Organ Donation: Transplant & Research
Maria Menikou
on
July 22, 2021
By Maria Menikou, Category Director, Human Biological Samples at Scientist.com and Gina Dunne Smith, Executive Director at International Institute for the Advancement of Medicine (IIAM).
What is Organ Donation
‘Organ donation is a precious gift that saves lives.’
We have all heard stories of people in need of an organ to save their life, but we rarely hear about organ donors, each one being able to help up to eight patients.
Organ donation is a complicated, highly regulated process that requires many parameters to align before a recipient can receive a new organ. Here are just a few considerations:
- biological suitability/cross-matching
- physiological suitability (size and age)
- organ functionality
- ischemic damage
- perfusion (circulation) quality
It is important to note that for organ transplantation no organ will be retrieved unless a matching recipient has been found. If any single factor does not meet the parameters at any point of the organ donation process, then the organ(s) will be rejected for clinical transplantation purposes. However, if the donors or the next of kin have previously given consent for research purposes, any organs already retrieved and deemed unsuitable prior to transplantation can be re-directed to research. It is worth noting here that post-mortem donations for research purposes only are also possible but follow a different clinical and compliance pathway.
“We thank the families who have selflessly entrusted us with their most precious donations. Your courage and generosity enable the research community to develop lifesaving technology and improve the lives of others.” – IIAM researcher
Who can donate organs, and what organs can be donated?
Most people, regardless of age or medical condition, can donate organs for research. In fact, a medical history that might make an organ or tissue unsuitable for a transplant recipient may be the very thing a researcher is looking for to carry out important research to develop potential treatments. Organ donors for transplantation can simultaneously be a donor for research, provided that proper consent has been granted.
The most commonly transplanted organs are:
- Heart
- Lungs, which can go into one recipent each
- Liver, which can be split and implanted into two recipients
- Kidneys, which can go into one recipient each
- Pancreas
- Bowels, which are often implanted along with the pancreas
Tissues can also be donated, such as whole eyes or corneas for restoring eyesight; skin, which is commonly used to treat burn victims; and bone, which helps reconstruct orthopaedic injuries.
Who is responsible/can facilitate organ donation?
Each country has its own network that manages the local transplant lists, donor lists, communications and consent, the logistical aspects of the process as well as maintaining all the related records. A few examples of these organisations are listed below.
United States: United Network for Organ Sharing (UNOS) is the private, non-profit organization that manages the nation’s organ transplant system under contract with the federal government. Organ and tissue donation is initially coordinated by one of the 57 organ procurement organizations (OPO) in the U.S.
United Kingdom: National Healthcare Service Blood & Transplant (NHSBT) safely collects and processes blood donations for transfusions. They support and care for organ, tissue and stem cell donors and patients and support clinical research in order to producing new and pioneering products and services to improve patient health, including supporting clinical trials. Interestingly, England, Wales and Scotland have changed their laws to an opt-out system, where all adults are considered to have agreed to be an organ donor, unless they have recorded a decision not to donate.
Did you know?
Organ donation is always discussed with the family should donation be possible, so it’s important that your family know what you want. - NHSBT
France: France has employed an opt-out system for organ donation under the Loi Caillavet (‘Caillavet Law’), which was passed in 1976, making everyone an organ donor except for those who have explicitly refused, as well as minors, and those under someone else’s guardianship (such as the mentally disabled).
The French Agency of Biomedicine (Agence de la biomédecine ) is the public institution created in 2004 Bioethics Law to oversee organ and tissue procurement and transplantation, heamatopoietic stem cell harvesting and transplantation, medically assisted procreation and human embryology and genetics.
For more information surrounding local legislation regulating the provision of human samples for research, see the COMPLi HBS Legislation Series.
How does the allocation of organs occur in research?
In most cases, research studies are ranked in order of importance in terms of impact on public health. Therefore, in order to obtain tissues for research, the managing organization will request interested researchers to complete certain project requirements that will be kept on file to be matched in future referrals of donor organs/tissue. For example, IIAM requires all research clients to have an approved Application and Biomaterial Transfer Agreement vetted by an internal and external review committee.
