Supporting Organ and Tissue Donation in Clinical Settings: The Pennsylvania Requirement _ ____________
Following recovery, tissues are processed, tested for infectious disease, and distributed by accredited tissue banks operating under Association for Advancing Tissue and Biologics (AATB) standards and U.S. Food and Drug Administration regulations [10]. Processing methods vary by tissue type and intended use, ranging from aseptic processing to terminal sterilization. HEALTHCARE PROFESSIONALS’ ROLE IN TISSUE DONATION In the acute care or emergency setting, the clinician’s role is primarily one of identification and timely referral. Any patient who has died or is expected to die should be referred to the OPO. Do not attempt to independently determine tissue eli- gibility. Timely referral is both a regulatory requirement and an ethical obligation to the patient whose prior wishes may have included donation. ORGAN DONATION PROCESS Organ donation is a highly time-sensitive process that depends on the seamless coordination of clinical, logistical, and legal elements. Understanding the sequence of events helps clini- cians play a more effective role. TYPES OF ORGAN DONATION There are two pathways to organ donation: donation after brain death (DBD) and donation after circulatory death (DCD). Donation after Brain Death (DBD) Also referred to as standard criteria donation, this pathway involves a patient who has sustained a catastrophic neuro- logical injury and meets established neurological criteria for brain death. The donor remains on mechanical ventilation to preserve organ perfusion while authorization is obtained and procurement logistics are arranged. Donation after Circulatory Death (DCD) This pathway applies to patients who do not meet brain death criteria but have a non-survivable injury or illness, and for whom a decision has been made to withdraw life-sustaining treatment (WLST). Following WLST, organ procurement occurs after the patient experiences cardiac death, typically within 60 to 120 minutes. DCD procurement has expanded significantly over the past decade and now accounts for a sub- stantial proportion of donor cases nationally [1]. IDENTIFICATION OF POTENTIAL DONORS Potential organ donors are typically patients with severe, non-survivable acute neurological injury (e.g., traumatic brain injury, intracranial hemorrhage, anoxic brain injury, stroke). Clinical triggers for OPO referral include [11]:
TISSUE DONATION PROCESS While organ donation garners much of the public’s attention, tissue donation is equally impactful and far more prevalent. A single tissue donor can benefit more than 75 recipients [10].
WHAT TISSUES CAN BE DONATED? Recoverable tissues include:
• Musculoskeletal tissue (bone, tendons, cartilage, ligaments): Used in orthopedic reconstructions, spinal surgeries, and trauma repairs • Cardiovascular tissue (heart valves, pericardium, great vessels): Used in cardiac surgeries and vascular reconstruction • Skin: Used for burn treatment, wound coverage, and reconstructive procedures • Corneas and ocular tissue: Used to restore vision in patients with corneal disease • Amniotic membrane: Used in ophthalmology and wound care ELIGIBILITY FOR TISSUE DONATION Tissue donation can occur following both cardiac death and brain death, and it can be pursued even in cases where organs are not being donated. Importantly, tissue donation can occur up to 12 to 24 hours after cardiac death, making it possible even when the patient was not identified as a potential organ donor in time. This broader window significantly expands the pool of potential tissue donors [10]. Most medically suitable individuals of all ages may be consid- ered for tissue donation. Contraindications are tissue-specific and include active systemic infection, certain transmissible viral diseases (e.g., untreated HIV without suppressed viral load), and certain malignancies. As with organs, the tissue recovery organization (often the same OPO or an affiliated tissue bank) makes the final eligibility determination. THE TISSUE RECOVERY PROCESS Tissue recovery is typically performed in a hospital operating room, tissue recovery facility, or hospital morgue after the family has authorized donation and medico-legal clearance has been obtained (i.e., medical examiner approval when applicable). Tissue recovery is a sterile surgical procedure per- formed by trained technicians, and it does not interfere with the body’s appearance for funeral purposes — an important point to communicate to families. The body is treated with dignity and respect throughout, and any incisions are closed and covered.
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