Organ Donations
The following text is to help you understand the theme of organ donation. Even after reading it, do not hesitate to ask doctors or coordinators of the transplant center about anything that you would like to know, are concerned with or need to be informed about.
in the Czech Republic, about a thousand patients a year wait for rescue or significant improvement of their quality of life. Their only hope is organ transplantation. The most frequent cases are represented by kidney transplantations, and common are also transplantations of the liver, the heart, the pancreas, the lungs or the small intestine.
Deceased donors give these patients a hope for rescue of their lives. There are around three hundred deceased donors a year. Each of them can help up to a dozen patients. Deceased donors deserve great thanks as without them the miracle called transplantation could never be materialized.
At the same time, we would like to express our thanks to the families of organ donors for help and valuable suggestions.
Yours faithfully
Institute of Clinical and Experimental Medicine
Deceased Organ Donors
A deceased organ donor is usually a person with brain death as a consequence of severe brain damage (by trauma, bleeding, inflammation, ischemia etc.). Death must be medically proven by accurate and strict examination confirmed by an imaging method such as CT, angiography, ultrasound, scintigraphy etc.
Organ collection from a dead donor may only be performed if the patient´s death has been unmistakably proven. The physicians specifying the diagnosis must not take part in the organ collection from the dead donor or in the transplantation and must not be the treating physicians of the considered recipient.
The potential donor´s death ascertaining must always be performed by at least two specialized physicians examining the donor independently of each other, and proven by irreversible blood circulation arrest or irreversible loss of function of the whole brain, including the brain stem, in cases when ventilation or blood circulation are maintained mechanically, i.e. by instrumentation.
Irreversible Blood Circulation Arrest
In some cases, organ(s) can be collected from a deceased donor after proven irreversible blood circulation arrest. These patients usually suffer from severe brain damage as well, albeit without fulfillment of all criteria for brain death. All available therapy options are considered vain on the basis of careful assessment and consideration by a group of experts and continued purposeless therapy is unethical, also in view of the patient himself/herself. In such situation the family of the patient is informed about switch to palliative (merciful) care, as well as about potential organ collection after death, by the patient´s attending physician. The time of active, already vain therapy end is scheduled in consultation with the patient´s family. After termination of active care, blood circulation arrest is awaited. Death as irreversible blood circulation arrest must again be confirmed and after that quick organ collection in an operating theater follows. This time from a deceased donor whose heart has stopped beating.
Irreversible Whole Brain Function Loss
Irreversible loss of function of the brain as a whole is a condition of definite extinction of consciousness, final spontaneous breathing stop and loss of reactivity. Thanks to medication and instruments, the person´s heart is still beating, ventilation continues and the body temperature is normal but the patient shows no signs of life. Such person does not perceive anything, does not feel anything, has died.
Living Organ Donors
People can donate organs also in the course of their life. This must be a pair organ (kidneys, exceptionally lungs) or part of an organ that is able to regenerate (liver). The donor, whether a close relative of the patient or an unknown altruist, must always undergo strict health tests, a psychological interview and, in some, cases, ethics committee´s approval. After the organ collection, the donor´s health condition is under lifelong monitoring in a healthcare facility.
Assumed Consent
Czech legislation lays down the concept of assumed consent with organ donation after death. Anybody can express their disapproval in the course of life. The disapproval is usually recorded in the National Register of Persons Not Consenting with Posthumous Tissue and Organ Donation. If there is no proof that the deceased demonstrably expressed his or her disapproval with posthumous organ collection in the course of his/her life, then he or she is deemed consenting with his or her organ donation.
Organ collection from a deceased donor is therefore only precluded if
- The deceased himself/herself (or his/her legal representative) demonstrably expressed disagreement with posthumous collection of tissued and organs int he course of his/her life, which means that:
- The deceased is entered in the National Register of Persons Not Consenting with Posthumous Tissue and Organ Donation, or
- The deceased, while still living, directly in the healthcare facility in front of his/her attending physician and one witness, explicitly states that he/she does not agree with his/her organ collection in the case of his/her death, or
- A legal guardian of a minor patient (child under 18) or a legal representative of a person deprived of eligibility for legal acts, directly in the healthcare facility in front of the patient´s attending physician and one witness, explicitly states that he/she does not agree with the patient´s organ collection; this statement in case of death of the minor patient or the patient deprived of eligibility for legal acts can be made either when the patient is still alive or after his/her death.
