Organ donation/transplantation

Question 1

What organs/tissues can be donated?

Answer 1

The heart and heart valves
Lungs
Liver
Pancreas
Kidneys
Eyes
Skin

Question 2

How are donors identified from dead and dying patients?

Answer 2

Organ donors are always dead or dying patients in ICU

Brain death
- All organs and tissues

Circulatory death
- No heart donation
- Sometimes no liver donation

Death in a normal hospital ward, hospice or community
- Tissue-only donation (heart valves, skin, eyes)

Question 3

What can happen with a donated liver to give as many people a transplant as possible?

Answer 3

The left lobe of the liver can sometimes be given to a paediatric patient, while the remaining right lobe can be given to an adult patient

Question 4

Will smokers, heavier drinkers, and older patients be automatically eliminated as potential donors?

Answer 4

No, each donor is evaluated individually

Question 5

If “donor” appears on a driver’s license, will doctors aim to retrieve their organs rather than save their lives?

Answer 5

Absolutely not…just no

Priority is always given to saving the patient’s life after an accident

Question 6

What is the principal aim of transplantation?

When is the ideal timeframe during a potential recipient’s disease progression for a transplant?

Answer 6

The principal aim of transplantation is to improve the survival of the transplant recipient

The ideal timeframe is before a potential develops systemic complications leading to death or becoming too sick for transplantation

Question 7

Does the US have an opt-in or opt-out donor system?

Does New Zealand have an opt-in or opt-out donor system?

Answer 7

The US has an opt-out donor system
- Presumed donation consent

New Zealand has an opt-in donor system

Question 8

What is involved in recipient assessment?

Answer 8

Surgical and medical consultations
- Is transplantation necessary and the best action? If not, what other options are there?
Education from the transplant coordinator
Liver imaging
Cardiac and respiratory assessment
Psychosocial evaluation
Nutritional assessment

Question 9

What is the necessary predicted survival rate after 5 years to be eligible for a liver transplant?

Answer 9

Greater than 50% chance of survival after 5 years

Question 10

What are some contraindications to liver transplantation?

Answer 10

Medical factors
- Extrahepatic sepsis
- Poor cardiac function/advanced coronary artery disease
- Diabetes with significant end-organ damage
- Advanced lung disease
- Extra-hepatic malignancy or history of malignancy with a
significant risk of recurrence

Psychosocial factors
- Lack of social support
- Uncontrolled psychiatric disease adversely affecting treatment compliance
- Ongoing alcohol or substance misuse
- < 6 months abstinence from alcohol
- High risk of relapse to drugs or alcohol

Question 11

What are some possible complications after a liver transplant?

Answer 11

Surgical
- Infection
- Biliary complications
- Hepatic artery/Portal vein thrombosis
- Pain

Recurrent disease
Rejection
Cancer
Nutrition/Obesity (Metabolic disease)