar and achilles tendons are removed, stored frozen and are used to repair damaged ligaments, most commonly the cruciate ligament in the knee. The uses are for traumatic injury to the knee where long-term mobility is in question e.g. young fit adults whose normal daily activities are hampered due to restrictions in movement that can affect job prospects and normal mobility. Patellar tendons can be split in two, so six people can benefit from tendon donation from one donor. |
Corneas | Corneas are used when a patient’s own cornea has become compromised, either through disease or injury that results in the loss of sight in the eye. Diseases such as keratoconus, corneal ulceration, herpes simplex and trauma are a few examples of such illnesses that may require corneal transplantation to restore vision. Corneas are stored in eye banks either in Manchester or Bristol. |
Bone | Bone is retrieved from live donors who electively donate the femoral head that is to be replaced when undergoing primary hip replacement. Surgeons use this to repair any areas of bone where osteogenesis is necessary to form new bone e.g. chips for small joint surgery, spinal and facial surgery or it can be ground down and used with cement for secondary hip revision surgery. |
Skin | Skin is used to save the lives of people that have sustained major burns. |
Who Can Donate?
Each of the different tissues have limitations over who can donate and these are generally to help protect the recipient. Tissue cannot be donated by anyone who does not fall within the criteria set within the nation donor selection guidelines. However each tissue has specific exclusions and acceptance criteria e.g. the upper age limit for heart valve and tendon donation is 60 years, but there is no upper age limit for cornea or bone donation. All of the above tissues are described as being life enhancing not life saving and are therefore subject to the same rigorous guidelines with regard to safety as blood and blood products.
Does retrieval cause the body to be disfigured?
Retrieval of all tissue is carried out in such a way that there is no loss of shape to that part of the body. There is however, a scar that is sutured in the same manner as at any operation. All of this is fully explained to relatives at the time of consent.
Does tissue donation cause delay in arranging a funeral?
Donation takes place in the mortuary within 24 hours of death. This means that donation will not cause delay to last offices and funeral arrangements.
How can I find out more about tissue donation?
The first point of contact should be the regional transplant or tissue donor co-ordinator.
Tissue donor co-ordinator, Agnes Barr – based in SNBTS at Gartnavel General Hospital in Glasgow
– 0141 357 7700 or via the main tissue bank in Edinburgh on 0131 536 5751
