Glossary of Donation Terms

Brain Death

What causes brain death?

Brain death results from a major injury to the entire brain. Often brain swelling has injured the brainstem, which connects the brain to the body. This injury cannot be reversed. Brain death is often caused by traumatic head injury. Other causes are brain hemorrhage (bleeding) and cardiac arrest followed by CPR.

How can doctors know for sure when a person is brain dead?

The doctor will examine the person carefully. He or she also will use several tests to make the diagnosis. A ventilator must be used to keep the body functioning. Tests given to stimulate breathing show the person cannot breathe without the ventilator. The doctor also will rule out any conditions that may make the examination unreliable.

Examples are extremely low body temperature and evidence of alcohol or drug use (prescription or other drugs). Sometimes the doctor will confirm the examination results with a laboratory test. However, usually the examination is enough for diagnosis.

What happens after a brain death diagnosis is made?

After the diagnosis, the doctor will go over next steps the family must take to make important decisions. These include discussion of organ donation with a representative of LifeShare. If organ donation does not take place, the doctor will turn off the ventilator and any other support machines.  In either scenario, the surviving family members are given time to say their good-byes to their loved one.

Donation After Cardiac Death (DCD)

A DCD is a patient who is on a ventilator and has minimal brain function, is not expected to survive, and whose family wants to discontinue mechanical support. The family, physicians and OPO staff determine the time and place of ventilator withdrawal. This usually occurs in an operating room so that the organ procurement process can take place soon after cardiac death is declared.

DCD recovery will only occur after the family has provided written consent for organ donation. These donors are also declared dead by a medical professional not affiliated with the organ recovery team before LifeShare can do anything related to the patient’s care.

Directed Donations

News events have sparked public questions regarding directed donation. The following information is intended to address common questions about the practice.

Directed donation is a request made by a donor or donor family to provide an organ for a specific recipient. This practice is legally authorized by the Uniform Anatomical Gift Act (UAGA) and by most state anatomical gift laws which use the UAGA as a guide.

The policy of the National Organ Procurement and Transplantation Network (OPTN) operated by the United Network for Organ Sharing (UNOS) recognizes directed donation as long as the agencies involved take steps to verify the medical suitability of the organ offer for the specified recipient. The federal regulation that guides the OPTN expressly allows directed donation to a named individual.

In recent years, at least 100 deceased donor transplants each year have occurred through directed donation. Such requests occur most frequently when the donor or donor family either are related to the recipient or know the recipient personally.

In a number of instances, news reports of a celebrity needing a transplant have led to offers from the public to direct a donation to help that person. Given the power of celebrity status in our society, it must be expected that some individuals feel a connection to certain celebrities and will seek to help them personally. Most of the time either the celebrity has declined such offers or the person was not medically eligible to donate.

Living Donation

There are two methods of living donation: directed and non-directed. Directed donation takes place when donor and recipient know each other and the donor has agreed to give that recipient a transplant. Non-directed donation occurs when the donor does not know the recipient and chooses to donate as an act of kindness to someone in need. Living organ donors may donate a kidney, segment of a liver or a lobe of a lung.

Although there are health risks attributed to becoming a living donor, living donations are important and valuable because of the shortage of deceased donor organs. For many patients, the pre-transplant period is a long wait. With appropriate planning, use of a living donor makes it possible to reduce the waiting period and waiting list.

Those interested in becoming a living donor should contact the Transplant Department at Carolinas Medical Center at (704) 373-0212.

Paired Donation Exchanges

Paired kidney exchange programs help patients get a kidney when they have a willing, donor whose blood type is incompatible with their own.  In a paired kidney exchange, a kidney from such a donor is matched and transplanted into the recipient of a second donor-patient pair and vice versa. The transplants are performed simultaneously. It is estimated that paired exchanges could benefit about three percent of patients on the waiting list.