By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
DONATING AND RECEIVING ORGANS are life and death issues -- and complex and emotional.
LifeBanc in Cleveland, the federally approved nonprofit organ procurement organization for Northeast Ohio, helps guide potential organ donors and recipients through the process.
In Ohio this week, National Organ Donor Awareness Week, about 1,320 people are waiting for organ transplants. Nationally more than 79,000 men, women and children await transplants.
LifeBanc's staff includes organ procurement coordinators, whom Brendan Minogue, a Youngstown State University bioethics professor, calls "super nurses."
The coordinators assist families and hospital staff with all phases of organ and tissue donation.
They are the "requesters," said Minogue, who serves on LifeBanc's board of trustees. His wife, Judith, was recently placed on the national kidney transplant list.
Minogue said coordinators can be called to the hospital at any time, day or night, and can be there many hours working with the doctors and donor and family.
"It's very hard work. They all get high marks from me. They are my heroes," said Minogue, who also teaches clinical bioethics at Northeast Ohio Universities College of Medicine and for Forum Health.
Monica Heath, LifeBanc spokeswoman, said the typical organ donor has suffered some type of major head trauma -- stroke, gunshot wound, or accident -- causing him to become brain-dead.
Required by law
A 1998 FEDERAL LAW MANDATES that hospitals notify LifeBanc when someone is a potential donor before the person is brain-dead. When that occurs, a LifeBanc coordinator goes to the hospital and talks to the medical staff.
"We won't talk to the potential donor's family until a series of neurological tests have determined the patient is brain-dead, which means no blood is flowing to the brain and it no longer functions at any level. This is not just a coma or a vegetative state," Heath said.
The family is then given some time before being approached about organ donation. They are asked a series of questions about the patient's medical history, and blood tests are done to make sure no infectious disease or anything else is present that could potentially harm a recipient. Only then, with the family's consent, are the donor's organs entered into the national registry.
Heath said brain-dead patients are treated no differently from any other patient. If someone walked into the intensive care unit at a hospital, they would not know which patient was brain-dead and which wasn't, she said.
When the family says yes to organ donation, LifeBanc first calls transplant centers in its area to see if there are any potential matches.
TIME IS OF THE ESSENCE, SO IN some cases, distance can prevent transplants, even if there are potential matches, Heath said.
She said heart and lungs remain viable for transplant for only two to four hours after removal from the donor; liver and pancreas, 12 hours; and kidneys, up to 48 hours, although they are usually transplanted within 24 hours.
Tissue can be stored for longer periods, depending on type. All organs are infused with preservation solution, which removes the blood, and are packed in ice to be shipped to the hospital where the transplant will take place.
If for any reason the donor organ cannot not be transplanted, LifeBanc seeks a separate permission from the donor family to use the organ for research, Heath said.
Organ recipients are referred to LifeBanc by their physicians. They are evaluated to make sure they would be a good candidate, which basically means are they healthy enough to survive surgery and-or do they have other health issues that might cause loss of the organ, Heath said.
There's more to it than matching blood types and physical size to determine placement on the transplant list. It can also depend upon how badly a person needs a transplant.
For example, Heath said, someone designated Status 1, which is literally days from dying, would move to the top of the list. Status 2 means a person is ill and needs an organ, but is not in immediate danger of dying.
Why there's a shortage
HEATH SAID THERE ARE A number of reasons for the shortage of organ donors.
First, of all the people who die everyday, only 1 percent or 2 percent are declared brain-dead, making them potential organ donors. If heart death, called cardiopulmonary death, occurs, donation may be limited to tissue and eyes.
Of those declared brain-dead, some can't become donors because of infection or because the coroner says the body can't be disturbed.
In other cases, the potential donor has not talked to next-of-kin about their wishes, and the family does not wish to go forward, Heath said.
It is very important that people who want to be organ donors make their families aware of their desire. Even if an individual signed a donor card or said yes on their driver's license, the family can stop the process, Heath said.
Once transplants are completed, donors and recipients can communicate anonymously with each other through LifeBanc. About two weeks after the transplant, LifeBanc informs the donor family about the outcome of the surgery. LifeBanc does not provide identification to either party.
Transplant centers serviced by LifeBanc are: Cleveland Clinic Foundation, University Hospitals of Cleveland, Akron City Hospital of Summa Health Care System, and St. Elizabeth Health Center (kidneys only) of Youngstown.
LifeBanc also serves three tissue banks: Mid-American Tissue Center, now part of LifeBanc's Tissue Services in Massillon; the national Musculoskeletal Transplant Foundation; and the Cleveland Eye Bank. Also, LifeBanc recently became affiliated with LifeNet, the largest nonprofit, full-service tissue bank system in the United States.
LifeBanc is a member of the United Network for Organ Sharing, a national computer network that matches donor organs with potential recipients.
Information about becoming an organ donor can be obtained by calling LifeBanc at (216) 752-5433 or (888) 558-5433. LifeBanc's Web site is www.lifebanc.org.