Every year a number of grieving families will be asked to donate tissue following the death of a relative. The consequences of their decision have implications for patient’s awaiting transplantation, and the donor families.
Tissue is donated to infants requiring cardiac surgery for survival; burns victims dependent on skin; children who face limb amputation due to bone cancer; athletes with shattered tendons, and people of all ages who require eye tissue to see.
It’s vital that donor families (and people yet to decide about donating), know that their gift is of enormous value to the recipients of the transplanted tissue, their families and community. And, equally importantly, that the process is well regulated.
Recent investigations have revealed the dark side of human behaviour by exposing corruption in poorly-regulated international tissue donation practices. They’ve raised questions about the illicit trade in body parts and profiteering from donated tissue.
It’s no surprise that tissues (like organs) are hugely valuable. They’re difficult to substitute artificially, and provide transformative therapeutic benefits. Like organs, tissue is a scarce resource and its value and method of recovery is poorly understood and obscured behind the veil of death.
Although most of the horror stories are generally confined to overseas practices, they add to the sense of disquiet some feel about donating body parts. And they counter the efforts of pro-donation public awareness campaigns to dispel the negative aura around giving body parts to others.
Could it happen here?
It’s important to examine the Australian experience after such revelations because there has to be transparency in donation processes so families can confidently give the gift of tissue, and where possible, organs.
In Australia, strictly regulated organ and tissue donation processes protect the public and are the responsibility of the Therapeutic Goods Administration (TGA) along with various other professional, medical and specialist bodies. And recent legislation makes the traffic and sale of organ and tissue a crime. This aligns with Australia’s status as a signatory of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, an international collaboration to address the organ trade.
Perceptions are important and opportunities for exploitation exist whenever clinical, legal and regulator processes are unknown. Importantly, the community needs clarity about what to expect when a decision to donate tissue (or organs) is made on behalf of a relative. People need to be confident that strict regulatory processes are in place. And an important first step is to know what tissue donation is.
What is tissue donation?
In the context of therapeutic organ and tissue donation, tissue is specialised cellular structures that can survive without blood flow (and oxygen), for periods up to 24 hours, and are transplantable. This means that following most deaths (defined as breathing, heart and circulation have stopped, followed by brain function), it’s possible to donate tissue for up to 24 hours. This tissue can then be preserved for future use.
Tissue includes corneas (membrane on the surface of the eye), heart valves and vessels, tendons, skin, bone, pancreatic islets. But organs (heart, lungs, liver, kidneys, pancreas, intestines) perform specialist processes and their cells require a constant flow of oxygenated blood. Without circulation, the cells die and organs stop functioning within a very short time (minutes).
This means that unless there’s an extremely high expectation that a death will happen at a predicted time (enabling all the family agreements, legalities, processes, surgical teams and recipients to be in place when circulation stops and death is declared), donation surgery is pointless because the organs will not survive. This is why organ donation is rare.
Brain death is linked to organ donation because it’s the only instance when, despite confirmed death (no blood flow to the brain or brain function), critical care experts can keep organs functioning until everyone has agreed and all requirements are met for organ donation surgery. With family agreement, the deceased is then transported (with the technology still preserving respiration, heart beat and organ function) to the operating theatre. This allows the organs to be recovered within minutes of the heart stopping.
It’s not uncommon to hear the term organ donation used interchangeably with tissue donation. This normally doesn’t matter but, when a family is being asked to donate, knowing the difference is extremely important. Unambiguous information about what happens when a decision to donate is made is vital for public confidence. And transparency protects the interests of deceased donors, their families and recipients.
When the needs of patients waiting for transplantation are subverted by distrust about donation practices, our society is damaged. Knowing what to expect before making the decision will increase confidence in and consent for organ and tissue donation.
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