Who do I tell if I want my organs donated after I die?
Though this topic is not typically brought up in a palliative care conversation (read Post 1: What Exactly Does a Palliative Care Specialist Do?), occasionally someone will ask me, "Who do I tell if I want my organs donated after I die?"
The decision to donate is a highly personal, generous decision. Once a person has made this decision, they can take action by either of the following:
- registering with their state's donor registry (for example, signing up online at their state's donor registry website)
- registering with their state's version of the department of public safety (for example, marking that they would be interested in becoming an organ/tissue donor when they are obtaining or renewing their driver's license or state identification card. The department would then forward the person's information to the state's donor registry.)
Formally registering as a potential organ/tissue donor is called "first person authorization," which means family and close friends cannot legally override a person's wishes for organ donation. If a loved one registered in the donor registry has died or been declared brain dead and determined to be an eligible donor of organs and/or tissues (based on a multitude of factors including the person's medical history), organ procurement organization (OPO) liaisons will inform family members of their loved one's wishes, answer family members' questions about logistics, and support family members the best way they can during a time of potentially strong emotions and grief. The medical team taking care of a patient in the hospital focuses on the medical care of the patient and is not involved in this process; their management is kept separate from the OPO conversations with family members.
Because a loved one's decision to donate may come as a surprise or shock to family members during a medical emergency, I always encourage people to discuss their thoughts with family and close friends. Even if a person does not have the opportunity to officially register as a donor, communicating their wishes to donate their organs/tissue would go a long way towards their wishes being carried out. If family members were approached by an OPO liaison about their loved one's eligibility to donate organs/tissue, family members can make decisions with greater certainty based on their loved one's wishes even if their loved one never officially registered with a donor registry.
As with most medical decisions, people can change their minds about registering (or cancelling their registration) as a potential organ donor. They would update their status in their account on their state's donor registry and/or update their driver's license or state identification card, which may involve obtaining a new card, as well as tell their family.
Who can donate what organs and when?
Donations of organs such as heart, lung, liver, kidney, pancreas, and intestines become possible only in specific situations, specifically after someone is declared brain dead and the body is maintained with life support machines. When a person is brain dead, the brain shows no activity. Examples are people whose brains are affected rather than their bodies, such as from a massive stroke or severe head trauma.
A person who is brain dead, and therefore medically and legally dead, and whose body is maintained on life support will still have functioning internal organs with oxygen circulating through the organs because of life support machines. The organs are then functional enough to transplant into another person awaiting donation. According to organdonor.gov, about 3 in 1000 people die in the specific circumstances that allow them to become a organ donor (the numbers would be different if you included live organ donors).
When a person dies at home or in the hospital in a manner other than brain death, their organs "fail" during the dying process. These internal organs are nonfunctioning and cannot be donated.* Most people die in this manner, and their wishes to give to others can still be honored. After reviewing a loved one's medical chart, OPO liaisons may inform family members that their loved one who had indicated a desire for their body to help others could still have tissues - such as parts of the eye to help restore vision; skin for burn victims; bones for grafts; and other tissues - donated to help others.
A decision to become a potential organ donor is a highly personal decision that a person can make at any time. If these are your wishes, consider registering at your state's online donor registry and communicating your decisions to your family and close friends. If you wish to know more details about the organ or tissue donation process, the website organdonor.gov would be a good first step.
* In specific circumstances, organ donations are possible if someone has severe irreversible brain injury but not technically brain death. This is called DCD (Donation after Cardiac Death).