Introduction to organ donation (brain death patient)

Organ transplantation using the organs of a dead person (corpse) has long been in the human mind.

From time immemorial, man has attributed death to the cessation of heart and lung function. The first transplants of the corpse were performed in such a way that the organ was quickly removed from the deceased person and transplanted to another person.

This method is still used in many countries; However, it should be noted that using this method for transplantation is associated with many problems. When blood flow to an organ is cut off due to cardiac arrest, that organ suffers a lot of damage that will impede the success of the transplant.

Gradually, in the 1950s, another concept of death was introduced, and that death was due to coma or irreversible coma or brain death. The concept of brain death was first defined in 1968 by a group of physicians and ethicists at Harvard University in the United States.

According to this definition, a person suffering from brain death:

1- Has no understanding and response to environmental stimuli.

2- Has no spontaneous movement or breathing.

3- Has no reaction or reflex.

People with this condition will usually experience cardio-respiratory arrest within a few hours to a few days. It should be noted that so far no disease has returned to life from this condition. It is sometimes heard that people come out of a coma and wake up; But the cause of their coma was not brain death.

This form of death in our country has also been approved by legal and religious authorities. Brain death is a scientifically, legally and religiously recognized form of death, and if the patient’s relatives consent, the organs of the person with brain death can be used for transplantation. Because this form of death eventually leads to cardio-respiratory arrest (the usual form of death), there is little time for organ donation.

The advantage of organ donation from a brain-dead donor is that the organs are removed from the body in a state where blood flow and oxygen supply to the organ are still maintained, so the transplant is more likely to succeed than organ donation from a person with cardiopulmonary arrest.

There are special laws in the field of confirming brain death in our country. First, at least two doctors who are not the patient’s direct physician must confirm brain death. Sometimes it is not possible to confirm brain death by clinical examination alone; Other tests, such as an electroencephalogram or angiography, should be done to prove that the brain has no blood supply or no electrical activity in the brain.

Numerous organs such as the kidneys, liver, pancreas, heart, lungs, bones, cartilage, cornea, and small intestine can be removed from a brain-dead patient for transplantation to patients in need.

Because a person with brain death quickly develops multiple organ disorders and eventually cardio-respiratory arrest, it is necessary for a team familiar with these issues to take care of the patient to control the disorders and optimize blood flow to these organs. Until the organ donation and finally the transplant is successful.

Despite the organ donation card, people in our country can express their desire to do so in the event of brain death, but it should be noted that the full consent of the patient’s family is still required for organ donation after brain death. Satisfaction in this situation is very difficult for the patient’s family and is associated with sometimes conflicting emotions and feelings, so it is necessary for doctors and staff to explain these issues to the patient’s family with full sobriety and full awareness.

After the patient’s family consent and additional tests to check the health of the patient’s organs and the existence of cases that exclude organ donation (such as some infections), the person is transferred to the operating room to have his organs removed for transplantation.

During this operation, blood must be completely removed from the organs and the organs must be cooled until they are transplanted into another person’s body. Keep in mind that even this process damages the organs, so the organ must be transplanted to the recipient as soon as possible. This time is 3 to 4 hours for the heart and lungs; Therefore, all arrangements must be made in advance for the organ to reach the recipient as quickly as possible and for the transplant to take place as soon as possible.

Today, attempts are being made to reconstruct the body exactly outside the body using special pumps so that the organ is less damaged.

Using the organs of patients with brain death today in many countries, including our country Iran is one of the important ways to provide organs for transplantation to patients in need. For example, in our country, 2500 kidney transplants are performed annually, more than half of which are organs of patients with brain death.

Of course, not all patients with brain death are candidates for organ donation, or sometimes their families do not consent to organ donation, so organ shortage has become a problem in many communities for transplant patients.

Therefore, other ways must be found to reduce the problem of organ shortage. One of these ways is to use the organs of living people, which is used in certain cases, such as kidney and liver transplants, and sometimes lung transplants.

Dr. Reza Saidi Firoozabadi – Transplant surgeon