Less than 100 deceased organ donations take place in South Africa every year, while around 5000 patients are on the waiting list for an organ. This is according to the South African Transplantation Society and the South African Transplant Coordinators Society.

Dr David Thomson is an abdominal (kidneys and liver) surgeon at Groote Schuur Hospital in Cape Town and former president of the Transplantation Society. He says there is a need to focus on how end of life care is presented in conversations with families of deceased donors. End of life care can be understood as support that is dedicated to people in their final months or years of life. It goes hand-in-hand with the organ donor referral process by facilitating the understanding of organ donation to the family of the potential deceased donor.

“All organs are in short supply and the demand outstrips the supply in all countries. Improving education around end of life care is important in addressing cultural and spiritual beliefs about organ donation in families,” says Thomson.

Thomson adds that end of life care is about how doctors communicate and handle the families in their time of grief, when the topic of organ donation is brought up. Donation needs to be separated from the discussion about the patient’s medical condition. Families need to understand that organ donation and talking about it is still a dignified process that is a part of end of life care. This can potentially increase deceased donor numbers.

Samantha Nicholls, executive director of operations at the Organ Donor Foundation adds that a contributing factor to the shortage of donors is that there are too few transplant coordinators in South Africa to facilitate the process of donation. 

“If there were more coordinators available, it would dramatically increase the opportunity for face-to-face interaction between medical professionals and donor families. That could dramatically increase the consent rate for donations.”  

In addition, she says that more training of ICU/trauma unit staff on how to approach the subject of organ donation is needed to improve the consent rate from families. 

Becoming a donor

A person can still donate some organs and tissue while they’re alive. There are two types of live donors: an elective donor and an altruistic donor. 

“An elective donor is usually a family member of the recipient, which ensures a higher success rate due the compatibility of the blood group and tissue type. This donor may also be a person who is not related, but knows the recipient, such as a friend,” says Nicholls.

An altruistic donor is a person who donates an organ to a stranger. The donor and recipient are strangers and neither the donor, nor the recipient’s identity, can be revealed.

“All potential live donors are assessed by medical professionals, a psychologist or social worker to ensure that the donor and recipient are a blood and tissue match, that they [donor] are physically and emotionally healthy, that the donor understands the risks, and wants to donate for the right reasons,” explains Nicholls.

All non-related and altruistic donations have to be approved by the National Department of Health to ensure that there is no money or favours being exchanged to coerce the donation.

What is the process?

For the donation of organs, such as lungs, the heart, and the liver, the process has to start with the doctor looking after the deceased patient. Their role is to talk about the end of life and present the option of organ donation to the grieving family. Followed by a referral to the transplant team.

The next step is for the patient to be legally certified dead by two doctors who are independent from the transplant team, to ensure that there is no conflict of interest. Registering as a potential donor on the registry is not considered to be informed consent and is not enough to initiate the donation of organs once one is certified dead. There needs to be informed consent from the deceased patient’s family before organ donation can take place.

“Informed consent means that the decision maker on behalf of the deceased patient has to give permission for the organs to be donated. We still need the explicit permission of the family to move forward,” explains Thomson. 

The medical manager of the hospital where the organs are going to be recovered must also give permission.  

“In the case of an unnatural death, we also need permission from a forensic pathologist. The surgeon would then also write a report on the condition of the organs,” says Thomson. 

The allocation of organs is based on who’s been waiting the longest, who’s the best match, and then preferentially allocated within the blood group. 

Other considerations

The donor and their family aren’t charged any costs. The hospital or Tissue Bank cover medical expenses from the moment a family gives consent for the donations of organs/tissue.

Having HIV doesn’t exclude potential donors because there is a waiting list of patients with HIV who need organs too.-Health-e News