Transcription:
The Importance of Becoming an Organ Donor

Melanie Cole (Host):  More than 123,000 men, women and children currently need life-saving organ transplants. But what's involved in becoming an organ donor? My guest today is Dr. Ken Brayman. He’s a board certified surgeon and serves as the Division Chief of Transplant Surgery at UVA. Welcome to the show, Dr. Brayman. What's the biggest need right now in organ donation? What are you seeing the most?

Dr. Ken Brayman (Guest):  Hi, Melanie.  Thank you for having me. The biggest need for an organ transplantation is organ donation. With 123,000 people on the wait list, we have a need for more donor organs. The number of transplants has remained relatively stable but the number of people waiting for transplants increases every week. So, the availability of donor organs has not kept pace with the number of people that need transplants and that's the biggest problem we have in transplantation today.

Melanie:  Speak about organ donation. There are a few different types. People think that there's only cadaver donation or when somebody's brain dead, but speak about all the types for us.

Dr. Brayman:  With regard to organ donation from an individual that has been declared brain dead, that’s fairly standard. There are also organ donations that take place of individuals that haven't met the legal criteria of brain dead, but then they are allowed to donate after they die. So, those individuals are labeled “donation after cardiac death”. Of course, there’s live organ donation where an individual who's healthy donates a kidney or part of their liver. So, there are really three different types of organ donations that take place.

Melanie:  We hear about living donors or people giving a part of their liver or a kidney to a complete stranger. What you want people to know about volunteering to become a live donor?

Dr. Brayman:  Well, the technical term for that is an “altruistic donor” and every year, a number of people of contact transplant centers such as our own to tell us that they would like to donate a kidney or part of their liver and it’s the most gratifying gift that one could possibly give. Of course, the donors are screened very closely to make sure they are medically suitable. That’s true whether you’re a relative or an altruistic donor to make sure that the donor isn’t hurt long-term by having donated a part of one of their organs.

Melanie:  Speak about liver transplantation a little bit. You just take a piece, correct?

Dr. Brayman:  Well, for a living donor liver, we would use a portion of the donor’s liver so that the remaining part of the liver would stay in place and then it does regenerate in both the donor and recipient. With kidney donation, a whole kidney is removed and the kidney doesn’t regenerate but the patients have been followed for years and years and there is no increased incidence of kidney failure in individuals that have donated kidneys.

Melanie:  What do you want people to know about becoming an organ donor? On the back of our license; telling our loved ones what our wishes are?

Dr. Brayman:  Well, it’s very important that that information is shared with your loved ones because in the context of a stroke or a car accident, it's very difficult to muster the answers to difficult questions. So, it is true that besides signing up to be an organ donor at the motor vehicle registry, it’s very important to talk with your family members and your loved ones about what your wishes are with regard to organ donation. With regard to live organ donation, obviously, that's something that an individual could choose to pursue. The best way to find the one solution about that would be to contact the transplant center. We have individuals whose job it is to speak with people either in person or on the phone about their interest in possibly donating an organ.

Melanie:  So, let’s bust up a few myths about organ donation, Dr. Brayman.  People hear about things and they're scared to actually say, “I will donate an organ if I am brain dead or in cardiac arrest.” So, speak about some of the myths that if somebody is in that situation that organs would be taken before all measures have been used to try and save that person.  Just break up a few of those myths you must hear all the time.

Dr. Brayman:  Well, that’s true, Melanie. There are myths that exist around organ donation primarily, as you alluded to, where there are individuals who feel like they won’t get  the whole full court press to save their lives if they sign up to be an organ donor. That’s absolutely not true. I mean, the job in the emergency room and in the intensive care units and so forth is to save the life of the individual. It’s only when those individuals have been determined to either meet the legal criteria of brain death or not to be salvageable that they’re actually referred for consideration for organ donation. So, there are a lot of checks and balances in the system at the level of the emergency room, the intensive care unit, the organ procurement organs and so forth to make sure that people are not inappropriate referred for organ donation.

Melanie:  So, if someone has a history of medical illness, can they still donate various organs?

Dr. Brayman:  It’s possible. It really is up to the professionals who are involved in screening donors to determine individual suitability. So, I would never rule somebody out either for deceased donor or for live donation until a transplant professional has been consulted to look at the entire picture.

Melanie:  I think one of the barriers to organ donation is also that the donor feels it’s going to cost them a lot of money, like they’re going in for surgery for themselves. So, speak about that a little bit.

Dr. Brayman:  Sure. Well, with regard to living donors, all of the costs associated with the evaluation, surgery and the follow up of the living donor is paid for by the recipient’s insurance. So, we instruct donors to not pay any lab tests or hospital bills related to the organ donation process but send them to the transplant center if they’re inadvertently received at home because they’re supposed to be paid for by the recipient’s insurance. That’s something which is standard in the industry.

Melanie:  What about the recipients? Do they know who the donors are? Do they ever get to meet up if it’s a live donor?

Dr. Brayman:  Well, that’s up to the donor for the most part. There are people who are altruistic donors who want to meet the recipient eventually. There are some who don’t. With regard to deceased cadaver donation, the way that that works is that if a recipient wants to get in touch with a donor family, they usually write a note and it’s given to the coordinators at the transplant center and forwarded to the organ procurement organization who then forwards it to the family and the family can decide whether to respond to the recipient directly or indirectly. So, it is possible to contact the donor but there are safeguards in place to protect the anonymity of the donor.

Melanie:  Dr. Brayman, organ and tissue donation:  does that mean that the body is disrupted? Some people like to have an open casket funeral for someone that they’ve lost. Is that affected?

Dr. Brayman:  No, it’s not. When somebody donates abdominal organs or chest organs such as a heart or a lung, the body is posed up. The face and the extremities are intact and with appropriate clothing, there’s no way that individual would know that somebody had donated by looking at them in the casket.

Melanie:  In just the last few minutes, Dr. Brayman, and this is wonderful information, I applaud all the great work you’re doing. Give the listeners the information you really want them to know about the importance of organ donation and why patients should come to UVA for their transplant care.

Dr. Brayman:  Sure. Well, in the United States every day there are 18  people who die waiting for organ transplant It's really unfortunate because of the University of Virginia is the only comprehensive transplant center in the state of Virginia and by that, I mean comprehensive  in doing the 5 major organ transplants:  kidney, liver, pancreas and heart. So, it’s life-saving therapy for end-stage diseases of the lung, the heart, the liver, the kidneys—even for diabetes, with pancreas transplants. However, there’s an organ shortage. So, it’s really important that we have maximum availability of donor organs. The University of Virginia has been doing organ transplants for 50 years. The results of transplantation at the University of Virginia are outstanding. I would feel comfortable sending my family or even having my transplant here because the physicians and the surgeons and the nurses and all of the people that are involved in transplantation are highly professional. They’re highly committed and the results are really some of the best in the country. So, we have a great organ transplant group. We’ve been doing the procedure for a long time and the results are fantastic. We don’t just treat the patient, of course, we focus on treating the family. We’re very sympathetic to the stressors associated with the entire family during the transplant process.

Melanie:  Thank you so much, Dr. Brayman. You're listening to you UVA Health Systems Radio. For more information, you can go UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening