Step 3: The gift of a donor liver
The transplantation process depends not only upon the skill of medical and nursing staff and the compliance of patients and support of their families, but largely on the generosity of the families who have suddenly and tragically lost a loved one. This gift made by the donor and donor family is a precious and rare resource and is regarded as a privilege, and not by any means, a right.
The process by which donor organs become available to recipients is governed by both medical and legal criteria. In Queensland, this legislation is the Queensland Transplantation and Anatomy Act, 1979. DonateLife is the agency which manages organ donation in Queensland.
Not everyone who dies is able to donate their organs. Less than 2 per cent of people die in a way to allow for donation of organs for transplant. To be eligible to become an organ donor, a person must have died in an Intensive Care Unit (ICU) and be supported on a mechanical ventilator. Medically, their organs must be working at the time of their death and be free of transmissible disease and cancer.
There are 2 pathways for organ donation after death has been determined. Donation after brain death (DBD) and donation after circulatory death (DCD).
Brain death occurs when a person’s brain has been so badly damaged that it completely and permanently stops functioning. A DBD donor is a person who has died while on a ventilator in ICU with a beating heart. The deceased person will go to the operating theatre for the donation operation while still on the mechanical ventilator.
Circulatory death occurs when a person stops breathing and their heart stops beating. The opportunity for DCD donation can be considered when a person is in an ICU on a mechanical ventilator following a severe injury or illness from which they cannot recover. The doctors and family then agree it is in the person’s best interests to remove the ventilator and any other life sustaining therapy. For a DCD donor, death is declared after withdrawal of the mechanical ventilator and circulation has stopped. The deceased patient will then go to the operating theatre for the donation operation.
When a donor liver becomes available the DonateLife donor coordinator will notify the liver team and the liver consultant on call. The consultant will decide the most suitable recipient by consideration of various criteria; mainly those of compatible blood group and matching size or weight between donor and recipient. The general health condition of the recipient is also considered.
The consultant then contacts a patient on the liver transplant waiting list who has been selected to receive the donor liver. On some occasions, a second patient from the transplant waiting list is called in to standby, in case for medical or other reasons the first patient is unsuitable for that donor liver.
Meanwhile arrangements are made to take the donor to the operating theatre for organ retrieval surgery. The donor could be from any hospital in Queensland, Australia or New Zealand. The DonateLife donor coordinators organise surgeons, transport, and operating theatres and provide support to the donor’s family. This support continues throughout the donation process and
is followed up with a phone call the next day and at various intervals in the first year after the donation. Ongoing support is provided to donor families by the DonateLife Donor Family Support Coordinator for as long as they need it.
Every year around May or June, a special Service of Remembrance for donor families, transplant recipients and their families are held in all major Australian cities and in many regional cities Statewide. Check the DonateLife website for details.
Many transplant recipients and families write to their donor families anonymously, expressing their heartfelt thanks, for what is truly the “Gift of Life”. Read more about contact between donor families and recipients.
Information and brochures are available to assist with letter writing, and counselling is available to patients and families to help with any aspect of their transplant journey that may be causing distress or concern. It is often a good idea to discuss any worries you might have with the social worker, before receiving your liver transplant, to comfortably manage feelings you might be experiencing about the donation process or receiving a transplant.
For more information about donation and transplantation visit DonateLife.