[Questions & Straight Answers About Transplants] The technique of transplanting human organs allows more than 2500 people in the UK every year to take on a new lease of life - a full and healthy lifestyle replacing a terminal illness. A further 3000 have their eyesight restored to them. Transplants are now so successful that many more people cn be considered for treatment in this way. More people are being added to the waiting lists each week, and this is now happening at a faster rate than organs become available. As a result many peple die each year who could, with a transplant, have lived. It needs many more of us to say - "Yes. When I die, you can have my organs for transplantation." After all, once we die, we don't need them anymore, so why burn or bury something that could give life to others? One donor can give life to several different people and restore the sight of two more. If you think that basically this is a good idea - a way in which you might help as many as eight other people after your death - this booklet provides answers to the questions most often asked by people thinking about donation. It also tells you how you can make sure you become an organ donor, leaving the wonderful legacy of life for others, after you have gone. --------------------------------------------------------------------------- FAQ about Transplants 1). When was the first transplant? A cornea was first transplanted in 1905. Blood transfusion became established in 1918 and the first successful kidney transplant was in 1954. The first heart transplants took place in 1967. 2). What can be transplanted? Kidneys, hearts, livers, lungs, pancreases, corneas, heart valves and bone can all be transplanted. Skin can be used to treat patients with severe burns. Techniques are improving all the time and it may soon be practical to transplant other parts of the body. 3). Can you donate an organ while you are still alive? Yes, in some cases. The most common is a kidney as it is possible to live a normal lifestyle with only one kidney. Part of a liver can be transplanted and it is possible to donate part of a lug or pancreas. Live donations are nearly always between close relatives, often between parent and child, partly because the similarity of blood groups and tissue types gives a higher possibility of success. 4). Can older people be donors? In the case of corneas and bone donations, age does not matter. For other organs, the age of the donor is important and doctors decide in each case whether it is possible to use them. 5). Can a donor be under eighteen? Yes, if he or she wishes to. 6). Why do we need to agree to become donors? Because in the United Kingdom organs from a potential donor cannot be taken for transplantation without the relatives' permission. Carrying a donor card or putting your name on the Donor Register makes everyone aware of your wishes and makes it easy for them to agree. To help this process along, we ask people also to make sure their families know that they wish to be a donor. 7). What if I want to be a donor but my family would object? You can get a solicitor to put your wishes in writing in such a way that you could carry it with you. This would help, but in any event tell your family and closest friends your decision to be a donor when you die. If there is written evidence of your wish to be a donor, most people will accept that, after death, your wishes should be respected. It also makes it much easier for them to reach a decision, at a very difficult time. 8). Why are even more donors needed? Because transplantation is now so successful, more and more patients have a chance of benefitting from transplants. Many of these, who could lead normal lives, still die while waiting for a transplant because there are not enough donors. 9). Are there religious objections to transplants? Most major religious groups pprove of and support organ transplants as it is consistent with life-preserving traditions. However, if you have any doubts, you should discuss them with your own spiritual or religious leader. 10). Does organ donation leave the body disfugured? No. The recovery of organs and tissues is carried out by surgeons and trained staff with great care and does not disfigure the body or change the way it looks. 11). How do they know you are really dead? Two different doctors have to carry out a series of tests independently in order to confirm that a patient is "brain-stem dead". The standards are very strict and are accepted medically, legally and ethically in the UK and most other countries in the world. Brain-stem death usually results because of a severe brain injury which causes all brain activity to stop. This could be caused by a major road accident resulting in head injuries, or by a fatal stroke, when the blood supply to the brain is interrupted. 12). Can't they keep you alive with machines? Machines can keep the blood ciruclating after death and this allows organs to be used for transplantation, but a patient who is brain-stem dead cannot recover. 13). Will they just let you die if they know you want to be a donor? No. The doctors looking after a patient have to make every possible effort to save the patient's life. That is their first duty. If, despite their efforts, the patient dies and is certified brain-stem dead, only then can organ donation be considered and a completely different team of doctors would be called in. 14). Who would get my organs if I become a donor? There is a national computerised list of patients waiting for an otgan transplant. The system for matching donated organs to these patients has been agreed nationally by the medical specialists involved. The computer automatically produces either the name of the next person on the list who matches correctly the otgan which has become available, or the transplant unit to whom the organ is to be offered. The waiting list and donor organ allocation system is operated independently by the UK Transplant Support Service Authority (UKTSSA). It works round the clock, every day of the year, and covers the whole of the UK and the Republic of Ireland. 15). How are donated organs matched to patients? There are many characteristics which need to match or be very close - blood group, age and weight are all taken into account. For kidneys the most important factor is the tissue type which is much more complex than blood grouping. The more accurate the match the better the chances of success. Tests are carried out on the donor and the results of these must match those already carried out on the waiting patient. 16). Would a transplant patient ever know who the donor was? No. Confidentiality is always maintained, except in the case of living donations which are usually within the same family. 