Understanding Donation

Deciding in favour of organ and tissue donation

Organ and tissue donation and transplantation offer patients in need a wonderful opportunity of healing and life. By becoming an organ and tissue donor, you can ensure that you leave a wonderful final legacy of love and hope in helping another.

What is the difference between organ and tissue donation?

The concept is the same: A person decides that after his/her own death, another individual should benefit from healthy organs and tissue through transplantation – rather than these being committed to the grave.

Organs are retrieved when a patient is brain stem dead, still in hospital and medically supported. About 1% of people die in circumstances in hospital that allow for successful organ donation. These circumstances seldom occur, however.

To put this into context, statistics show that the greater population will either pass away at home, at work or on the road, under circumstances that prevent successful organ retrieval. In such cases the donor can donate tissue, which is equally as valuable and life-altering to a patient in need of a transplant. This means that a far greater number of people have the opportunity to donate tissue.

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People from every walk of life depend on organ and tissue donations, regardless of race, origin, religion or language.

The need for organ and tissue transplantation is great yet impossible to overcome without people who, despite the pain and absolute finality of death, still find it within themselves to make the decision to help others in need.

Despite the fact that a person may be registered as a donor, SA law requires that the next-of-kin sign consent for the donation at the time of death. It is therefore vital that family members discuss donation well in advance to ensure that their wishes are fulfilled.

There are numerous myths surrounding the donation and retrieval process. Some people might think it is against their religion to donate, or worry that the procedure is disfiguring. Others wonder about the cost involved, or who in fact will benefit from their loved one’s donation. Even others think their loved one was too young, too old, or too sick to be a donor. The information provided on this platform is designed to address these questions.

Tissue donation

Human tissue donation and transplantation offer patients in need a wonderful opportunity for healing and in some cases may be life-saving.

Each year the lives of thousands of South Africans are transformed through the transplantation of donated tissue.

‘Tissue’ is described as Cornea, Skin, Bone and Tendons, and Heart Valves and donation is facilitated by a Tissue Bank. Different from organ donation, these tissues are retrieved from the donor after cardiac death. Depending on the type of tissue, retrieval of tissue can take place any time between 12 hours and 5 days after death. In the case of unnatural death, the retrieval of tissue often takes place after the Post Mortem examination.

Through the ‘miracle’ of tissue donation, tissue ‘grafts’ or transplants have made it possible for one donor to transform the lives of many people, and often multiple recipients will benefit from one multi-tissue donor.

  • Tissue donation makes skin grafts possible for thousands of critically burned patients every year.
  • Donated corneas avert or correct blindness.
  • Donor heart valves help repair cardiac defects or damage.
  • Bone, cartilage and tendon grafts help restore function and mobility in people who would otherwise be incapacitated or disabled, and are used to treat a wide range of medical conditions such as maxillofacial and orthopaedic injury, spinal surgery, and treatment of trauma.
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Everyone is a potential donor, and tissue is generally retrieved from people between 15 and 80 years, but cornea and heart valves can also be retrieved from small children.

The public is encouraged to discuss their thoughts about tissue donation with members of their family. Physicians and medical caregivers are encouraged to become familiar with the various donation possibilities and to pay close attention to the wishes of the family. Although not an easy task, offering the option to donate to a bereaved family often brings comfort in a seemingly hopeless situation, through the knowledge that their loved ones live on by way of helping others. The majority of religions support donation as a final act of compassion and generosity, and a means of showing love for another individual.

Human tissue donation and transplantation offer patients in need a wonderful opportunity at restorative health and quality of life; that would otherwise have been impossible.

Although thousands of patients receive tissue transplants annually, there is still a great deal of ignorance around the fact that donors are required, and that the selfless gift of one donor can enable doctors to treat up to 65 or more patients.

What tissue can be donated?

Eye tissue donation

Cornea and sclera (white of the eye) – donation of eye tissue facilitates corneal and sclera transplantation.

The cornea is the thin clear tissue which covers the coloured part of the eye (iris) and pupil. It allows light to pass through to the retina allowing sight. When problems develop in the cornea, people’s vision rapidly deteriorates. Disease, infection, injury and scarring can leave the cornea cloudy or distorted, causing vision loss.

Donated eye tissue can prevent blindness and can restore sight to people who are partially or completely blind due to corneal damage following a genetic condition, illness or injury.

