Organ, Tissue, and Eye Procurement

Supporting Families During Death And Organ, Tissue, And Eye Donation As A Certified Child Life Specialist

Donate Life America (2022) reports that more than 100,000 people are awaiting life-saving transplants throughout the United States. While the transplant waiting list is extensive, fewer than three in every 1,000 people are eligible to provide the gift of life to another through organ donation (Health Resources and Services Administration, 2021), and only 60% of adults are designated or registered organ, tissue, and eye donors. One organ, tissue, and ocular donor, via deceased donation, can save up to eight lives through solid organ transplant, enhance more than 75 lives through the gift of tissue donation, and restore vision to two people (Donate Life America, 2022).

For many families facing end-of-life (EOL) decision-making on behalf of a loved one, organ donation is typically not considered until the family is approached by a representative of an organ procurement organization (OPO). There are 57 OPOs throughout the United States, separated by region and population (United Network for Organ Sharing, 2022); each organization is certified by the Centers for Medicare and Medicaid Services. The American Academy of Pediatrics Committee on Hospital Care (2010) “supports the role of OPOs by recommending that all potential donor families be approached in a systematic method by individuals trained in the psychological, social, and medical aspects of organ donation” (p. 823). Methods often include decoupling; a purposeful delay that occurs between the time a family is notified of brain death or the decision is made to compassionately withdraw life-sustaining therapies (WDLST), and when the opportunity for organ donation is presented. Decoupling aims to ensure separation between critical care teams that primarily focus on treating a patient’s illness or injury, and an organ procurement organization. This separation occurs in order to effectively and empathically support families through EOL decision making, offering the opportunity for organ, tissue, and eye donation when a patient is eligible (Kao, 2000). Eligible organ donors must be receiving ventilatory support to be considered a viable donation candidate, to ensure potential gifts receive adequate blood circulation and oxygenation; as mentioned previously, the number of people ever in a position to donate their organs is relatively small, fewer than one percent. Tissue and eye donors, however, are considered eligible after the point that an individual’s heart stops beating, or cardiac time of death. Following a thorough review of medical records and documentation of the circumstances surrounding the death, eligibility determination for tissue and eye donors is made based on known medical history (i.e., patients diagnosed with cancer with metastases or communicable diseases are often disqualified), active infections at the time of death, and permission from state medical examiners. The amount of possible tissue and ocular donors far exceeds the number of potential organ donors, however exact statistics are not widely available.

OPOs consistently have a number of varying departments within their organizations with unique goals and team configurations. The professionals responsible for providing support and the opportunity for donation to families include, by formal title (Association of Organ Procurement Organizations, 2022):

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  Donation and family advocate

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  Donor family grief advocate

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  Donation liaison

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  Family care coordinator

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  Family services coordinator

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  Family support counselor

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  Family support specialist