By Isabel Stenzel Byrnes & Kirsten Incorvaia
What is Organ Donation?
Everyone can be an organ donor regardless of age, gender, ethnicity, or medical history. Living donors can give a kidney, or a portion of the liver, lung, intestine, or pancreas. Organs that can be used from a deceased donor include kidneys, pancreas, liver, lungs, heart, and intestinal organs. The global demand for organ transplant far exceeds the number of donors. In the United States alone, there are over 112,000 people waiting for an organ to become available.
What is Organ Transplantation?
Organ transplantation is the moving of an organ from one body to another for the purpose of replacing the recipient’s damaged organ. It is now an acceptable treatment for end-stage organ failure. Organs and/or tissues that are transplanted can either be from a living or deceased person.
Eight organs can be transplanted from one deceased donor, including the heart, two kidneys, liver, two lungs, pancreas, intestine. Up to 50 tissues can be transplanted from one donor, including bones, tendons, cornea, skin, heart valves, and veins.
Organ donors may be living persons who can donate one of their kidneys, or portions of their liver, lung or pancreas. Deceased donors are virtually all determined to be brain dead. Brain death means that the brain has permanently ceased to function and no longer has blood circulation due to traumatic injury and swelling. A brain dead patient on life support can appear alive, but actually the heart will stop shortly after the life support is discontinued. Tissues, kidneys and in rare cases other organs, may be recovered from donors whose hearts have stopped (cardiac death).
The first transplant, a kidney transplant, was performed by Dr. Joseph Murray in Boston, Massachusetts in 1954 between identical twin brothers. Transplantation was limited due to rejection of the foreign organ by the recipient’s immune system. Organ transplantation did not become more successful until 1969 when cyclosporine was discovered in Norway, and later in 1984, when tacrolimus was discovered in Japan. These two drugs allowed the body’s immune system to be suppressed enough for the donated organ to remain functional inside another person’s body for the long term.
The first long term successful lung transplant was performed by Dr. Joel Cooper in Toronto in 1983. On March 9, 1981, the first heart-lung transplant was performed by Dr. Bruce Reitz at Stanford. Survival after lung transplantation has improved significantly, though, due to the lung’s exposure to the environment and its accompanying immunogenicity, lung transplantation remains the least successful solid organ transplant, with the average survival after surgery remaining around 5 years.
Currently, there are over 112,000 patients who are waiting for life-saving organs. Each year in the United States, approximately 28,000 transplants are performed, half of which come from deceased donors. About 1700 lung transplants are performed each year from deceased donors, and about 200 of them are on patients with cystic fibrosis (CF). CF patients make up 12 percent of the waiting list for lungs. (Living lobe lung donors only constitute a handful of lung transplants.) Only 1% of deaths in the United States are brain dead, so the pool of potential organ donors is extremely limited. That is why consent and organ donation education are critical for the public to understand the facts about organ donation and transplantation.
Transplantation in Japan
Japan is a wealthy, medically advanced nation that struggles with the issue of organ donation. Japan is the industrialized nation with the lowest rates of organ donation in the world. Japan’s Shinto religion honors all things from nature, and tampering with death through organ recovery and donation goes against the natural order of Japanese culture and beliefs. Other traditional beliefs against organ donation in Japan include the superstitions associated with touching a dead body, that the body belongs to the ancestors, that death only happens when the heart stops, and that the soul does not leave the body after death. Also, charity, or helping others, is usually limited to within the family unit, and the tradition of helping strangers is also less respected than in the West. As a result, living donation among family members has been very successful in Japan.
The first heart transplant was performed by Dr. Wada in Japan in 1968. However, due to the subsequent death of the recipient and ethical concerns associated with the transplant, the public image of organ transplantation in Japan turned negative. In 1997, the first organ donation law passed allowing for organ transplantation, but it contained strict rules that continued to limit donation. For example, the law did not allow children to donate organs, nor did it clearly define death. As a result, thousands of Japanese have died of organ failure that could have been treated by transplantation. A handful of Japanese have raised money to go abroad to receive organ transplants in Western countries. In 2010, over 12,000 people were waiting for organs in Japan, and they have extraordinary long wait times. In 2009, there were only 6 brain dead donors. That same year, a new law was passed to define brain death as death, and in 2010, there were about 30 brain dead donors. The first successful lung transplant on a CF patient in Japan was performed on Christmas Day, 2010.
Suggested Reading from our Community Partners
Learn more about organ donation from Donate Life America and California Transplant Donor Network.
Read about the history of organ donation from UNOS.
See this Stanford Clinics & Hospitals newsletter featuring Ana & Isa for more resources.