Injuries such as injury on duty, for example chemical burns in the eye, or object injury due to a motor vehicle accident can cause severe damage to the cornea, and create a desperate need for corneal transplant.

Many South African patients urgently require corneal transplants but due to the shortage of corneal tissue only a fraction of people are privileged enough to receive the gift of sight.

Bone and tendon donation

Bone is the second most commonly used donated tissue (only blood is donated and received more regularly). Donated bone and tendons can be grafted to replace bone and ligaments that have been lost as a result of disease, tumours or injury, restoring health and in some cases independence and mobility.

Donation can enhance fracture healing, strengthen hip and knee joint replacements, replace torn ligaments or repair spinal deformities. Donation can also save a limb in a person who has developed cancer and would otherwise be facing limb amputation.

Without these essential transplants, the recipients’ opportunity to lead normal, healthy and active lives would be impossible.

Heart tissue donation

Sometimes, even in the case where the deceased’s heart is no longer beating, the organ may be donated and the aortic and pulmonary valves transplanted to correct a heart abnormality within another patient. Heart tissue donations are often used to repair congenital defects in young children and babies and to replace diseased valves in adults. Heart tissue donation allows transplants that improve or restore the patients’ health and quality of life, and sometimes save lives.

Whilst artificial valves and even certain animal valves can also be used, human heart tissue is preferable because it is more resistant to infection, and can enable the recipient to lead a life without the need for ‘chronic’ blood thinning medication. This factor makes human heart valves safer for women of childbearing age and allows children to lead normal active lives.

Skin donation

Only the very top outermost layer of skin (epidermis) is carefully removed from some areas of the donor’s body, to effectively treat burn victims. Uncontrolled shack fires cause life threatening burn wounds to thousands of South Africans every year, most of whom are children. Without donor skin these people suffer agonizing injuries and often face certain death.

Skin grafting has been medically recognised as the most effective way to minimise scarring and promote healing of severe burns. Children particularly need skin grafts as a small burn or scald can cover most of their body, and these skin grafts may prove lifesaving. A burn patient suffering with severe burns may need repeated skin grafts from numerous donors until their burns heal sufficiently.

When skin is donated, only a very thin layer (similar to tissue paper) is removed and the area from which it is retrieved looks like a light graze.

Living tissue donation

Unlike most other tissues, bone tissue can also be donated by living persons – this at the time of hip replacement. The femoral head can be donated to the tissue bank who will remove all the diseased parts of the tissue and then utilise the remaining bone in certain application. This tissue is then used in some Neuro and Orthopaedic procedures to improve quality of life in recipients.

Organ donation

Organ transplants such as heart, kidney or liver usually draw media attention because they are dramatic in that they are life-saving interventions.

All potential organ donors are patients on support systems. Two doctors, independent of the transplant team, are required to perform detailed tests before the patient may be declared brain dead. Once brain death is certified, the death is then documented and the option of donation offered to the family in a sympathetic and sensitive manner.

The criteria for brain death is very strictly adhered to and accepted medically, legally and ethically in South Africa and internationally.

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Once consent has been obtained from the donor family transplant arrangements will begin. The organ transplant takes place after the patient has been declared brain dead, but whilst still being supported on a respirator; and the transplant recipient will receive the donated organ shortly after retrieval. Organs are retrieved in a hospital theatre and transplanted within only a few hours.

Currently thousands of South Africans are waiting for a life-saving organ transplant, but the situation is such that very few of them will actually receive a life-saving transplant in time. Unfortunately less than 1% of the population are currently registered as organ donors.

The need for organ and tissue transplantation is great yet impossible to overcome without people who, despite the pain and absolute finality of death, still find it within themselves to make the decision to help others in need.

Living organ donation

Although most organ donations take place after a donor has died, living donation is possible in some cases.

In South Africa, a live donation (one kidney or part of the liver) may be done to save the life of a patient in need, once certain requirements have been met (blood group and tissue type match). Usually living donors are family members, but in some cases may be complete strangers. The more compatible the blood groups and tissue types the better the chances of transplant success.

Full body donation

Fully body donation is in no way related to transplantation. This is the donation of the donor’s body to the Anatomy Department of a University, and is usually documented by the donor prior to death.

The donor body is preserved for use in the education of medical and other students, and in some instances medical procedures may be practised on the donor body for research purposes.

After a period of some 2 to 3 years, and if so agreed with the relevant University, the donor body will be cremated at the University’s expense and the donor ashes returned to the family.