Organ/Tissue Donation: From The Death To The Living
What is Organ/Tissue Donation?
Based on Human Tissue Act 1974, organ donation is defined as the use of parts of deceased persons’ human bodies for the following purposes; therapeutic, medical education and research.
Organ donation is a surgical procedure involving removal of organs from donor. These organs will be used for transplantation and the above-stated purposes. In general, there are two types of organ donation namely:
- Deceased organ donation or cadaveric donation
- Living organ donation.
This article shall elaborate the first type of organ donation; deceased organ donation, where the organs and tissues are obtained from cadaveric donors. Cadaveric donation comprises organ donation – that is, taking organs (heart, lungs, kidneys, liver, pancreas) from brain dead people, as well as tissue donation, meaning taking tissues (skin, corneas, tendons, bone) from brain dead as well as heart of the dead people.
Who Can Donate Organs or Tissues?
Any person can be an organ donor as there is no age limits for donors. By law, if any person either in writing or orally (with two or more witnesses) has requested that his/her body or any parts of the body to be used for therapeutic, medical education, or research purpose, he/she is a donor.
In Malaysia, however, children and people with mental disorders are not allowed to donate organs while they are still alive. Prisoners are also not allowed to donate organs unless under life threatening conditions involving family and close relatives with approval by Ministry of Health and other related authorities.
Becoming an actual organ donor is very much depends on where and how a donor dies. Suitability of the organs is assessed by specialized health professionals. Those with transmissible diseases such as HIV, Hepatitis B or C, and Syphilis are not permitted to donate their organs.
To be an organ donor, the potential candidate must be in good health. Depending on the evaluation and decision of transplant team, certain medical conditions may prevent a person from donating.
Types of Organs/Tissues can be Donated
Many types of organs and tissues can be donated. These include heart, kidneys, intestines, liver, lungs and pancreas. Tissues can also be donated, including corneas, heart valves and skin.
Someone who has died may donate kidneys, liver, heart, and lungs. Tissues like cornea, heart valves and bones may also be donated.
Procedures in Organ Donation
Should a person wish to be an organ donor, he/she is advised to inform family, friends and physician upon their intention to be a donor. In order to declare as an organ donor, a person should later fill out a consent form and a donor card according to the system practiced in their respective country.
In Malaysia, we practice an opting in system for deceased organ donation where retrieval of organs or tissues requires consent from family members.
Under the circumstance of brain dead donor, the organ transplant procedure is done by surgeons in the operating theatre. In broader scope, forensic pathologists are involved in cadaveric tissue donation as well as taking tissues from cadavers for the purpose of diagnostic autopsy, research and training.
Several tissues may still be taken from ‘true’ cadavers for the purpose of transplantation. In this case there will be collaboration of forensic pathology team and the surgeons. The process of harvesting the tissues will be conducted in the autopsy room.
Role of Forensics in Organ/Tissue Procurement
In the aspect of forensic medicine, forensic pathologists and their team (e.g. medical examiners and medical assistants) play an important role in tissue and organ procurement process for transplantation. They hold responsibility to or not to authorize organ and tissue procurement process on case-by-case basis since many donors fall under medico-legal jurisdictions.
The role of forensics in organ and tissue procurement process can be listed as below:
- Authorization of organ and tissue procurement process, since majority of persons who are suitable and eligible for organ donor fall under medical examiner jurisdictions.
- Determining and certifying the cause and manner of death.
- Authorization or denial of tissue removal from the deceased in order to strengthen the opinion in determination the cause and manner of death.
- Completion of external and internal examination upon opening of the body, such as injuries or blood within the cavities.
- Collection, preservation and documentation of evidence.
- Providing the facilities and equipments (e.g. autopsy room and autopsy sets) in organ and tissue procurement process of ‘true’ cadaver.
Facilities Involved in Organs/Tissues Procurement
Organs and tissues procurement following cardiopulmonary death are usually conducted in the mortuary. For dead brain donor, the procedures are carried out in the operating theatre. For living organ donation, the process can be conducted in most of government and private hospitals as well as at home (eyes donation only)
After procurement, these organs and tissues are processed in various tissue bank facilities such as:
- Tissue Bank, Universiti Sains Malaysia (HUSM)
- Bone Bank, Hospital Kuala Lumpur (HKL)
- Corneal Bank, Hospital Sungai Buloh
- National Heart Institute (IJN)
- Malaysian Nuclear Agency (for sterilization process)
Donated organs and tissues will be used for transplantation which can only be performed in accredited facilities established by Ministry of Health.
Teams Involved in Organs/Tissues Procurement
In most cases both the forensic medicine team and the surgeon team will be present during the procurement process. The forensic medicine team include Forensic Pathologist, Medical Officer, Medical Assistants, and ‘Pembantu Perawatan Kesihatan (PPK)’. The respective Surgeon, Medical Officer, Health Officer, Medical Assistant and Staff Nurse are of the surgeon team. These teams will works side by side in order to ensure that the organs and tissues are properly harvested without deforming the original physical appearance of the donors’ body.
Upon pledging as an organ/tissue donor, a person shall receive a donor card. This donor card is used to identify an organ donor in any event of his/her death. This card is also used as a consent from him/her.
In Malaysia, there is a high demand in organ donation because of an increased number of patients in need of transplant. The removal of organs and tissues from the donor will not cause deformation or disfiguration of the body. From religious perspective, organ donation is permissible because organ donation and transplantation fulfill the aim of saving and preserving human lives.
Awareness of the importance of organ and tissue donation should be spread to every level of society. This role should be played by both government and private sectors as to date; our country has more than 16,000 patients waiting for organ transplantation (mainly kidneys). A deceased donor can save at least eight patients by donating his/her organs and tissues.
- Cadaveric Tissue Donation: A Pathologist’s Perspective, Journal of Medical Ethics, 29:135-136, 2003
- Human Tissue Act 1974, Laws of Malaysia (Reprint), The Commissioner of Law Revision Malaysia, 2006
- Living Organ Donation: What You Need to Know, Transplantation Unit, Medical Development Division, Ministry of Health Malaysia, 2011
- National Association of Medical Examiners Position Paper on the Medical Examiner Release of Organs and Tissues for Transplantation, The American Journal of Forensic Medicine and Pathology, Vol.28 No.3, 2007
- Organ Donation, The Journal of The American Medical Association, Vol.299 No.2, 2008
- Transplantation Unit & National Transplant Resource Center. Website: http://www.dermaorgan.gov.my/en/
- Who can be a Living Organ Donor? Questions and Answers about Live Organ Donation, 2012.
|Last Reviewed||:||8 September 2015|
|Writer||:||Nor Asyikin bt. Suaidi|
|Accreditor||:||Saravanakumar a/l Maniam|