Organ Donation – Not As Gruesome As We Feared!

“Where do we go after we die?” is an age-old question that plagues everyone, regardless of religious standing. Perhaps a less common question however, is the literal definition of this conundrum. What happens to our physical body after passing is hardly pleasant fodder for conversation, but is scarcely less important considering that a single person’s passing creates the opportunity help up to 10 people. Organ and tissue transplant technology has made remarkable progress in the last decade, but unfortunately thousands of Australians are denied its benefits for want of a donor.

The process of becoming a donor in Australia however, is somewhat more involved than in other countries. In the United States for example, opting to be a donor is as simple as ticking a box on your license. According to the Organ and Tissue Authority, approximately 1,500 Australians are on a waiting list at any given time, and while this may seem considerably low on the general population scale, no one wants to be caught on the wrong side of that number. Often the most unappealing aspect of difficult topics is the element of the unknown, but in this situation the unknown need not remain that way.

The Organ and Tissue Authority website presents many helpful facts in a clear and concise manner, but ultimately fails to answer those slightly awkward, slightly morbid questions that arise from contemplating donation. Exactly what happens after the medical staff are given the go-ahead to harvest organs and tissue from a recently deceased person? How does one person’s donation really affect another person’s life? Why is the word “harvest” used to describe organ and tissue retrieval? Is the donor treated like a gizzard-filled crop to be gutted and then discarded once their purpose has expired? It’s a macabre topic, and it breeds macabre questions that need to be answered before it is too late and a family is left with the decision of either permitting their loved one’s innards to be shipped off or condemning waiting list patients to a longer wait.

Thankfully, there are people like 26-year-old nurse, Rachel Driemel, to answer some of these questions for us. As a clinical nurse in the Rockhampton Base Hospital intensive care unit (ICU), Rachel has experienced the medical side of seeking and preparing organ donors first hand.

“The ICU is where most organ donors will end up before the decision to donate occurs,” Rachel explained.

“The process of being deemed fit for donor status is very thorough, with multiple criteria to be met before an organ donor coordinator is called in to apply to the donor’s family for final permission.

“If the patient fits this process it is then alerted to the organ donor coordinator to see whether they are an appropriate donor,

“If it is decided they are, the family are approached by our organ donor coordinator and the doctor and nurse looking after them,” Rachel said.

Before you commence panicking over the possibility of being prematurely pronounced brain-dead and consequently chopped up and shipped off, you need to understand the process of being deemed a suitable candidate for donation. Firstly, a patient must be under the age of 80. Check? A patient must also be intubated and ventilated – meaning sufficient life support measures have to be in place to ensure the health and continued functionality of organs and tissue (for example, respiratory aid must be in place to ensure the body remains oxygenated). Check? Finally, to become eligible for donation, a patient must score lower than five on the Glasgow Coma Scale (GCS). The GCS is the most commonly used method of assessing consciousness after potential brain damage. Patients score between three and fifteen, with three categories of functions assessed: eye opening, verbal response and motor response. A mild brain injury patient will score a GCS 13-15, moderate brain injury GCS 9-12, and severe brain injury GCS 3-8, with three being the lowest possible score. Therefore, to have a GCS of below five and be eligible for donation, a patient must have essentially no response to any outward stimuli. Even a response as seemingly small as eyes opening in response to a voice, with no motor or verbal response automatically raises the GCS score to at least five, and therefore excludes a patient from donor status.

“Two consultants will then do separate brain death testing and once the second testing is concluded is when the patient is declared dead,” Rachel explained. Meaning, after being declared fit to donate and having family consent to do so, a patient must also undergo testing by two separate consultants before the process of retrieving organs and tissue commences. So fear not, there will be no unnecessary death in the search for acceptable donors – a fact that can ease the minds of family members and potential donors alike!

Ok, so we’ve established that earning donor status is legitimately thorough, but what about the questions concerning who is receiving our beloved innards? Again, this need not be left to the perils of our imagination. Angela Diamond, a 28-year-old administration officer in Rockhampton received a successful kidney transplant in 2011 at the age of 25.

“Both my kidneys were at three per cent functioning and weren’t clearing the toxins out of my body,” Angela explained.

“This led me to start dialysis and once you are doing dialysis you get put on the transplant waiting list.”

Dialysis is a process of filtering blood through a special membrane to remove waste products and excess fluid – the functions a healthy kidney normally handles. Creatinine is waste made by the breakdown of muscles and is usually filtered out by the kidneys and discarded through the urine. When the kidneys are not functioning correctly, the creatinine remains in the blood and the measured level is elevated.

