WHAT IS ORGAN DONATION ?
There are two main types of organ donation:
Living Donation: a living person makes a decision to donate an organ to someone else, usually a relative or spouse. Occasionally, this is done altruistically where the donor does not have knowledge of the recipient. As we do not want to damage the health of the donor, the only organs that can be donated in this way are kidneys, or rarely part of a liver. At JODA we are focusing our efforts on deceased donation.
Deceased Donation: a person donates their organs after they have died. In the UK, this can occur after brain death is diagnosed, or after cardiac death is confirmed. Following death, almost all vital organs can be donated: heart, lungs, liver, pancreas, kidneys and small bowel, and also parts of the eye, bones and skin. A single donation can result in life-saving transplants for up to 8 people.
FIRST DUTY IS TO SAVE LIFE
The first duty of doctors is to save a patient’s life. All efforts are made to do this, and donation is only considered when it is clear to the doctors looking after a patient that death is inevitable. Any decisions about futility of on-going treatment, or withdrawal of life sustaining treatment, are entirely independent of decisions relating to potential for organ donation.
HOW IS DEATH DIAGNOSED?
When it comes to deceased donation, there is an inviolable rule that is followed at all times: known as ‘the dead donor’ rule: it states that donation can only take place once the patient is confirmed to be dead. Donation cannot cause, or even hasten the patient’s death. It is therefore important for us to consider how death is diagnosed.
Death can be diagnosed in one of two ways: either that the heart has stopped (death on circulatory criteria) or that the brain has stopped working (death on neurological criteria, or brainstem death). In both circumstances, strict criteria are followed and those diagnosing death are entirely separate and independent of organ transplant teams.
For death diagnosed on circulatory criteria, a doctor examines the patient and establishes that the heart is not beating. After 5 minutes of no heartbeat, death can be confirmed. For brainstem death, doctors examine the patient and establish that brain reflexes are absent, and that the patient is not breathing. These two methods of diagnosing death are equally accurate, valid and are the ways that death is diagnosed across the world.
HOW DOES DONATION HAPPEN?
It is worth noting that donation is actually very rare. Only 1% of people die in circumstances where donation would even be a possibility: almost always they are on Intensive Care, on a ventilator and are critically ill.
Before donation can even be considered, a series of steps must occur. Firstly, the medical team looking after the patient make the decision that on-going treatment is futile, there is no hope of recovery and death is inevitable. This decision is independent of any potential for organ donation.
Once the futility of on-going treatment has been established, a Specialist Nurse for Organ Donation will check the organ donor register and contact the patient’s family to establish what the patient’s wishes were regarding organ donation. No donation progresses past this point without the agreement of the patient’s family, friends or any other significant person that would have been important to the patient. This includes faith leaders (and indeed there is now a specific faith declaration that people can tick on the organ donor register).
Donation itself occurs once the patient has passed away, and is an operation performed by highly specialised surgical teams. The donor’s body is always treated with the utmost respect and is returned to the family for burial in the usual way.
There are many trusted resources available to help you further your knowledge regarding organ donation.
Suggested resources include:
Please note that JODA UK cannot comment on Jewish law (Halacha). Should you require more insight into religious matters, we recommend speaking to your respected faith leader.