Organ and tissue donation is a subject that arouses strong feelings in a great many people. The BATB often receives questions from the general public and medical professionals alike, with regards to this. We have listed below a few of the common questions that are put to us, along with answers, in the hope that this will help inform people about the subject. If you have any further questions, comments, or suggestions please contact your local co-ordinator or tissue bank.

Question 1: What is the difference between organ and tissue donation?

Organ donation receives a great deal of media attention. There are very often reports of the latest advances in the transplantation of hearts, livers, kidney and lungs. Few people realise, however, that tissues can also be donated. Tissues are classed as parts of the body that consist of 'an aggregation of similarly specialised cells united in the performance of a particular function'. Examples would be bone, skin, and the cornea of the eye.

With whole organ donation, it is vitally important that the organ in question is removed from the donor and implanted into the recipient in the shortest possible time, so that the organ does not deteriorate. With tissue donation, however, it is possible to retrieve the tissue and store it over a period of time. This allows tissue to be screened for possible infectious agents, and allows a pool of available tissue to be established.
Organs must be retrieved from a donor that has been declared brain stem dead, and is supported only by a ventilation machine. In this way the function of the organ is maintained. Tissues can be retrieved once ventilation has ceased, in Question 2: Which tissues can I donate?

Question 2: Which tissues can I donate?

It is possible to donate several tissues following death. The most common are cornea (the clear 'window' at the front of the eye), bone, skin and heart valves. It is also possible to donate tendon and cartilage. All of these tissues can be used to save lives, or to greatly improve the quality of life of a great many people. In some cases the tissue, for whatever reason, is unsuitable for transplantation. In such cases it may be possible to put the tissue forward for scientific research (specific consent for this must be obtained).

Question 3: How can I ensure that my tissues will be donated after my death?

If you wish to make a donation following your death, it is vitally important that you inform your next of kin of your wishes. Simply carrying a donor card does not guarantee that donation will occur, since it is the next of kin that must provide consent. If your next of kin does not give their consent, donation will not proceed. Carring a donor card, however, will mean that family, and hospital staff, are aware of your wishes, and this may make the decision easier for them.
It will also help if you sign up to the National Organ Donor Register . See www.nhs.uk/organdonor This provides a database of donors from all over the country. If you become a potential donor, and you do not have a donor card on your person, the register can be checked and your wishes made known. To join the National Organ Donor Register please telephone:
Telephone: 0845 60 60 400

Question 4: What will happen to the tissues that I have donated once they are removed?

The majority of tissues removed for donation will be sent to tissue banks throughout the U.K. They will be tested for any diseases that may be passed on to a tissue recipient, sterilised to make tham safe for implantation, and placed into storage. The tissue will then be issued to hospitals for implantation,as and when it is required. There is a page available on this web-site for each tissue, giving details of the procedures involved.

Question 5: Who will benefit from my donation?

In whole organ donation, a single organ is removed from the donor and implanted into a single recipient. With tissue donation, the donated tissue can possibly be used to benefit a large number of people.

In the case of heart valve donation, the aortic and pulmonary heart valves are removed from the donated heart. This means that two people can benefit from a single donation. In cases where the valve itself is unsuitable, the artery can be divided into small patches that are used to repair damage to the great blood vessels of the heart. It is usually possible to obtain five or six patches from a single donation. In this way, five or six recipients may benefit. Heart valves are used to repair congenital heart defects in children (i.e. Fallot's Tetralogy) and to correct acquired disease of the heart valves in adults (i.e. bacterial endocarditis). Heart valve transplants are life saving operations.

Bone is retrieved from the femur (thigh bone) of a donor, or in the form of a femoral head, the 'ball' at the top of the femur that inserts into the 'socket' of the hip. Strips of bone can be used to act as a splint, holding severe fractures together, or a sections to replace lengths of bone that have been removed. Bone is also very commonly ground into a fine powder and used as a cement for artificial hip replacements. The quality of life of over 250,000 people has been improved through bone donation.

Skin is used primarily in the treatment of burns victims. If someone is severely burned, it is vitally important that treatment begins immediately. The patient must be given plenty of fluids, and the charred tissue removed to prevent toxins entering the victim's bloodstream. Following this, donated skin is placed over the burned area. This acts as a scaffold over which the patient's own skin can re-grow. The cosmetic results of this treatment are excellent, and the rate of healing is greatly improved using this technique.

Donated corneas are used in corneal transplant operations, in which the patient's own cornea has become compromised, either through disease or injury. Invariably, severe damage to the cornea will lead to loss of sight in that eye, and the cornea must be replaced in order to restore vision. A pool of donated corneas is now available, through the U.K. Corneal Transplant Service Eye Banks. These are issued to ocular surgeons throughout the U.K. who now use them routinely in corneal transplant surgery. The availability of this service has meant that corneal transplantation has now become an elective rather than emergency procedure.

Question 6: Who can donate?

Each of the different tissues have limitations over who can donate, and these are generally to help protect the recipient. For instance, tissue cannot be donated by anyone who is HIV positive, or at risk of being HIV positive. Many of these limitations are specific to each tissue, for instance someone who has suffered intrinsic eye disease is excluded from donating corneas.
It is important that you do not let the fact that you think you may be excluded from donation prevent you from putting yourself forward as a potential donor. It is far better that the offer of donation is made, and rejected, than not made at all.

Question 7: What might prevent me from donating?

Tissue banks will not accept tissue from donors that are considered to be in 'high risk' categories, and there is a list of these, produced by the Department of Health. 'High risk' basically covers anybody that has or is at risk of contracting illnesses that may be transmitted via tissue donation. Full details can be found by clicking here.

As explained earlier, tissue banks also have lists of specific contraindications relating to the tissue in question. These can be found on those pages relating specifically to each tissue. For medical professionals, it is not necessary to try to remember all of these contraindications. If you are approached by someone interested in the possibility of donation, contact your local transplant coordinator, or tissue coordinator if you have one, and refer the case to them. They can then liaise with the tissue bank to see whether the donor is suitable.

Question 8: Does tissue retrieval cause the body to be disfigured?

No. Retrieval of all tissues is carried in such a way that there is no sign that donation has taken place. Bone that has been removed is replaced with a prosthetic of the same weight and density as real bone, the eyes are also replaced with prosthetics, and the eyelids closed. In the case of skin and heart valve donation, the areas of retrieval are covered upon viewing and will not be visible. If you were to look at the body of someone who had donated skin, you would only see a light coloured are from which the skin had been removed- such a thin layer is taken that it is barely noticable. Given this, and the excellent work of the morticians in presenting the body for viewing, there is no visible evidence of donation.

Question 9: Does tissue donation cause delay of the funeral arrangements?

No. Donation takes place in the mortuary, or sometimes the funeral home, within 48 hours of death. Most tissue is retrieved on the day following death. This means that donation will not cause a delay to last offices, and the family is free to go ahead and make the necessary arrangements.

Question 10: How can I find out more about tissue donation?

If you are interested in finding out more general information regarding tissue donation you will find a range of leaflets available at your local G.P. practice. You can also contact your local co-ordinator or tissue bank.