1. Organ & Tissue Donation and Transplantation

2. Transplantation
Transplantation has a long history of fascinating the public – as is evident in fiction (Mary Shelley’s Frankenstein, 1816) and various tabloid reports. Transplantation in fact has a long, successful history and is an accepted treatment for end-stage organ failure.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

3. History of Transplantation
bone
skin
corneal
knee joint
kidney transplant
pancreas transplant
liver transplant
heart transplant
The1st recorded transplants occurred in the 17th century. The 1st successful organ transplant, a kidney, was performed by a team led by Dr. Joseph Murray on December 23, 1954 between identical twin brothers in Boston. Dr. Murray went on to receive the Nobel Prize in Medicine for this accomplishment.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

4. Perhaps the most well known of all transplant firsts, Dr
Perhaps the most well known of all transplant firsts, Dr. Christian Bernard became a household name when in 1967 he performed the world’s 1st successful heart transplant in Capetown, South Africa.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

5. Unfortunately, early results were not as successful as initially hoped as was pointed out a mere four years later on yet another LIFE cover.

6. revolutionized transplantation increased survival rates
1st in a new generation of anti-rejection drugs
Introduced in 1978, the drug cyclosporine revolutionized transplantation by depressing T cell activation and reducing organ rejection.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

7. Further Successful Firsts in Transplantation
heart-lung transplant
lung transplant
liver/bowel transplant
split liver transplant
living related liver transplant
cluster (liver,bowel,stomach,pancreas & kidney) transplant
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

8. Survival after Transplant
varies greatly among organ groups
depends on the patient’s condition before transplant
depends on the presence of other illness
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

9. Transplant Successes
Transplanted with a liver, bowel, stomach and pancreas at age 5.5 months, Sarah has a spot in the Guiness Book of World Records as the youngest multi-organ recipient.
Now 22 years post liver transplant, London ON success story Heather Fisher climbed Mount Kilimanjaro after her surgery.
Snowboarder, Chris Klug, won a bronze medal at the 2002 Olympics, two years after his liver transplant.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

10. Who Needs a Transplant? Transplantation is offered to patients who:
are in end-stage organ failure
have no other surgical or medical option available to them
have a limited life expectancy without a transplant
have undergone a rigorous and thorough assessment process and meet all necessary criteria
Baby Jane was listed for a liver transplant when no other life-saving options were available.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

11. Canadian Transplant Numbers (1994 – 2003)
statistics provided by the Canadian Institute for Health Information
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

12. Canadian Donor Numbers (1999 - 2003)
statistics provided by the Canadian Institute for Health Information
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

13. Donation two types of donors: deceased (dead) donors live donors
donor has been declared dead by two physicians independent of the transplant team
usually occurs only in cases of neurologically determined death (the brain stops working 1st but the donor is still on artificial support such as a ventilator to allow the other organs to maintain a blood supply and remain suitable for transplant)
live donors
patient chooses to donate one or part of an organ to someone on a transplant waiting list
can only occur with organs when removal will NOT cause grave harm to the donor
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

14. Deceased Donation neurologically determined death usual case
also referred to as brain death
intact heartbeat & circulation
on ventilator
less than 3% of all deaths
One the reasons that there are so few organ donors in Canada is that very few people die under circumstances that allow them to donate their organs.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

15. Deceased Donation donation after cardiac death
currently being explored in Canada
common in countries such as Spain and the Netherlands
occurs in hopeless cases in the hospital where the decision to withdraw life-support is made (decision is independent of the decision to donate)
organ donation occurs immediately once the heart has stopped and the patient is declared dead
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

16. Tissue Donation
tissues include eyes, heart valves, bone, tendons and skin
tissues do NOT need oxygen to remain suitable for transplant – do NOT need to have an active blood supply
can occur following death regardless of whether death was determined by neurological (brain death) or cardiac (heart stops) assessment
almost everyone can be considered for tissue donation after death
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

17. The Most Common Causes of Death Leading to Organ Donation
The most common cause of death in adult organ donors is an infarction or bleed to the brain; in those less than 18 years old, the most common cause of death is trauma.
cerebral bleed
cerebral infarction
primary brain tumour
trauma (i.e. motor vehicle accidents or a severe fall)
anoxia, hypoxia (a condition in which blood flow to the brain has been stopped leading to no or poor oxygen supply to the brain)
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

18. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

19. Can an 85 year old person still be a donor?
YES!
the oldest organ donor on record was a 92-year old woman whose liver was successfully transplanted by surgeons in London, ON
the age of the organ donor does not dictate who gets the organ – as long as the organ is healthy, it is offered to the patient next on the list
eye donation can occur in individuals up to 100 years of age
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

20. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
someone with diabetes …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

21. Can someone with diabetes still be a donor?
YES!
diabetes is not a barrier to donation although it may limit which organs can be donated
each organ is assessed separately and its suitability for donation determined
with diabetes, the kidneys and heart often are not suitable but this is not always the case
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

22. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
someone with diabetes …
someone who wears glasses …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

23. Can someone who wears glasses still be a donor?
YES!
not only can you donate your organs, you can still donate your eyes as well – wearing glasses does not mean your eyes are unsuitable for transplant!
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

24. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
someone with diabetes …
someone who wears glasses …
someone who has had cancer …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

25. Can someone who has had cancer still be a donor?
YES and NO
a benign, non-transmissible cancer is not considered a contra-indication to donation
a malignant cancer with the possibility of transmission to recipients is a contra-indication to donation
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

26. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
someone with diabetes …
someone who wears glasses …
someone who has had cancer …
someone with HIV …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

27. Can someone with HIV still be a donor?
when there is any risk of transmitting a fatal disease from a donor to transplanted recipients, the organs are NEVER used
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

28. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
someone with diabetes …
someone who wears glasses …
someone who has had cancer …
someone with HIV …
someone with hepatitis C …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

29. Can someone with hepatitis C still be a donor?
YES (conditional)!
because hepatitis C can be transmitted from donor to recipient, organs have not been used in the past and still are only used in certain circumstances
because there are many patients on the transplant waiting list who already have hepatitis C, many transplant teams will now accept organs from donors with hepatitis C and transplant them into a recipient who already has hepatitis C – the organ must still undergo a variety of tests to determine its suitability
hepatitis C is a contra-indication to tissue donation
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

30. Who can donate? Can … … donate their organs or tissues?
an 85 year old …
someone with diabetes …
someone who wears glasses …
someone who has had cancer …
someone with HIV …
someone with hepatitis C …
someone who died under suspicious circumstances …
… donate their organs or tissues?
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

31. Can someone who died under suspicious circumstances still be a donor?
YES!
if the cause of death is known
coroner’s consent is required and may be restricted to certain organs and tissues and may involve a time limit
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

32. Who can donate?
everyone who supports organ and tissue donation and transplantation is encouraged to express their intention to do so
at the time of death and following consent to donate, transplant teams will determine the suitability of the organs and tissues for transplant
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

33. How Do I Express My Intent to Donate?
varies between provinces
most provinces – donor card
BC – registry
Ontario – health card
in all provinces, physicians will talk to your next-of-kin at the time of death
talk to your family and let them know your wishes
The green ribbon is an international symbol of organ and tissue donation.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

34. Frequently Asked Questions
If donation occurs, is an open casket funeral still possible?
Yes – the only way people will know that donation occurs is if the family chooses to tell them.
Are any religions against donation?
All of the major religions in Canada support donation.
If I have a signed donor card, will doctors bother to try to save my life after an accident?
Definitely! – every effort will be made to first save your life – your well-being is the priority.
Is it true that the wealthy and influential get preferential treatment on transplant waiting lists?
Definitely NOT! – in Canada, all patients are treated equally while on the waiting list.
What if I’m not really dead when donation occurs?
Death is absolute and certain whether or not you become a donor. Donation can only occur if two physicians independent of the transplant team declare you dead.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

35. Who Gets the Transplant?
blood type
identical
compatible
status of recipient
sickest in hospital
stable at home
longest waiting
1st on the waiting list
last on the waiting list
size
Baby Jane, two weeks after receiving her liver transplant.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

36. Live Donation
due to more people on the waiting list and a severe shortage of organs for transplant – more emphasis is being put on living donation
kidney – most common
living liver donation on the rise
living lung donation – not as common
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

37. Live Donation
Baby Jared, two weeks after receiving part of his mother’s liver – mother and son both continue to do well.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

38. Live Donation
usually occurs between related individuals (blood or emotionally)
NEVER involves payment to the donor
Benefits:
can allow for pre-emptive transplant (before recipient requires dialysis)
allows for a planned transplant procedure
has improved graft survival
shortens time on the waiting list for the recipient
increases the total number of organs available for transplant
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

39. Live Donation (benefits to the donor)
a complete physical assessment –identification of a possible illness
the joy and satisfaction of helping a friend or family member – of saving a life
A brother and sister pair who shared the gift of life – a kidney – both continue to do very well four years later.
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

40. Live Donation (risks to the donor)
any patient undergoing surgery faces risks – the dilemma with living donation is that a healthy patient is undergoing surgery with no direct health benefit to themselves
every attempt is made to minimize risks to the donor
informed consent is required
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

41. Conclusion
Transplantation offers a second chance at life to thousands of Canadians. It has been proven over and over again to be very successful. However, transplantation can only occur if someone consents to the ultimate gift – organ and tissue donation.
Ernie – heart transplant
Rafe – liver transplant
Susan – heart & lung transplant
Presentation prepared by Corinne Weernink, London Health Sciences Centre, London, ON, Canada

42. or the beginning for someone on a transplant waiting list
the end …
or the beginning for someone on a transplant waiting list
consider organ and tissue donation