- The deceased cannot be identified.
In the case of children under 18 or persons deprived of eligibility for legal acts their legal guardian/representative must always be informed about their organ collection. In such case the medical file of the patient must include an entry saying that the legal guardian/representative has not expressed disapproval. A signature of the legal guardian/representative is not required, the entry is signed by the attending physician and one witness.
In practice, the attending physician of the potential donor speaks with the family or other close persons of the patient about the donation options, but to comply with the law, he/she should only inform the family about this fact, not find out or request their consent. Their potential disagreement is not legally justifiable, the only binding fact is the will of the patient - the potential donor - demonstrably expressed in advance in the course of his/her life.
Organ Donors
If a patient´s attending physician (mostly from the ARD or ICU department) finds the patient a potential donor, he or she informs the transplant center and usually after that also the family or other close persons of the patient. The decision is only made when the patient´s life can no longer be rescued.
The transplant center checks for an advance wish of the patient not to donate organs, i.e. whether the patient is or is not entered in the Register of Persons Not Consenting with Posthumous Organ Donation, and if not, then the medical criteria are assessed on the basis of the available laboratory results, after which the patient is either indicated for organ collection or excluded from organ donation.
The transplant center is (also legally) responsible for assessment of medical appropriateness of the potential deceased donor. The assessment is also performed in relation to the individual recipients who may be in a life-threatening condition.
Organ Collection
If a deceased with confirmed diagnosis of brain death or a patient with expected irreversible blood circulation arrest is found to be a suitable donor, the collection is only started after agreement with the transplant center. The transplant center sends an organ collection team to the hospital where the potential donor is hospitalized for direct organ collection in that healthcare facility. Or, if the collection or the transplantation is more complicated, the donor is transported to the Institute of Clinical and Experimental Medicine and the collection is completed there.
Organ Collection in the Facility where the Patient is Hospitalized
Organs may only be collected after the donor´s death has been confirmed. Following agreement with the transplant center, an organ collection team, consisting of physicians, nurses and a coordinator, is sent to the hospital where the donor is hospitalized. Until the collection commencement, the potential donor is kept collected to artificial ventilation and other potential supporting instrumentation. The family and other close persons of the patient are allowed to say good bye to the dying donor with dignity, after which the collection is performed at the operating theater of the donor´s hospital.
After organ collection, the autopsy is performed if required by law and, on the basis of agreement with the funeral service, the donor´s body is transferred to the place of the funeral.
Transfer to the Institute of Clinical and Experimental Medicine
If brain death cannot be confirmed in the hospital where the donor is hospitalized, for example because the hospital does not have a physician with the required specialization or equipment by which the confirmation can be performed, the transplant center coordinator together with the donor´s attending physician organize transport of the potential donor to the Institute of Clinical and Experimental Medicine. Here brain death confirmation can be made any time, 24 hours a day, 7 days a week.
Organ donors are also transferred to IKEM if the organ collection is complicated or the time between the collection and the donation to the recipient must be kept as short as possible. Even in this case the coordinator arranges for the donor´s family and close persons to be able to say good bye to their dying family member.
If the organ donor must be transferred to IKEM, the physician from the donor´s hospital always informs the donor´s family
- about the potential donor´s transfer to IKEM
The transport of the potential donor from the hospital to the Institute is usually agreed with the donor´s family in advance. The family and friends of the donor are given an opportunity to say good bye in dignity, and only then the patient is transferred to IKEM by ambulance or helicopter. - about the way of informing the survivors about the time of death
The time and place of death are specified after proven brain death, in this case verified at IKEM. An agreement is made with the donor´s family about who will inform them about the time of death and how. - about the healthcare facility where autopsy will be performed
Autopsy is required by law in the case of every organ donor. Autopsy is usually performed in the regional hospital at the pathology or forensic medicine department.
After Organ Collection
The donor´s body is transported to the place of autopsy immediately after the organ collection. In Prague, autopsy is usually performed at the Forensic Medicine Institute of the General University Hospital, or the body is returned to the place of the patient´s last hospitalization and autopsy is performed there.
