April 16, 1999

More than 55,000 Americans are waiting for transplants – from kidney, heart, liver, pancreas, small bowel and lung transplants to donated tissue such as bone, heart valves, eyes and skin. According to the New England Organ Bank, only 5,400 organ donations were made in 1997. Approximately 4,000 patients died as they waited for needed donor organs.

Francis Delmonico, MD, director of MGH Renal Transplantation, is medical director of the New England Organ Bank. He says the reasons why donations are so few include a limited pool of potential donors and a reluctance of some families to consent to donation.

Organ donation is considered only after a potential donor is determined to be brain dead, a circumstance that applies to a very small number of patients. Under strict medical criteria, brain death occurs when all brain activities have ceased and breathing and heart function can no longer be maintained independently. Tissue donation does not require brain death circumstances.

Coordinators from organ banks can help hospital staff deal with issues surrounding donation. As the MGH donor coordinator from the New England Organ Bank, Kris Frank, RN, CCRN, helps to clarify donation policies to make sure that potential donors are identified. Once a potential donor is identified, Frank, working with the caregivers, approaches the family about donation. "My goal is for families to be dealt with in the most sensitive manner possible," says Frank. "I believe that every suitable family has the right to be offered the opportunity to give their loved ones' organs, and my job is to make sure they have the information to make the decision that is right for them."

The Health Care Financing Administration recently enacted a federal regulation requiring that the option of organ and tissue donation be offered to families of all appropriate patients. Under the new regulation, hospitals must report all deaths and impending deaths to a designated organ procurement organization. The regulation is a Medicare "condition of participation" that requires all hospitals to comply to obtain Medicare payment.

"The transplant community anticipates that this new regulation will enable organ banks to become aware of all potential organ donors," says Delmonico.

During National Organ Donation Week, April 19 to 23, the MGH Transplant Unit will host an information table April 19, 20, 22 and 23 in the Main Corridor next to Coffee Central. Organ donor T-shirts will be on sale to benefit the MGH Transplant Education Fund. For more information about organ donation, call Frank at 6-9220.

Please see "One family's experience with organ donation," in this issue.