Organ Donation Demystified

Scott Nyberg, M.D., Ph.D.

DEAR MAYO CLINIC:

It's time to renew my driver's license, and I'm ready to check the organ donor box. But first, I want to talk with my family. What can I tell them so they're comfortable with this decision?

ANSWER:

I appreciate your willingness to be an organ donor. There's a huge need. Consider that last year organ donors made more than 28,000 transplants possible. But more than 110,000 people are waiting for organ transplant and many die while waiting.

You're taking the right steps to ensure that your desire to donate is honored. Noting your donor status on your driver's license is important. Most states also have donor registries where you can sign up. Or, you can sign and carry a donor card. (Learn more about registries and donor cards at OrganDonor.gov.)

And, it's great to have this discussion with your family and answer their questions. In most situations, the hospital will seek consent from your family. Should your family not agree with your choice, you can work with a lawyer to make sure your wishes are followed.

Questions posed by family members vary, depending on the donor's age and overall health. I often hear questions regarding the following topics:

Donor age: There's no specific donor age cutoff, though acceptable age limits vary by organ. Decisions are generally made on a case-by-case basis. Especially for liver transplants, my area of expertise, donors are almost never too old. That's because the liver is constantly regenerating itself. No matter how old we are, the hepatocytes (liver cells) are at most three to six months old. Organ donation has been performed successfully in many cases in which the donor was older than 80 years but otherwise healthy. The quality and outcomes of liver transplants from elderly donors is very good.

For kidney transplants, donors in their early 70s would likely be the upper limit because kidneys tend to wear out over time. For heart transplants, the upper age limit of donors is closer to 60.

Donor health: Cancer that may have spread to organs would preclude organ donation. Most other health conditions would be evaluated on an individual basis.

People on the waiting list for an organ, especially a heart or a liver, are very ill. The likelihood of living another year without a transplant probably isn't good. Typically, potential recipients are happy for a chance at a donated organ, even if there's a small risk of a problem due to the donor's health condition.

Regardless, we do our best to minimize risk to the recipient. The transplant doesn't occur unless there's a very high likelihood that the donated organ will function and benefit the patient.

Benefit to recipients: The benefit to recipients really can't be measured, because the donated organ is likely saving a life. For kidney, liver and heart transplants, the success rate of surgery is greater than 90 percent. We have patients who live normal lives after transplant for 10, 20 or 30 years. Think of all the partners, children, grandchildren and friends who are able to share in the recipient's life for decades.

Cost: There will be no cost to your family for organ donation. These costs are covered by the recipient's insurance. On the flip side, it's illegal in the United States to pay for organs. There would be no reimbursement to your family or estate for organ donation at this time, though forms of recognition and reimbursement are being considered by the government to encourage donation.

Funeral: At most, a funeral may need to be delayed for 24 hours. An open casket funeral is still possible. The donor's body is treated with the utmost care and respect.

Thanks for checking the donor box and informing your family. Really, I don't think there's any reason not to be a donor. Donating organs means that tremendous good can result from death.

Scott Nyberg, M.D., Ph.D., Transplantation Surgery, Mayo Clinic, Rochester, Minn.

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