No one likes being at the DMV, but it’s time to fill out that license renewal form.
It’s mostly routine - name, address, and other information - but there’s one box
that sticks out.
It reads “Do you wish to be an organ or tissue donor?”.
You’ve heard about organ donation of course, but you’re not really sure what it entails
- and you’ve got to decide whether to sign up for it right now!
What actually happens when you donate your organs?
Around the world, countless people are sick because one of their organs isn’t functioning
properly.
This could be due to an injury requiring the removal of an organ, an illness that causes
damage to the cells in the organ, or a genetic condition that slowly degrades the function.
In past times, there was little way to save someone with a malfunctioning necessary organ,
although some artificial methods like dialysis were developed.
But in the 19th century experiments began in transplanting a healthy organ from a donor
to a new recipient.
The earliest attempts at organ transplant were called autografts and involved skin - transplanting
skin from a healthy area of a person’s body to a damaged area on the same person.
Some reports indicate this technique was created by the Indian surgeon Sushruta over 2000 years
ago, and later continued by Italian surgeon Gasparo Tagliacozzi
The science of organ donation, though, had a long way to go.
Experiments in transplanting parts from one person to another may have gone back much
further, but lacked the understanding we have today.
Roman Catholic doctrine say Saints Damian and Cosmas managed to replace the gangrenous
leg of the Roman Emperor Justinian with the leg of a dead Ethiopian man.
If it happened, it would have been a miracle - even today most amputees are still limited
to state-of-the-art prosthetics, with limb transplants still being a work in progress
and very rare.
Other reports say Pien Chi’ao, an early Chinese physician, performed a double heart
transplant between two men to balance their spirits.
But all these reports are apocryphal and heavily doubted by modern scientists.
It would be centuries later before doctors would find the trick.
Transplant of organ or tissue to a different donor is called the allograft, and it wasn’t
until 1837 when the first successful attempt was made - on a Gazelle, who had been used
for experiments on corneal transplants.
Once it was successful, it would be Doctor Eduard Zirm in the Czech Republic who performed
the first successful transplant of a cornea on a human.
The next step would be transplanting of Thyroid tissue to replace an organ’s function, performed
in 1883 by Doctor Theodor Kocher - twenty-two years before Zirm’s breakthrough.
While this was successful, tissue was working and organs weren’t - yet.
That changed in 1954.
Richard Herrick was a Navy man who was gravely sick with kidney failure.
His brother Ronald was willing to do whatever was needed to save him, and Dr. Joseph Murray
believed he could help.
He performed a kidney transplant, and unlike past unsuccessful cases where recipients lived
less than a month, Richard lived another eight years!
Dr. Joseph Murray received the Nobel Prize, but there was one key to this surgery that
wouldn’t be easy to duplicate.
The Herrick brothers were identical twins and had identical genetics, meaning the kidney
transplant was essentially an autograft.
But not everyone has an identical twin to be their perfect donor.
So what’s the trick to making organ donation work?
Preventing rejection.
Our bodies are complex, and two key elements have to match for an organ to be a suitable
match for a person.
The first is blood type, and there are four blood types - each with different compatibility
for donation.
While type O blood is considered the universal donor and is the most common, type A, B, and
AB are progressively more limited in who they can donate to.
Then it’s on to HLA typing, to make sure the proteins, or antigens, in the body cells
won’t conflict.
If the antigens are different, the body can make antibodies against their new organ and
reject it.
That’s where the wonder of modern medicine comes in.
While perfect matches on HLA type are rare, medicine is available to keep the body from
creating these antibodies.
These anti-rejection medications are prescribed to people after almost all transplants, and
most people wind up taking these drugs as long as they have their transplanted organ
- so ideally, their whole life.
Medical science marched on, and with the development of anti-rejection drugs, it became possible
to transplant many organs that people couldn’t live without.
So what organs are transplanted today?
Besides corneas and kidneys, which started it all, today heart, lung, and liver transplants
are common.
Pancreas and intestine transplants are less common but possible, and tissue transplants
of skin, bone marrow, and blood are almost routine.
Experiments in transplanting hands and arms have been performed, but preventing rejection
is far trickier and many have failed after a period of time.
There are even experiments in transplanting a uterus so that a woman who has had a hysterectomy
can carry children.
The most stunning recent advancement in transplant science, though, is also the most visible.
In the last twenty years, scientists have successfully managed to transplant whole faces!
When dealing with patients who have been seriously disfigured from gunshots, industrial accidents,
fires, or animal attacks, they take the facial tissue from a donor and place it on the surgically
prepped facial surface of the disfigured recipient.
After transplant, the face eventually shifts to the skeletal structure of the donor, so
they don’t look exactly like they did before - but not like the donor either.
This surgery requires vigilance with anti-rejection medication, but was successfully performed
first as a partial face transplant on a woman who lost all the skin on her lower face in
a dog attack.
This led to full face transplants being performed around the world.
But in almost all these cases, the donors had one thing in common.
They were all dead.
The most common type of organ donation today is from a cadaver to a living donor, and this
is what you’re being asked when you sign on that dotted line.
You’re agreeing that should you meet an untimely end, your organs will be harvested
from your body before you’re buried or cremated.
Those will then be given to people who need them, letting you live on beyond your body.
There’s no real downside - you don’t need them anymore, right?
So why wouldn’t everyone sign up?
Well, some object because of religious rules, and others worry that the doctors wouldn’t
work as hard to save them in the hospital if they saw that their organs would be harvested.
