During an organ transplant, physicians use the healthy organs and tissues from one individual and transplant them into another. In 2018, there were 36,527 organ transplants in the U.S., which set a record for the sixth straight year in a row.1 The total number has exceeded 750,000 since 1988, when the first transplant data were collected.
Organ donation can be done in one of two ways. The first occurs when the donor is living and chooses to give an organ or tissue to another individual. Living donors can offer a kidney or part of a liver or lung.2
The second type happens when the organ donor has died and left instructions for donation. More than 155 million people are registered as organ donors, yet only three out of 1,000 will qualify after they die. There are several different organs and tissues that can be transplanted from a deceased person, including:3,4
Heart and heart valves
Bone or bone marrow
As of March 2020, there were 112,000 men, women and children on the waiting list. According to the Health Resources and services Administration,5 20 people die every day waiting for an organ transplant, while another person is added to the list every 10 minutes.
Advances in technology and medicine have made it possible to successfully transplant more organs and tissue than ever before. Yet, each year the number of people waiting for a transplant grows faster than the number of people willing to donate, whether living or deceased. One individual who dies can donate up to eight lifesaving organs and impact the lives of many others.
Organ Donation and Transplant Numbers Down
When the shelter-in-place orders went into effect across the country, many states saw a decline in traffic accidents and fatalities. An April report from the University of California Davis6 noted that the number in California had been reduced by half in the first three weeks.
By comparison, in Minnesota, the number of fatalities from January to April in 2019 and 2020 were actually close.7 Preliminary data showed there were 81 people killed in car crashes in 2020 as compared to 78 the previous year during the same time of year.
Deaths from accidents account for nearly 33% of all organ donations,8 which were down 23% nationwide from March 8 to April 11. Spring break, outdoor activities and travel often signal a greater number of accidents. April is usually when organ donations surge. However, the United Network for Organ Sharing (UNOS) has found that numbers were consistently lower across the board during the pandemic.
Janice Whaley, CEO of Donor Network West, told a reporter from Kaiser Health News, “Spring break accidents are almost nonexistent because there’s no spring break — beach accidents, motorcycle accidents, hunting accidents.”9
Another factor limiting the number of available donor organs is a decline in emergency room visits. George Rutherford, infectious disease specialist at the University of California San Francisco, remarked:10
“Where are all the people with heart attacks? Where are all the people with strokes? Are those patients staying away from the ERs for fear of COVID? Clearly, the census is way down in ERs.”
Transplant Teams Balancing Risk Against Need
Individuals who die from a stroke or a heart attack are the second and third largest sources of organ donation. When individuals die at home, the organs can’t be used for transplant since they are not kept viable after death.
For an organ to be usable, a person must die or be declared brain-dead while they’re on a ventilator, which keeps the heart, lungs, liver and kidneys viable. Although transplants are considered essential, teams have been making decisions as each case is presented.
The criteria for surgery are based on the recipient’s risk of death without receiving a transplant and the hospital’s current census, staffing and number of ventilators available.11
With the uncertainty of how many ventilators the hospital may need for patients with COVID-19, clinicians have been reluctant to take on transplants. For the organs to remain viable, the donor must remain on a ventilator until a transplant team can be assembled and recipients identified. The organ recipients also need to be on ventilators during surgery.12
Although many of those who died in the hospital from COVID-19 were willing to donate their organs, they were declined since they could potentially infect the recipient. Living donations have also been canceled at many hospitals because it doubles the risk by bringing in two patients — the donor and the recipient — for the procedure.
Transplant procedures have a complex logistical process. Once a person is declared brain-dead, a medical provider from the organ procurement organization will evaluate them to be sure they’re suitable for donation.13
Authorization must be received from the patient’s family before their information can be added to the national computer database to find a match. Once this is completed, the hospital must organize transportation, transplantation and recovery for the recipients.
Paired Organ Donation Program
Living donors have a second option if they find they’re not a good medical match for the intended recipient. The kidney paired donation pilot project14 is managed by the United Network for Organ Sharing through the Health Resources and Services Administration. This is the program a kidney transplant patient featured in The Wall Street Journal used when his sister found she wasn’t a match for him.15
The program involves multiple institutions, candidates and donors. The sister agreed to donate her kidney to a stranger with whom she was a match, in exchange for the understanding that another individual who is a match for her brother would donate to him. Experts believe nearly 16% of paired kidney transplants occur each year.
The Wall Street Journal16 reported on May 25, 2020 that their featured subjects were still waiting for the transplant teams to agree to do the surgeries, as the procedures were put on hold during the pandemic. In the meantime, the kidney patient is on dialysis 17 hours a day as he waits for the surgery.
How Organ Donation Works
When a person needs to be placed on the organ transplant waiting list, they must have a referral from their physician to be evaluated for the program. A team of people, including a transplant coordinator, social worker and surgeon, work with the patient and family to organize the process.17
The patient undergoes specific tests to gauge medical necessity as well as their social support and psychological readiness.18 This helps determine if the person is a candidate. Once accepted, their medical information is entered into the national database. Patients are encouraged to seek living donors when appropriate.
Kidney transplants are crucial for those with end-stage kidney disease. One factor that can raise the rate of success is ensuring viability of the organ. Researchers from the University of Cincinnati have discovered a gene that may predict the potential risk of a donor having kidney disease later in life.19
The test may help identify individuals whose kidneys may not remain viable for the recipient, and who may need to keep their kidneys long-term. This can assist with expanding the living kidney transplant program because it identifies potential challenges for donors and recipients.
Myths About Organ Donation
There are several myths about organ donation that may have stopped you from considering becoming an organ donor. Many of these have been perpetuated in the movies. It’s important to know the facts to make an informed decision. These are some of the more common questions and concerns:20,21,22
• Will the decision to be an organ donor affect the quality of my medical care? — The quality of care you receive during an illness or after an accident is based on saving your life, not someone else’s. Nonliving organ donation is only allowed after brain death has been diagnosed.
• Will I really be dead before they sign my death certificate? — Although Hollywood has created a market for movies about people who suddenly “wake up” after they’re declared dead, in reality, physicians are required to thoroughly test for brain death. Only those who are truly dead will be evaluated for organ donation.
• I’m too old to donate and I’m not in the best health — There is no age at which you can no longer donate organs. Instead, the decision is based on other criteria. Physicians decide at the time of death whether your tissues and organs are viable.
There are a limited number of conditions that automatically exclude you from donating your organs. A systemic infection, such as COVID-19, may be one of them. However, don’t exclude yourself from donating your organs; instead, let medical professionals determine viability.
• My family will be charged when they take my organs — The recipient’s health insurance policy usually covers the cost of removing the organs and families are not charged for the additional testing to ensure the donation is possible. Donating your organs does not cost your family or estate anything.
• I can’t have an open casket if I donate — Organ donation is not disfiguring, so an open casket is an option. A donor’s body will be closed and cared for by the mortuary and no signs of organ donation will be visible at the funeral.
How to Become an Organ Donor
There are several ways of indicating your interest to become an organ donor. It’s also important that even after registering and adding the information to your driver’s license, that you also share your decision with your family. During times of crisis, it’s important for your family to know and understand your wishes so they can be carried out.23
A donor registry, such as the National Donate Life Registry,24 is one way to indicate your interest.25 Each time you renew your driver’s license, you’re asked if you want to make an anatomical gift or become an organ donor. When you say yes, the indication is added to your license.
You can also pick up a form at the Bureau of Motor Vehicles. It’s important to sign and carry an organ donor card; this can be downloaded from OrganDonor.gov.26 It’s used to communicate your wishes to emergency personnel after an accident or catastrophic event.