In each country the responsible body (e.g., IIAM in the U.S.), will receive calls from Organ Procurement Organizations with organ referrals for research. These organizations then screen the donor information to confirm proper authorization/consent for research and review vital medical and social information. The organ will then be matched to a research client’s criteria against the donor information and begin disseminating the organ profile and allowing the researcher to accept the offer. Upon acceptance, organ recovery, preservation and transportation instructions are arranged.
Advancements made through research
Improving the process and outcomes of transplantation:
Normothermic perfusion machines:
Donation of organs from donors after declaration of brain death (BD), or from donors after cardiac death (DCD), is often the only source of transplantable organs; however, the combination of warm ischemia (cessation of blood supply) and cold preservation can be highly detrimental to the transplantable organ and may lead to delayed graft function or organ rejection. Therefore, research has been focused on improving the quality of the procured organs using normothermic (i.e., body temperature) perfusion with oxygenated blood to increase the number of transplantable organs. Such devices have been created for the liver, heart, lungs and kidneys.
Nasralla et al, 2018 demonstrated that normothermic preservation of livers resulted in a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time.
IIAM lung researchers have also established a lab-service ‘lung rehabilitation’ center enabling lungs, and potentially other organs, that were previously rejected to be resuscitated, repaired and transplanted into patients!
Disease Investigation:
Liver Disease
Over the past 35 years, IIAM has been a leading provider of non-transplantable livers for the research community. Primary cells, such as hepatocytes, are isolated from livers and placed in the hands of researchers in the U.S. and all over the world. Working with these cells, some investigators are looking at ways to treat acute and chronic liver failure through clinical applications of hepatocytes.
Drug Safety
Additionally, many researchers are developing new or improved medicines that are first tested with liver cells to ensure they are safe and effective. Cancer, malaria, hepatitis and HIV are just a few of the diseases that have improved treatment options now considered life-saving or life-enhancing.
Donor hearts help researchers investigate potential side effects of new drugs and enable the FDA to approve drugs that are proven safe from adverse of fatal cardiac events.
Diabetes
IIAM is a proud provider of human pancreas for research supported by some of the largest NIH-funded projects to combat Type I and Type II diabetes. The consortium is comprised of experts from around the world who address fundamental questions relating to beta cell development and regeneration, viral infection, autoimmunity, genetics, and more. With pancreata provided through IIAM, the research facilitates in-depth analyses of neonatal to adult pancreata from organ donors with Type 1 Diabetes (T1D) or the autoantibodies that make them susceptible to the disease, as well as from healthy donors, in order to develop a comprehensive view of how T1D develops at the cellular level. A donor organ provided through IIAM enabled a research institution to show how integrating clinical information with molecular and cellular analyses identified that what appeared to be Type 1 Diabetes, was in fact part of a broader spectrum of insulin-deficient diabetes; and provided translational insight into an incompletely understood form of human diabetes.
Lung Airway Disorders
With extraordinary efforts made in the research community to combat lung airway disorders, IIAM can proudly highlight yet another NIH-funded study. This team of researchers is seeking ways to trigger lung cell regeneration to ultimately help the lung development in premature babies, as well as treat adults suffering from COPD. By bringing the greatest lung development experts in the country together to work with non-diseased human lungs from the neonatal stage through 10 years of age, this research team will create a publicly accessible reference for the research community regarding normal human lung development at the structural, cellular, protein and gene level. This helps guide researchers toward novel and more effective treatments for chronic lung disease in children and adults.
Organ Donation in undoubtably the greatest gift an individual or their family can ever give. Each organ can save a life through transplantation, or impact potentially thousands of lives through advancements in medical research!
To find out more about how to donate, reach out to your local Organ Donation organisation.
If you are interested in understanding how the donated organs are utilized in research, contact Scientist.com or visit our Human Biological Samples page.