After autopsy completion, the body of the organ donor is taken over by the funeral service who transport it to the place of the funeral. The funeral service is ordered by the survivors who tell the service where the body is located and the funeral service then arranges for the rest.
In the case of judicial autopsy, ordered by the Police of the Czech Republic, the investigator must issue a permit for the donor´s body collection. Only then the funeral service can proceed in arrangement of the last farewell with the deceased.
The body of the deceased is treated with dignity and respect for the whole time. The organ collection procedure is performed at an operating theater and the only difference from normal operation is in that the procedure is performed on a dead body.
Frequent Fallacies and Persisting Myths
Organ transplantations are subject to various myths and fallacies which may cause that a particular individual is not even considered as a potential donor. One of them is the age. There is no age limit for organ collection nowadays. All depends on the health condition of the potential donor. Information from the family and friends of the potential donor is a valuable source of data for the decision-making process.
A lot of prejudices and questions are also connected with the relationship between religion and organ donation. No religion prevents organ collections. The only religion not yet accepting posthumous organ collection is shinto. All other religions not only accept but even actively support the idea of organ donation. Representatives of the largest religious group in the Czech Republic, the catholic church, consider organ donation an “act of fellow feeling” and have openly and repeatedly supported it on many recent occasions.
Legal Claims
Human life is never enough regretted and the value of an organ for a patient waiting for rescue of his or her life is impossible to express in terms of money. The law explicitly prohibits any benefit or advantage granted/received in connection with organ donation. Despite that there is a possibility of certain remedy for the survivors as a thank you for help to critically ill patients.
The act stipulates that the person paying for the funeral of a deceased organ donor is entitled for CZK 5,000 as a refund towards the funeral cost.
To receive this refund, the person that has paid for the funeral of an organ donor must fill out the relevant application form and attach a copy of an identity document with the name of the deceased and the name of the person paying for his/ her funeral. A copy of the receipt slip documenting payment for the funeral must also be attached. The application, together with the attachments, must be sent by registered mail to the following address: Transplantation Coordination Center - Koordinační středisko transplantací, Ruská 85, 100 00 Prague 10. After checking the application, the Transplantation Coordination Center will immediately transfer the amount to the bank account or address of the applicant that has paid for the funeral.
The deadline for applying for the remedy is relatively long - 12 moths form the date of the funeral at the latest. Vain elapse of this deadline makes the entitlement null and void.
Recipients
One organ donor can help to up to nine, or, in the case of women, up to ten critically ill patients. In the Czech Republic, like all over the world, the most commonly transplanted organs include kidneys, liver, heart, pancreas, lungs, small intestine and uterus.
Patients with these organs damaged are included in the waiting list and wait for a suitable donor. The donor should meet not only the medical criteria, such as blood type or laboratory results, but also criteria such as urgency of the transplantation and the weight and size proportion between the donor and the recipient. The waiting time strongly depends on whether a suitable donor is found or not. In the case of deceased donors this waiting time ranges from a couple of days to several years.
The transplantation is performed in a specialized transplant center. There are multiple transplant centers in the country but not all of them perform all types of transplantations for all patient age groups. The Prague Institute of Clinical and Experimental Medicine is the only center in the Czech Republic performing transplantations of all of the above listed organs, except lungs. IKEM is also the only center performing pediatric liver transplantations. Lung transplantations and other pediatric transplantations are performed at the Motol University Hospital in Prague. The Brno Center of Cardiovascular and Transplantation Surgery focuses on heart, liver and kidney transplantations. The other centers, in Plzen, Olomouc, Ostrava and Hradec Králové, exclusively perform kidney transplantations.
The law prohibits telling the family or friends of the donor details of the transplanted organ recipients. What is allowed, though, is to provide information about the transplanted organs: what organs were collected, whether their recipient was a male or a female and whether the transplantation was successful.
Transplant Centers in the Czech Republic
Contacts
If you need and explanation or have any questions, please do not hesitate to ask. You can contact us any time, even after a time. We will be happy to answer any question.
Contact:
Round-the-clock service (24 hours a day, 7 days a week) +420 602 202 809, e-mail: koordinace@ikem.cz