The transplant process differs depending on the way the donor has died.
Donation after brain death
Brain death occurs when the brain is so badly damaged that it stops functioning permanently. It's usually the result of bleeding in the brain, stroke, infection, a trauma to the head from an accident or assault, or a lack of oxygen to the brain. The brain controls everything in the human body, so when it dies, circulation ceases and all other organs stop functioning. Clinical tests indicate brain death has occurred when there is no brain function, no blood flow to the brain and no possibility that the brain will recover and function again. Brain death is not the same as a coma, where the brain still functions.
Organ donations from a patient who has suffered brain death can only take place when brain death occurs in a hospital's Intensive Care Unit, while the patient is on a ventilator. The ventilator keeps blood and oxygen pumping around the body artificially to keep the organs functioning. The skin continues to be pink and warm even though the person is dead.
Ventilation cannot be permanently maintained. Without brain function, the organs will deteriorate. However, they can continue to function for long enough to be used for donation. Before organ donation after death can begin, two senior doctors must separately test the person for brain death. The family's consent must also be obtained before organ and tissue donation can proceed. Corneas can be donated within 12 hours of brain death and other tissues within 24 hours.
Donation after cardiac death
Most people die a cardiac death, where they stop breathing and have no heart beat. This can follow a sudden illness or accident, or be the final stage of a long illness that has gradually shut down one or more essential organs. On death, the blood stops carrying oxygen through the body. The person feels cold to touch and changes colour as the organs, including the brain, are starved of blood and oxygen.
Tissues can be donated within 24 hours of cardiac death and stored for several months or years until they are needed. The exception is corneas, which must be donated within 12 hours of death and used within a week. Organs can be removed following cardiac death, but only in very specific circumstances
Viewing and funerals
Organ donation will not affect viewing of the body and funeral arrangements for the organ donor. After death organ and tissue donation happen quickly, so there is no need to delay the funeral. Viewing of the body and an open casket funeral are both possible because the body will look normal.
Organs and tissues are removed surgically by highly skilled surgeons. If necessary, they are replaced with prostheses. The incision is stitched closed and covered with skin-coloured tape as in any surgical procedure. The body is dressed for viewing and for the funeral, hiding the incision.
When skin is donated, only a small section of one layer is retrieved from the torso or legs, resembling the skin that peels from sunburn. With other tissue donation after death, bone, corneas or eyes are retrieved, and reconstructive procedures are performed if necessary to return the body to its normal appearance. The person looks like they are asleep.
Autopsies and coronial investigations
A coronial investigation does not usually prevent a person from being a donor. Under the Coroner's Act, an investigation into the death is sometimes required. The coroner will investigate a number of issues, including if an anaesthetic was given in the 24 hours prior to death.
A DonateLifeTM organ donor coordinator contacts the coroner to confirm if a coronial investigation is required and to seek permission for donation to proceed. The organs and tissue are then retrieved before the autopsy or coronial investigation takes place.