17). Does the colour of my skin make any difference? Yes and No. Successful transplants are frequently carried out between people from different races, wherever the matching criteria are met. There is a better chance of getting a very close match if donor and recipient are of the same race, so it is important that we have donors from all races. It is now known that some ethnic groups are more likely to be prone to kidney disease of a type that produces kidney failure. As a result, even more donors are needed amoung these groups, to ensure that as many as possible within a particular group can have access to successful treatment. 18). Does being a donor cause delays to funeral arrangements? No. Everything has to be done very quickly to improve the chances of successful transplants. Once relatives have agreed, everything will be completed in less than 12 hours. 19). How is transplantation organised? When brain-stem death has been confirmed in a patient who could be consiedered as a potential organ donor, the local Transplant Coordinator is contacted. They check immediately to see if the patient has indicated a wish to be a donor and then confirm with the next of kin that they agree to donation. A computer search is then made to find the most suitable patients, as the donation may involve more than one organ. Once the patients and their locations are identified, the doctors at those hospitals are alerted and asked to confirm acceptance of the organ. As they do so, they begin the preparation of their patients for the operation. A team of specialist surgeons is called to the donor's hospital to carry out the surgery and preserve the organs for transport to the transplant hospital. Special transport arrangements are made to ensure no time is lost. Problems can occur if any of the donor's organs, once examined, are found to be affected by disease or damaged in some way. This will mean that a waiting patient's hopes are dashed for the moment and that their wait for a transplant must continue. If all is well, the organ is received at the transplant hospital and transplanted immediately and the process of recovery and new life can then begin. 20). Who are Transplant Coordinators? They are members of the transplant tema based at hospitals which specialise in transplangation. They are experienced in all aspects of orga donation and transplantation. One of their main roles is education, providing information to both the generl putlic and health professionals. They are also responsible for organising the logistics of the donor and recipient operations. 21). Does a donor's family have to pay the cost of donation? No. There is no question of any payment at all. 22). Can people buy or sell organs? No. The Human Organ Transplants Act, 1989 absolutely prohibits the sale of human organs. 23). If someone needs an organ desperately, is there any point in mounting a special appeal? Yes and No. Any special appeal usually results in more people agreeing to become donors and can increase the number of organs available. However, family appeals through the newspapers and television will not result in an organ immediately becoming available for the person on whose behalf the appeal was made. The patient will still be on the waiting list, just like everyone else, and the rules that govern the matching of donor and recipient are just the same, as described in this leaflet. 24). Is there a national register of people willing to be donors? An NHS Organ Donor Register has been set up as a computer database at UKTSSA. The Register is accessible to each of the Transplant Coordinators who will be able to check the Register first, each time they have a potential donor to consider. Remember that even if your name were on the Register, your relatives would still be asked for their approval before you could become a donor. However, they are likely to agree readily if you have specifically entered your name on the NHS Organ Donor Register for the purpose, and the whole process will be made easier for everyone. 25). How do I confirm my wish to be a donor? You can fill out a donor card and carry it with you. You can also mark in the box provided on the back of any driving licence sent to you after March 1993, that you wish to be a donor. However, should you be completing one of the new driving licence application forms, you can indicate your willingness to become a donor on that form. Names collected off these forms will be entered on to the NHS Organ Donor Register. Best of all, you can write direct to the NHS Organ Donor Register and ask for your name to be added to the Register. But most importantly, tell your family and friends that you wish to be a donor. 26). Can I agree to donate some organs and not others? Yes. You can specify which organs you would donate. 27). Can I change my mind? Yes. You can simply tear up your donor card and tell your family that you have changed your mind. If your name has been added to the NHS Organ Donor Register, write to the Register and ask them to remove your name. --------------------------------------------------------------------------- Some definitions 1). A "Required Request". In some countries, including some States in America, all families are asked to agree to the donation of organs and tissues from their deceased relatives. Hospital staff are required to ask the family, whether or not the person concerned carried any kind of donor card. 2). "Presumed Consent". In some countries, including Austria, Belgium and France, hospitals will automaticaly remove organs and tissues unless they know that the patient, when alive, was not in favour of organ donation. 3). "Informed Consent" In the UK and most other European countries, organs and tissues will not be removed unless the deceased patient's relatives have agreed. 4). A "domino transplant". For some patients needing a lung transplant, it is more effective to transplant both the lungs and the heart as one unit, even though the patient's heart may be working perfectly. In these cases, the patient's heart is then transplanted into a second person waiting just for a new heart. In a recent example, at the annual UK Transplant Games, one man found himself running in a race against another man who had received his heart. 5). "Immunosuppressive drugs". The human body will normally try to reject any organ or tissue that is put into it, using its own immune system. For this reason, in addition to careful matching of the organ, as described under question 15, immunosuppressive drugs are used to reduce the likelihood of rejection. For more detailed and technical answers to these or similar questions, the Publicity Section at UKTSSA will try to help or will be pleased to recommend suitably qualified sources of information. The printed version of this information is published by UKTSSA - a special health authority of the NHS. Further printed copies may be obtained by contacting the Publicity Services Section at: United Kingdom Transplant Support Service Authority Fox Den Road Stoke Gifford Bristol BS12 6RR Tel: 0117 975 7575