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Synopsis About this title Rates of organ donation lag far behind the increasing need. Liverman, Editors "About this title" may belong to another edition of this title. Buy New Learn more about this copy. Customers who bought this item also bought. Stock Image.
Organ Donation: Opportunities for Action : Health and Medicine Division
Published by National Academies Press New Paperback Quantity Available: 2. Seller Rating:. New Paperback Quantity Available: 1. New Quantity Available: 1. Childress Editor , Catharyn T. Liverman Editor. Once a person reaches the top of the waiting list, they will receive a transplant when the next matched donor becomes available. When an organ is available, the person seeking a transplant must respond quickly to the call from their doctor.
Surgery may occur within just a few hours of this call, as organs cannot survive for long outside of the body. After the transplant, the organ recipient will need to stay in the hospital for a few days as doctors monitor their condition. The length of their hospital stay will depend on various factors, including how well the surgery went and the organ recipient's overall health.
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Organ recipients who get sick can become severely ill. Their body may even reject the new organ, so it is important to see a doctor for any signs of infection such as a fever. Recipients must take anti-rejection medications , as well as other types of medication, to support their long term health. These medications prevent rejection by weakening the immune system, which lowers its ability to fight infections such as the flu , so it is important for the organ recipient to avoid infections.
New era for organ donation and transplant in China
Every day, more than 80 people in the U. Many more need to. According to the U. A single deceased donor can save up to eight people's lives, as well as improve the lives of more than people by donating tissue. Myths around organ donation deter some people from donating their organs. The following statements are untrue :.
Donating an organ is free and can save or lengthen a person's life.
Many people can live long and healthy lives with the help of an organ donor. How an organ transplant will affect a person's life expectancy varies depending on their age, the organ transplanted, and the reason for the transplant. Not all transplanted organs last forever. A kidney from a living donor lasts an average of 12—20 years, whereas a kidney from a deceased donor lasts around 8—12 years. For people who need an organ, finding a donor may take weeks, months, or longer.
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- Organ Donation: Opportunities for Action.
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There are two legal ways to obtain an organ:. There are two types of donor :. It is illegal to buy or sell organs.
Missed Opportunities: The Institute of Medicine Report: Organ Donation: Opportunities for Action
Some nations, including Iran, allow paid organ donation. Sometimes, the system allows wealthy donors to pay much more for organs. This means that people in dire financial situations may be more likely to donate organs, raising concerns that they may sacrifice their health for financial gain. The benefits of an organ transplant depend on the organ a person receives.
Some benefits may include:. Most people who need an organ will die or live a much shorter life without a transplant. However, organ transplants are risky surgeries, especially since those who need them often are very ill.
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Some risks associated with organ transplant surgery include:. The outlook for a recipient depends on the organ they receive, the reason for the transplant, their age, their overall health, and other factors. Some people may need another organ transplant. A very young kidney recipient, for example, might outlive their organ.
Others may live long lives without the need for another organ. Most people, however, will need ongoing medical care, and they must continue to take anti-rejection drugs. It is vital to discuss the risks and benefits of organ transplantation with a doctor. Because lifestyle directly affects organ health, including that of transplanted organs, organ recipients should talk with their doctor to get advice on how to lengthen their lives and protect their organs.
Article last reviewed by Tue 2 July All references are available in the References tab. Barnieh, L. The cost-effectiveness of using payment to increase living donor kidneys for transplantation. Facts and myths.
To address its charge, the committee held five meetings and gathered information by holding a scientific workshop see Appendix B for the workshop agenda and two public comment sessions, talking with numerous individuals in the organ transplantation field, and conducting a literature review. The committee developed a set of perspectives and principles that guided its consideration of the complex issues that it was asked to address Chapter 3.
This report benefits from the work of prior IOM committees that examined organ allocation and donation after circulatory determination of death IOM, , , However, this report focuses on organ donation, not on the equally complex issues of organ allocation. Furthermore, it focuses on solid-organ donation and does not address eye and tissue donation. Finally, this report concentrates on increasing rates of deceased donation and considers living donation only briefly in Chapter 9.
To set the context for the report, this chapter provides an overview of the history and current status of the U. In , the first successful U. Immunosuppressive medications began to be used in the late s, leading to the first successful transplantation of a kidney from a deceased donor in Halloran and Gourishankar, This transplantation involved an unrelated donor and recipient and the use of the immunosuppressive drug azathioprine Morrissey et al.