But there is no evidence of that, and doctors say that the more people who sign up as organ
donors, the better.
So what happens when an organ becomes available?
Organ donors whose organs can be used are usually in good health, with their organs
functioning well.
But anything can happen, and a piano can fall on the head of anyone at any time.
If a person is dead or brain dead and they’re an organ donor, the hospital springs into
action to keep the organs in good condition until the time.
If someone is still clinically alive, they may be kept on life support longer than usual
to keep their organs healthy.
If they didn’t have a directive either way on whether they’re an organ donor, the doctors
will often ask the grieving family if they would be willing to sign the papers - but
it is always up to the person or their family.
From there, the organs will go to the next person on the organ donation list.
Wait, there’s a list?
In the United States, the United Network for Organ Sharing oversees the transplant system
for most cases, keeping a registry of everyone who is in need for an organ.
When an organ comes in, they filter it by compatibility, size, and geography to give
the transplant the best chance for success.
Each person’s place on the list is determined by their medical urgency, their waiting time,
and their age - with younger recipients being higher on the list.
The things that don’t play a role?
Income, insurance status, or celebrity status.
If you wind up on the organ donation list, it doesn’t matter who you are - the factors
are always the same, and you can’t buy your way into a higher slot ahead of someone who
needs it.
And when the time comes, the organ donation team moves fast.
A patient comes in and can’t be saved.
They are assessed for organ health and matched to a recipient.
The organs are harvested and chilled until use, but the clock is ticking.
Doctors will try to find a match as close as possible, but if a high-priority recipient
is far away, they will transport that organ via courier with the highest priority.
The goal is to get it to the hospital for transplant while it’s still fresh and keep
it from getting damaged - although, despite what a TV show once showed, there are no reports
of transplant hearts getting eaten by dogs along the way.
The problem is, there are a lot more people in need of organs than there are organs available,
especially for those with rarer blood types.
That’s why there’s another way.
If you sign up to be an organ donor, the only time this will be relevant is if you’re
dead or almost dead.
But since the first living donor transplant between the Herricks, living donor transplants
have become more common, especially for rare blood types who could be waiting a long time.
Approximately one in three donors of kidneys is now still living, and it’s common for
them to be from family or close friends of the person who needs a kidney.
Doctors will assess the person’s physical and mental health and the health of their
organs, and make sure they’re not under any duress.
But what happens if someone doesn’t have anyone they know willing to donate a kidney?
The advance of the internet and social media have given new hope.
People with a rare blood type have put out blasts on social media, asking for help to
find a donor.
In 2009, Chris Strouth managed to find a kidney donor on Twitter.
And when there’s no direct match, a new possibility has emerged - kidney chains.
This is when someone gives a kidney to someone other than their loved one, in exchange for
one being given by another donor to theirs.
This can be as simple as a swap between two families, but for more complex cases, open-ended
chains have begun.
This can develop into a long, elaborate chain connecting dozens of families and giving one
person in each a new lease on life.
So what’s donating a kidney like for the donor?
Donating a kidney is a serious operation, but not usually one with any complications.
While some surgeries are more invasive than others, with minimally invasive laparoscopic
surgery becoming more popular, it’s common for a hospital stay for a donor to be between
four and six days.
Afterwards, it’s mostly a matter of letting the incision heal, and heavy lifting and contact
sports should be avoided for about six weeks.
The most common risk during the surgery is serious bleeding, but it’s a rare complication
and doctors are good at preventing damage.
After the surgery, donors can live a normal life - although they should be more careful
to protect themselves from injury, as they only have one kidney remaining.
And there is one perk of donating a kidney - if you should need a kidney donation later
in life, being a previous living donor bumps you up the list.
But have doctors perfected the art of living donations for any other organs?
Yes and no.
Most of our organs, we only have one or need both - like lungs.
But for liver transplants, it is possible to transplant a lobe from a living donor’s
liver to someone who is dying of end-stage liver disease.
This was originally common for parents to give a part of their liver to save their sick
child, who wouldn’t need a full-sized adult liver.
As this involves cutting into an organ, the risk of complications for the donor is higher
than with kidney donation, but the need for blood transfusions are still rare and most
donors recover in two to three months.
Sounds like living donors are usually pretty safe.
And you only need one kidney, right?
Many people have asked the question - if I can save a life with a kidney and I only need
one, can’t I sell my kidney to someone in need?
Well, that’s illegal.
Despite a worldwide shortage of organs available for transplantation, organ donation for profit
isn’t allowed in any country but Iran.
While some have argued that the potential good outweighs the ethical issues, experts
say that allowing the sale of organs would encourage corruption, lead to the poor selling
organs to survive, and give a boost to the black market where kidneys could be harvested
from trafficking victims.
The oversight on this is serious - while the medical costs of donors are usually paid for
through insurance, any financial incentive such as a gift from the recipient family could
be seen as a bribe, and is grounds for the transplant to be called off by the hospital’s
ethics team.
As of 2020, there are over a hundred thousand candidates on the waiting list for organ transplants
in the United States alone.
The wait for a heart or liver transplant can be close to half a year, while those with
the highest priority rating on the heart transplant list can still wait over two months on average.
So the people at UNOS are hoping everyone who qualifies checks yes on that organ donation
form - they need every organ they can get.
For more on the black market organ trade, check out “How Much Is an Entire Human Body
Worth?”, or check out this video instead.