“I was very lucky with my donated kidney as within the first week my creatinine level had dropped back to under 90 where it should be,” Angela recalled.

“Before I had my transplant my creatinine was up around 850. There were people who had transplants at the same time as me who were still waiting for their creatinine to drop down under 300 at the end of the eight weeks. So it made me realise just how well-matched I was with my donor, and I have not had any complications since my transplant.”

Although Angela’s transplant story is a positive recollection, the preluding circumstances were quite frightening. When we envision people who require organ or tissue donation, we imagine hospital patients who have been ill for extended periods of time; people with heart disease who have been hospitalised for years; recovered alcoholics who’s livers betray their progress; miners who have finally succumbed to the side effects of inhaling coal dust for 20 years. We do not picture a healthy 25- year-old with no history of renal problems and no noticeable symptoms to indicate that her kidneys were in the final stages of failing.

“It was a very big shock to us all, as I had no symptoms that I was aware of when I found out that I was at end stage renal failure,” Angela recollects. “It was quite an emotional and scary time for us all.

“I was on the wait list for eight months, I was very lucky!”

Lucky? Eight months of dialysis, constant blood tests, and the pressure to be healthy and avoid having any wounds or else risk missing out on a possible donation is lucky?

To put it mildly, yes. Some patients are forced to wait years for a suitable match to be found – years of dialysis, years of heart monitors, years of respiratory ventilation, years of hospital stays, years of never being able to live too far from a hospital. This is why the topic of organ and tissue donation – unpleasant as it may seem – is so vital to address.

We have now determined procuring organs and tissue from a donor is not quite the brutal task we imagined, and we have determined that successful organ donation is a life- changing gift for the recipient. So how does one go about registering as an organ donor in Australia?

Being the generation Y child that I am, I took the most logical first step I could think of and Googled it. The Organ and Tissue Authority website was the first result. Excellent – nothing I couldn’t handle thus far. Navigating the website itself was somewhat more challenging for the attention-deficit part of my brain, but eventually I spotted the three main categories covering facts, registration and informing family members. After perusing the facts – all of which seemed very positive and upbeat – I progressed to step two – registering my wish to be a donor. The actual registration form is very straightforward, similar to any medical form filled out in most medical practices. A pleasing addition to the form however, is the choice of what organs and tissue you wish to donate. Step three was significantly less hassle-free. In Australia, the final decision regarding donation is ultimately left to the deceased’s family, so discussing your wishes regarding donation is obviously a necessity. As I live in a separate state to my family, this meant some delightful phone calls were in order.

Call number one was to dear old Dad. Very straightforward, we soon established that we both believe donation should be mandatory if a person is eligible when they pass. All was going well until I directed the conversation onto a personal course, which inevitably caused a little emotional distress for both of us – for Dad because no parent wants to contemplate the demise of their offspring, and for me because no child wants to contemplate pain in any form for their parents. However, my logical side prevailed enough to salvage the situation with a simple statement of preferring to discuss this topic when everyone is healthy, young and well rather than when someone is ill or very old. In hindsight, I possibly should have avoided humourously stating that upon my death my organs and tissue are to be donated and my body given to a university – sparing a few fingers for my family to bury.

Call number two was to my mother, who is decidedly less logical and willing to discuss such matters seriously. When I asked if she would permit my organs to be donated and my body to be donated to medical research, she responded with a slightly crazed answer along the lines of ‘no, I will hide you in my freezer so I can still cuddle you whenever I want’, followed by rather hysterical laughter. You can probably deduce from which side of the family my humour originates.

Call number three, to my oldest sister, was very casual and unemotional – an excellent way to conclude my mission of becoming a donor. So while these were some uncomfortable conversations to be had, overall I found awkwardness and emotional distress could be avoided or quelled simply by offering up the facts I have uncovered through researching the process of organ donation. I can now sleep at ease, knowing if something unpleasant befalls me in the future, my demise will ultimately be the saving grace of up to 10 other individuals, and my family will be fully supportive throughout the process.

Time is not an issue when registering – are you standing in line at Woolworths? Are you sitting at the hairdresser? Are you waiting for some photos to upload onto Facebook? The process of registering takes less than fifteen minutes, including the time spent perusing the facts presented on the issue. Fifteen minutes of online time, and a few calls to family members who you are probably due to call anyway will not change your life in any drastic way, but has the potential to do just that for someone in need and their surrounding loved ones.