Organ Donation and Transplantation - How do people who have died donate kidneys?
- Most kidneys come from people who have died, called ‘deceased donors’
- Kidneys are removed with the permission of the donor’s family
‘Deceased donor’ transplants
The term deceased donor (or previously cadaveric) transplant is used to describe a transplant kidney that has been removed from someone who has died. About 2/3 of transplant kidneys in the UK come from this source.
Causes of Death
Most of these donors have been killed in car accidents or died from a brain haemorrhage, and have been on a life support machine in an intensive care unit. Their kidneys can only be removed after they have been diagnosed ‘brain dead’. This means that the part of the brain called the brainstem, which controls breathing, has stopped working permanently and that they are capable of living only if they are kept on a life support machine. When the brainstem is dead, there is a permanent loss of consciousness and all feelings (Click here for more detail on brain stem death).
If the donor is on a ventilator (life support) machine, they are taken to theatre for donation while the ventilator is working and their heart is beating. This is called ‘Donation after Brain Death’ (DBD). It used to be called donation from a heart beating donor. Even though the heart is still beating, they would not breathe if they were not on a life support machine. Their brain is dead, and they have no chance of recovery, and indeed they have already been certified as legally dead by doctors from the intensive care unit.
Permission from the donor family
In the UK the wishes of the family used to determine whether someone’s organs were used for transplantation after they died. Now, however, the stated wishes of the donor are taken into account. If someone has put their name on the national organ donor register, then their wishes have priority after death. If someone is not on the organ donor register, then the wishes of the family determine whether organs are donated. In some parts of Europe, the law has been made so that the State can take organs without consent, and some people think that should be the case in the United Kingdom. However, at present, so long as the family can be contacted, they have the final say in whether the kidneys can be used, unless the donor had previously put their name on the Organ Donor Register. This means that deceased donor kidney donation is a gift, even though it may come from tragic circumstances (click here for more details on the donor family and how kidney patients feel about kidney transplants).
Donation after circulatory death (DCD)
Many transplant units are obtaining transplant kidneys from people whose hearts have stopped beating. Their hearts have stopped beating and they are brain dead. About 40% of deceased donor kidneys come from non-heart beating donors.
Kidneys from DCD donors often do not work immediately (sleepy kidney) after transplantation and are not quite as good as those from DBD donors. If you are offered a transplant, you can ask whether it is from a DBD or DCD donor. You have the right to know this, though you will not be told many other details about the donor.
Adapted from ‘Kidney Failure Explained’ by Janet Wild and Andrew Stein, published by Class Publishing.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.