Cyclosporine, discovered in , provided significantly improved immunologic tolerance; and numerous subsequent pharmacologic, surgical, and clinical advances have continued to improve the rates of graft survival and reduce the potential for organ rejection. The growth and development of the field of organ transplantation and the nature of its organization and structure have been guided by state and federal laws and regulations Box Clarifying Criteria for Determination of Death The early transplants were generally the result of donations of kidneys from living donors or donations of organs from deceased donors who had been declared dead following the irreversible cessation of circulatory and respiratory function DeVita et al.
In the late s, improvements in mechanical ventilation and other types of medical support to sustain cardiopulmonary function highlighted the need to clarify the criteria for determining death. This led to clarification of the determination of death by circulatory criteria and to examination of the concept of determining death by neurologic criteria Report of the Ad Hoc Committee, ; Guidelines for the determination of death, As a result, in addition to clarification of the criteria for the diagnosis of death by irreversible cessation of circulatory function, criteria were developed for the diagnosis of death based on the irreversible loss of function of the whole brain, including the brain stem neurologic criteria.
For each set of criteria the diagnosis of death requires both the cessation of function and irreversibility Guidelines for the determination of death, The use of neurologic criteria for the determination of death has gained wide medical, legal, ethical, and public acceptance in the United States, although debates continue Bernat, ; Laureys, In , legislation authorized Medicare coverage for kidney transplantation as a treatment for endstage renal disease.
In , amendments to that legislation increased the length of availability of Medicare benefits after a successful kidney transplant from 1 year to 3 years and also increased coverage of kidney acquisition costs and home dialysis costs Eggers, The next breakthrough in transplantation came with the advent of reliable and effective immunosuppressive medications to improve graft functioning and survival for patients posttransplantation. The growing demand for organ transplantation, controversies regarding the allocation of organs, and concerns about payment for organs prompted congressional hearings on organ transplantation in the early s.
The resulting federal legislation, the National Organ Transplant Act of , prohibited the sale of human organs; established a task force to address organ donation and allocation issues; and established the Organ Procurement and Transplantation Network OPTN. OPTN is charged with developing policies for and implementing an equitable system of organ allocation, maintaining the waiting list of potential recipients, and compiling data from U. Department of Health and Human Services. OPTN has limited responsibilities regarding living donation and does not have oversight responsibilities regarding tissue donation and distribution, although most OPOs recover tissue as well as solid organs, and a few OPOs are involved in tissue processing.
Currently, the organ donation and transplantation system in the United States is coordinated by 58 OPOs serving unique geographic areas donor service areas Figure When a donated organ becomes available, the organ allocation algorithms developed by OPTN-UNOS identify a potential recipient on the basis of multiple factors, including severity of disease; geographic proximity; and blood, tissue, and size matches with the donor. Ongoing efforts are made to ensure impartiality in the allocation process. Reprinted courtesy of the Association of Organ Procurement Organizations. In addition to the OPOs, the other key organizations involved with organ donation are the donor hospital and the transplant center.
Although organ donation, recovery, and transplantation may all occur in the same medical center, it is often the case that the organs are recovered in the donor hospital and are then transported to several transplant centers in the region or across the country. This represents significant growth from the transplant programs functioning in UNOS, Some of the challenges in further improving the organ donation system result from the heterogeneity of the OPOs, donor hospitals, and transplant centers, each of which serves populations with different demographics.
Furthermore, the priorities and norms of the OPOs vary, such as in their approaches to families and their policies on donation after circulatory determination of death Chapters 4 and 5. For example, there is variability in the rates at which consent is obtained for deceased organ donation in various transplant centers and OPOs Chapter 4. A study examining the variability among transplant centers found that 30 centers 16 percent had consent rates of 70 percent or higher, whereas 18 centers had consent rates below 30 percent DHHS, This is similar to the variation of donation rates reported by OPOs, which ranged from As discussed throughout this report, efforts by OPOs and participating hospitals to increase the availability of organs for transplantation are focusing on increasing the consent rate for donation as well as on increasing the population of potential donors.
Although this report focuses on solid organ donation, many of the matters it discusses are closely tied with tissue donation. However, the tissue recovery and distribution system is quite different, particularly in the extent of private-sector commercial involvement. The resulting issues and challenges impact both the solid organ and tissue donation and recovery systems Youngner et al. Deceased Organ Donation In the United States, deceased organ donation is an opt-in system in which the donation decision is made by the individual or by his or her family.
Most current U. The donor-eligible deaths determined by neurologic criteria—estimated to number between 10, and 16, per year—represent only a small fraction of the more than 2 million annual deaths in the United States Guadagnoli et al. For deaths determined by neurologic criteria, organ viability can be maintained through ventilatory support and thereby improve opportunities for successful transplantation. Death determined by circulatory criteria is much more common in the population at large, but, because it often occurs outside of the hospital setting, maintaining the viability of the organs presents distinct challenges Chapter 5.