Part of preparing for an organ transplant is learning as much as you can about the organ donation and transplantation process. When your transplant team determines that you are a candidate for a solid organ transplant, you will receive educational materials and have opportunities to discuss your questions and concerns with members of your transplant team.
Deceased and Living Organ Donors
Most transplanted organs come from people who arrange for their organs to be donated upon their death. Organs that can be removed from a deceased individual and made available for transplantation include the heart, lungs, kidneys, liver and pancreas.
According to the non-profit United Network for Organ Sharing (UNOS), more lives were saved by deceased organ donors in 2020 than in any previous year — the 10th consecutive record-breaking year for deceased organ donations.
Two types of solid organs — the kidney and the liver — can be donated by a living person.
Safeguarding Organ Donation and Transplantation
Every aspect of organ donation and transplantation is regulated to ensure both ethical actions and patient safety. At the national level, oversight of organ procurement organizations and transplant centers is provided by policies created by the Organ Procurement and Transplantation Network (OPTN) with the guidance of the department of Health and Human Services (HHS). In addition, the Public Health Service (PHS) publishes guidelines on the screening and testing for infectious disease of potential donors and donor organs.
The OPTN also develops policies about how organ donors are evaluated, and how organs are procured for transplant and allocated to patients on the waiting list. The organization also monitors patient outcomes after transplant. Transplant centers like Michigan Medicine develop their procedures based on PHS and OPTN recommendations.
Every Minute Counts with Organ Donation
When you get a call that an organ is offered for transplantation, every minute counts. Your best strategy is to become educated on all of the potential transplant risks as soon as your doctor determines you are eligible to be added to the organ waiting list. Discuss all of the considerations with a member of your care team as early as possible, including the small and manageable risks associated with some donated organs, so that you are ready when an organ becomes available.
Risks Associated with Donated Organs
Rejection of the Organ
While the risk is relatively low, in any transplant there is a chance that the recipient’s body will reject the donated organ. Transplant recipients need to take anti-rejection medications for the rest of their lives to manage this risk. Your transplant care team will discuss this risk with you, and will help you manage your pre- and post-transplant medications.
Infection from the Organ
There is a very low risk of transplanting an organ from a donor who may have been infected with a blood-borne virus such as Hepatitis B (HBV), Hepatitis C (HCV) or Human Immunodeficiency Virus (HIV).
The latest PHS guidelines, titled Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) Infection, address this risk. The guidelines reflect the latest research and clinical experience related to the use of organs from donors who are known to have engaged in behaviors that increase their risk of carrying these diseases.
Today as many as 1 in 4 organ donors may have engaged in one or more recent behaviors that increase their risk of contracting HIV, HBV or HCV. To protect transplant recipients, every potential donor, living or deceased, is screened for HIV, HBV and HCV, using a highly accurate method called nucleic acid testing (NAT). When NAT testing is performed within weeks of a potential donor engaging in a behavior that increases his or her risk of infection, the chance of transmitting the infection to an organ recipient is extremely low — one in 100 or less.
But because it takes some time for an infection to show up on a test, there is still a small window of risk that a donor could have had a recently-contracted infection when tested and have tested negative. While NAT has made this window as much as ten times shorter than previous tests, it may not be able to detect an infection contracted in the final days before a potential donor’s death.
To counter the risk, all organ recipients are monitored for HIV, HBV and HCV beginning 4 to 6 weeks after transplant, regardless of the outcome of the donor’s NAT screening. This ensures that if an infection is transmitted, a proven treatment can begin as soon as possible. Also, an effort is made to give all organ transplant candidates the HBV vaccination.
When an organ donor tests positive for one of these infections, his or her organ may still be used in certain circumstances. An HIV-positive organ can be transplanted into an HIV-positive patient, or an HCV-positive organ can be transplanted into an HCV-positive recipient. Also, since we have a proven cure for the infection, an HCV-positive organ can be transplanted into a recipient who understands the risk and provides consent.
Informed Consent to Accept an Organ for Transplant
As part of the transplant patient education process, your surgeon and/or another member of your transplant team will talk with you about the risks involved. These conversations should begin as soon as possible after your name is added to the organ transplant waiting list.
Once you understand all of the potential risks, you will be asked to give your informed consent, acknowledging that you understand and accept these risks, before you can receive an organ for transplantation.
You have the right to decline an organ that has been offered, but that decision comes with significant risk. Some patients and even some doctors overestimate the risk of contracting an infection from a donated organ. The risk of infection is low, and infection is far less of a concern when there are highly effective treatments available, as there are for HBV, HCV and HIV. For most people, the risk of turning down an available organ is much greater than the possibility that you will contract an infection from the organ.
This is not a choice between two available organs, but a choice between a compatible organ that is available now and an uncertain wait for another available organ. Research in kidney transplant patients showed that declining a kidney significantly increased the risk of death in the following 5 years, largely because a patient will face only about a 1 in 3 chance of getting another chance at a compatible donated organ.