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Saying “Yes” to Organ Donation

Chief of Transplant Surgery, Dr. Will Chapman

Organ donors save lives every day. A single organ donor can save as many as seven lives. According to the Health Resources & Services Administration, 165 million people in the U.S. have registered as donors. There are currently more than 100,000 people waiting for a life-saving organ transplant.

Still, some people have concerns about becoming an organ donor. Transplant surgeon William Chapman, MD, explains the donation process and addresses common concerns people have regarding organ donation.

Organ Donation Explained

How many people can my organs help?

Dr. Chapman: Organ donation could save seven people. I don’t just mean help; I mean up to seven life-saving transplants. This includes the heart, lungs, liver, kidneys, pancreas and sometimes intestines. A younger, healthy donor can give someone a heart, kidneys to two people, lungs to one or two people and the pancreas to another person. That’s five or six people. Intestinal transplants are less common but can save a seventh person. When you add tissue donation, the number is even higher. Tissues, including bone, tendon, cartilage and corneas, go to many more people.

Who do my organs go to when I donate them?

Dr. Chapman: There are over 100,00 people in the United States waiting for organ transplants. The number waiting for tissue is even greater. Every year, we add on more people than we transplant, so there is always a gap. On top of that, about 20% of listed patients die waiting for an organ that does not make it in time. We have a significant gap and need that is not being fulfilled, even though our number of tissue and organ donors continues to increase.

What is the process for organ donation?

Dr. Chapman: After the care team has exhausted all of their options to save the patient, and the patient is declared brain dead, then the recovery team is notified. The organ procurement organization, or OPO, comes to the hospital to talk with the family about organ donation. The family makes the decision, and then the OPOs can begin the process.

Will I receive the same level of care in the ICU if I am an organ donor?

Dr. Chapman: Yes. That’s a common misperception. The donation team is totally separate from the care team. The care team is doing everything they can to save the life of the patient. Only when they have determined that there is no chance of recovery and the patient is declared dead, or that hope for meaningful recovery is no longer present, and the family talks to the OPO, only then does that process start. There is a deliberate effort to keep those aspects separate. The care team has nothing to do with donation or the recovery process. The care will not be different.

If I choose to be an organ donor, can I have an open casket funeral?

Dr. Chapman: Yes. One hundred percent. The OPOs work very closely with the funeral teams to be sure that the body is handled in a way that will not impact funeral services. There are incisions made, but those are not in exposed areas. Organ donation has no impact on an open casket funeral service.

Can everyone register to be an organ donor?

Dr. Chapman: Not everybody is in perfect health. Not everybody is at a young age when they die. Hopefully we all die at the end of a long life. Some people have the perception that if they are older than 60, 70 or even 80, their organs are not going to be able to be used. That’s just not the case. We are able to utilize older donors much more frequently now than we were even five or 10 years ago. We would encourage everyone to be an organ donor, no matter your age or health condition.

We have some novel approaches to expand the ability to use donor organs that, in the past, were considered too marginal. We are doing things like machine perfusion of organs to test their viability. This is a good way to potentially improve organ function and have a good idea to know that this organ is going to work. Washington University School of Medicine and Barnes-Jewish Hospital have a number of clinical studies underway to expand the use of organ donors that in the past we would not have been able to use. We’re trying to do everything we can to increase available organs.

Why is it important to register as an organ donor?

Dr. Chapman: This is really important for a couple of reasons. The biggest one is that it lets your family know your wishes. When a person dies, it is often a devastating time for the family. They’ve gone through a crisis, a tragedy, and it’s really difficult.

I think, conceptually, most people can agree that we should all want to be organ donors. Once you’re dead, why not allow your organs and tissues to be of use to people who are still living? There’s no use in taking them to the grave. Having said that, that decision is pretty tough for families to make in that difficult time they’re facing. That’s the biggest reason to sign up on the registry: let your wishes be known.

If the family does not know your wishes, there are questions. Do they really want this? And that can short-circuit the donation process. Registering to be an organ donor is a legally binding decision, and it is not meant to be overridden. All of us have to think about that when we sign up. The nice part is, your wishes are able to be kept, as opposed to families having to speculate about it.

In addition to signing the registry, I would encourage you to tell your family. All of us are going to die, and none of us think about it. You make those decisions when you go to get your driver’s license, you don’t give it much thought. You want to do it, you commit, then you don’t tell anybody. Your wishes will still be honored, but it’s even better to have a discussion with your family and let them know.

Do you have any advice on how to talk with my family about organ donation?

Dr. Chapman: April is National Donate Life Month. This is a great opportunity to focus on this topic.

Think about it from the perspective of the families with organ failure, waiting for transplant. If you or one of your loved ones was waiting for a transplant, wouldn’t you say everybody ought to think about being an organ donor? That puts things in perspective for me: What if it’s me or my family? And it can be. The majority of people don’t think they have any immediate connection to transplant. But when they look around, almost everybody knows someone who has been transplanted, or knows someone with a transplant in their family. Once you think about that circle of people, you start to think that we need to do everything we can to increase the availability of transplantable organs to save the lives of all these people that are in organ failure.

How can I register to be an organ donor?

Dr. Chapman: There are a couple of ways that people can register to be an organ donor. One is when you get your driver’s license or ID renewed. The other way is to go to the organ donor website. Either way, it’s a pretty simple process to register that you want to be an organ donor.

Is there anything else you would want people to know about organ donation?

Dr. Chapman: Our OPO is Mid-America Transplant. They are a very forward thinking and leading OPO, and they have improved organ and tissue donation to save even more lives. They’ve developed an organ recovery center, which has helped expand the use of donor organs. That puts St. Louis in a favorable position for transplantation. While there is still an organ shortage, we have significant advantages with our local situation.

To learn more about Washington University transplant surgery, visit the Transplant Surgery website.