About Organ Donation
Flowchart on the Process of Cadaveric Organ Donation
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When a patient is admitted to the hospital with fatal injuries or critical illness, healthcare professionals would make every attempt to save his / her life with effective medical treatment.
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If the patient fails to respond to medical treatment and his / her conditions continue to deteriorate to an irreversible state, healthcare professionals would provide appropriate end-of-life care and discuss the treatment and care plans for him / her
with the family members. Healthcare professionals would provide emotional support for the family members and take care of their physical, psychological and spiritual needs. They would respect the patient's dignity and honour
the wishes of both the patient and his / her family members.
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What is brain death?
With the advancement of medical technologies, patients without spontaneous breathing and heartbeat can still maintain certain organ functions with the support of drugs and machines. Some patients may even have residual cognitive functions. Cessation of heartbeat is therefore not the sole criterion for death determination. On the other hand, if the brain has lost all its blood supply (for example, due to severe ischaemic stroke) or if all brain functions are permanently lost due to severe damage, the patient is in "brain death". Brain death is an irreversible state and is another criterion for death.
Difference between brain death and vegetative state
Both brain dead patients and patients in vegetative state are in coma. However, for a brain dead patient, his / her brainstem has been completely damaged and has lost all its functions. He / she has no spontaneous breathing and can no longer control blood pressure and body temperature. The cerebrum will never perceive or react to external stimulus. Therefore, brain death is equal to death. In contrast, a patient in vegetative state still maintains certain brainstem functions which may enable spontaneous breathing or some brainstem responses. The cerebrum may be able to perceive or react to external stimulus. Therefore, a patient in vegetative state is not considered dead.
Determination of brain death
Two experienced doctors who are not involved in organ transplant services would carry out independent and stringent tests to determine if a patient is brain dead. Once brain death is declared, the patient is considered dead legally even if his / her heartbeat and breath are maintained with the support of drugs and machines.
Care for family members
Healthcare professionals would assess a patient's suitability for deceased organ donation only after he / she has been declared brain dead. The Organ Donation Coordinator of the Hospital Authority would provide bereavement care, emotional support and necessary assistance for the family members; and affirm if the deceased has expressed a wish of organ donation while alive through the following means:
The Organ Donation Coordinator would discuss with family members whether the deceased had expressed a wish of organ donation while alive. He/she would explain the details of organ donation to the family members and would also seek their written consent to deceased organ donation.
Written consent to deceased organ donation
The Hospital Authority would seek written consent of the deceased's family members or next of kin to deceased organ donation in accordance with the Medical (Therapy, Education and Research) Ordinance (Cap. 278).
Major duties of Organ Donation Coordinators
The major duties of Organ Donation Coordinators include:
With the advancement of medical technologies, patients without spontaneous breathing and heartbeat can still maintain certain organ functions with the support of drugs and machines. Some patients may even have residual cognitive functions. Cessation of heartbeat is therefore not the sole criterion for death determination. On the other hand, if the brain has lost all its blood supply (for example, due to severe ischaemic stroke) or if all brain functions are permanently lost due to severe damage, the patient is in "brain death". Brain death is an irreversible state and is another criterion for death.
Difference between brain death and vegetative state
Both brain dead patients and patients in vegetative state are in coma. However, for a brain dead patient, his / her brainstem has been completely damaged and has lost all its functions. He / she has no spontaneous breathing and can no longer control blood pressure and body temperature. The cerebrum will never perceive or react to external stimulus. Therefore, brain death is equal to death. In contrast, a patient in vegetative state still maintains certain brainstem functions which may enable spontaneous breathing or some brainstem responses. The cerebrum may be able to perceive or react to external stimulus. Therefore, a patient in vegetative state is not considered dead.
Determination of brain death
Two experienced doctors who are not involved in organ transplant services would carry out independent and stringent tests to determine if a patient is brain dead. Once brain death is declared, the patient is considered dead legally even if his / her heartbeat and breath are maintained with the support of drugs and machines.
Care for family members
Healthcare professionals would assess a patient's suitability for deceased organ donation only after he / she has been declared brain dead. The Organ Donation Coordinator of the Hospital Authority would provide bereavement care, emotional support and necessary assistance for the family members; and affirm if the deceased has expressed a wish of organ donation while alive through the following means:
- Checking against the Centralised Organ Donation Register;
- Checking for a signed organ donation card; and
- Asking the family members.
The Organ Donation Coordinator would discuss with family members whether the deceased had expressed a wish of organ donation while alive. He/she would explain the details of organ donation to the family members and would also seek their written consent to deceased organ donation.
Written consent to deceased organ donation
The Hospital Authority would seek written consent of the deceased's family members or next of kin to deceased organ donation in accordance with the Medical (Therapy, Education and Research) Ordinance (Cap. 278).
Major duties of Organ Donation Coordinators
The major duties of Organ Donation Coordinators include:
- Getting in touch with the deceased’s family members to provide consolation and bereavement support;
- Explaining the details of organ donation to family members with a view to seeking their consent to deceased organ donation, and coordinating the process of organ donation;
- Promoting organ donation among healthcare professionals to increase their awareness; and
- Supporting, planning and coordinating community promotional activities on organ donation.
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Organs and tissues accepted for deceased donation
The deceased may let his / her love live on by donating heart, lungs, liver, kidneys, corneas, skin and bone.
Evaluation and assessment of deceased organs
After obtaining the family's written consent, healthcare professionals would conduct comprehensive evaluation and assessment of the donor according to established risk assessment guidelines and criteria in order to determine if the deceased organs are viable for donation and transplantation. The Hospital Authority has set up registries of patients awaiting different organ transplants and a mechanism for allocation of deceased organs. The donated organs would be transplanted on suitable patients who are in need and with expected clinical benefits.
The deceased may let his / her love live on by donating heart, lungs, liver, kidneys, corneas, skin and bone.
Evaluation and assessment of deceased organs
After obtaining the family's written consent, healthcare professionals would conduct comprehensive evaluation and assessment of the donor according to established risk assessment guidelines and criteria in order to determine if the deceased organs are viable for donation and transplantation. The Hospital Authority has set up registries of patients awaiting different organ transplants and a mechanism for allocation of deceased organs. The donated organs would be transplanted on suitable patients who are in need and with expected clinical benefits.
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Upon successful cross match between the waitlisted patient and the deceased donor, the hospital would arrange harvesting of the deceased organs for transplantation as soon as possible. The operation would be conducted under general anaesthesia and healthcare professionals would give full respect to the deceased donor throughout the process. The incision would be properly managed to protect the appearance of the deceased donor.
Upon completion of organ harvesting, the deceased donor would be transferred back to the ward for last respect by the bereaved family. The procedure and time required for collecting the deceased body are comparable to those in other deceased cases without organ donation and would not affect the funeral arrangement.
Source of information: Hospital Authority