Understanding Donation

Tissue donation

What is the difference between organ and tissue donation?

The concept is the same: A person decides that after his/her own death, another individual should benefit from healthy organs and tissue through transplantation – rather than these being committed to the grave.

Organs are retrieved when a patient is brain stem dead, still in hospital and medically supported. About 1% of people die in circumstances in hospital that allow for successful organ donation. These circumstances seldom occur, however.

To put this into context, statistics show that the greater population will either pass away at home, at work or on the road, under circumstances that prevent successful organ retrieval. In such cases the donor can donate tissue, which is equally as valuable and life-altering to a patient in need of a transplant. This means that a far greater number of people have the opportunity to donate tissue.

Living Donation
Living Tissue Donation at the time of Hip Replacement

What is a hip replacement?Hip replacement surgery is usually necessary when the hip joint is worn or damaged to the extent that mobility is reduced and the person experiences pain even while resting. Adults of any age can be in need of hip replacement, although most are carried out on people between 60 and 80 years of age.

Hip replacement may be an option for patients when nonsurgical interventions such as medication, physical therapy, and the use of a cane or other walking aids no longer help alleviate the pain. Doctors generally try to delay total hip replacement for as long as possible in favour of less invasive treatments.

A hip replacement is a surgical procedure in which the diseased section of the hip joint is removed and replaced with a metal or ceramic joint called a prosthesis. If a person has advanced joint disease, hip replacement may offer the chance for relief from pain and a return to normal activities.

Living Tissue Donation donationAny patient undergoing hip replacement can decide to donate their femoral head to the tissue bank. The tissue bank will use a special process to remove all the damaged and/or deceased parts of the donated femoral head to expose the beautiful white porous bone underneath. This bone is then prepared in a new application for implant into another patient.

There is no cost involved for the patient or the medial aid in the donation or the testing of the blood specimens.

What is a femoral head? The femoral head (femur head or head of the femur) is the highest part of the thigh bone and once removed during surgery is usually discarded. Although the cartilage or the femoral head may be damaged, there typically remains healthy cortical and cancellous tissue. The discarded femur head thus provides an excellent source of bone tissue for use in various bone graft applications.

How will this impact the donor patient?At the time of hip replacement surgery, you will be requested to consider the donation of your femoral head to the tissue bank and to provide written consent should you agree to do so. You will be required to answer some health related questions, and this screening is intended to reduce the risk of possible bacterial, viral or other disease transmission to recipients of bone grafts.

If you agree to donate your femoral head, then blood samples will be obtained during your hip replacement surgery for laboratory screening for disease such as HIV, Hepatitis and other. The femoral head will only be approved for use once the required microbiological and serology tests have been passed.

HIV/Aids test:One of the blood tests performed with your consent is a HIV/Aids test. Your patient rights, however, are protected by the National HIV Counseling and testing policy guidelines (May 2015) and ensures that you have the right:

  • Not to be tested for HIV without your free and informed consent.
  • To refuse to take the test will of course necessitate the CTE rejecting your femoral head donation.
  • If you decide to take the test you have the right to be informed about the test format, its implications, its benefits and risks and alternatives before you give your consent.
  • You will also have the right to choose to have or wave pre-test counselling.
  • Your test results will at all times remain confidential.
  • Should you wish to access your results, you may contact the general manager at the CTE who will arrange that you receive counselling before the results are made available to you.

What happens during surgery?During a hip replacement procedure, the diseased bone tissue and cartilage are removed from the hip joint leaving the healthy part intact. The head of the femur (the ball) and the acetabulum (the socket) is replaced with new artificial parts.

The discarded femoral head removed during the procedure is transferred into a container labelled with the patient’s name and identity number and refrigerated until collection.

At the same time, 3 blood samples are collected and added to the femoral head within the container. This process does not interfere at any stage of the standard surgical procedures.

The femoral head and blood samples, together with your consent documentation is then sent to the tissue bank for testing and processing.

The blood samples are tested in a laboratory to ensure recipient safety. Only once the results have been returned are deemed acceptable, will the femoral head by processed and packaged according to internationally accepted standards.

Who benefits from the Femoral head donation?There are endless applications from the donated bone which can be used for patients of all ages. A few examples where your bone could be utilised are:

  • Cervical, thoracic and lumbar fusion and other spinal surgeries
  • Hip and knee replacements
  • Orthopaedic reconstruction of cancer or trauma damaged tissue.
Organ Donation
Organ donation

Organ transplants such as heart, kidney or liver usually draw media attention because they are dramatic in that they are life-saving interventions.

All potential organ donors are patients on support systems. Two doctors, independent of the transplant team, are required to perform detailed tests before the patient may be declared brain dead. Once brain death is certified, the death is then documented and the option of donation offered to the family in a sympathetic and sensitive manner.

The criteria for brain death is very strictly adhered to and accepted medically, legally and ethically in South Africa and internationally.

Once consent has been obtained from the donor family transplant arrangements will begin. The organ transplant takes place after the patient has been declared brain dead, but whilst still being supported on a respirator; and the transplant recipient will receive the donated organ shortly after retrieval. Organs are retrieved in a hospital theatre and transplanted within only a few hours.

Currently thousands of South Africans are waiting for a life-saving organ transplant, but the situation is such that very few of them will actually receive a life-saving transplant in time. Unfortunately less than 1% of the population are currently registered as organ donors.

The need for organ and tissue transplantation is great yet impossible to overcome without people who, despite the pain and absolute finality of death, still find it within themselves to make the decision to help others in need.

Living organ donation

Although most organ donations take place after a donor has died, living donation is possible in some cases.

In South Africa, a live donation (one kidney or part of the liver) may be done to save the life of a patient in need, once certain requirements have been met (blood group and tissue type match). Usually living donors are family members, but in some cases may be complete strangers. The more compatible the blood groups and tissue types the better the chances of transplant success.

Full Body Donation
Full body donation

Fully body donation is in no way related to transplantation. This is the donation of the donor’s body to the Anatomy Department of a University, and is usually documented by the donor prior to death.

The donor body is preserved for use in the education of medical and other students, and in some instances medical procedures may be practised on the donor body for research purposes.

After a period of some 2 to 3 years, and if so agreed with the relevant University, the donor body will be cremated at the University’s expense and the donor ashes returned to the family.