Tennesseans support organ donation in theory but not in practice

Staff Photo by Dan Henry / The Chattanooga Times Free Press- 8/15/16. Dr. Dan Fisher stands in the operating room before working on a patient Monday, August 15, 2016. Dr. Fisher has completed 550 kidney transplants in the Chattanooga area.
Staff Photo by Dan Henry / The Chattanooga Times Free Press- 8/15/16. Dr. Dan Fisher stands in the operating room before working on a patient Monday, August 15, 2016. Dr. Fisher has completed 550 kidney transplants in the Chattanooga area.
photo Staff Photo by Dan Henry / The Chattanooga Times Free Press- 8/15/16. Dr. Dan Fisher stands in the operating room before working on a patient Monday, August 15, 2016. Dr. Fisher has completed 550 kidney transplants in the Chattanooga area.

How to donate

To sign up as an organ donor, go to donatelifetn.org.

Ask Tennesseans if they approve of organ donations and the response is almost unanimous - 95 percent say they are a good idea, according to Jill Grandas, executive director of Tennessee Donor Services, the nonprofit company that coordinates organ transplants in the state.

But check the list of those who have actually signed up to donate their organs, and the percentage drops to less than 40, Grandas said in an interview Wednesday.

As a result, far more Tennesseans are in need of an organ donation than will ever receive one.

"There are roughly 110,000 recipients looking for kidneys on a list right now," said Dr. Dan Fisher, a surgeon with University Surgical Associates in Chattanooga who has done more than 550 kidney transplants in his 27-year-career. "We do roughly 18,000 kidney transplant operations a year [nationally]. The ratio is about 6 to 1."

Nationally, about 22 people die every day because they cannot find a donor for a needed heart, lung, kidney, liver or other vital organ, according to the American Transplant Foundation.

Why don't more people donate?

Grandas, who is a registered nurse, believes it is because they don't understand how the system works. Some people even fear that if they are a donor, doctors will not try as hard to keep them alive in order to get access to their organs, she said.

"Health care professionals take an oath, when someone is injured or ill, to take care of patients until nothing else can be done for them," she said.

Beyond their oath, the doctors who decide if a patient can't be saved are not those involved in the organ transplant process, Fisher said. "We go out of our way - way out of our way - to make sure there is no conflict of interest between the treating doctors and the [organ] procurement doctors," he said.

Anyone in need of an organ transplant is placed on a national registry or list. Patients are given a score based on how sick they are, how long they have been on the waiting list, and how close they are to a potential donor.

The geography can be important, because some organs cannot survive outside the body for more than a few hours. Hearts and lungs must be transplanted within four hours after being removed from a patient's body, while livers are OK for about 12 hours. Kidneys are viable for as long as 36 hours, Grandas said.

Most donors must be in a hospital with access to a ventilator, where the heart can be kept beating and pumping oxygen through the body even after the patient is legally dead. Those who die in their residence, or in a nursing home, or in an accident far from a hospital, are generally not good candidates to donate organs, Grandas said, although they may be a source of tissue, which remains viable for a longer period of time.

Whenever anyone dies, the local donor coordination agency is contacted. There are 58 such nonprofit companies nationwide, including Tennessee Donor Services, which covers 84 of Tennessee's 95 counties, all those except counties in West Tennessee.

For any death, the donor agency must decide whether any organs are suitable for donation. If the patient is 75 or older, the presumption is that they are not except for tissue and sometimes a liver. "The liver is one of these organs that age doesn't seem to make that much difference," Fisher said.

If the patient has signed a donor card, a representative of the donor agency will contact family members to explain how the process works. If the patient has not signed a card, and seems to be a good donor candidate, the family members will be asked to consider allowing organ donation.

It's important to allow family members time to grieve before asking about organ donation, Fisher said.

"If some doctor came in and said 'your wife's brain dead, and by the way, we want the organs ' it doesn't work that way," he said. "Some time or other at a later time period, after six hours, or 12 hours, or maybe a day, they have to come around to seeing that they can turn something bad into something good here. That's when they start talking about being an organ donor."

If the patient has signed a donor card or if the family agrees, doctors perform more tests to determine if the organs are suitable for a transplant. In Chattanooga, medical staff remove a blood sample and fly it on a private jet to the University of Pittsburgh Medical Center, which performs a series of tests to determine if a patient has any other illnesses or issues. It takes 12 hours to get those test results back, Fisher said. If they are promising, the medical staff then reviews the patient's medical history.

"They may have a bad heart, or be a smoker, or have a bad liver because they were a big drinker," he said. "We start ruling in and out various organs."

Only after that detailed analysis do doctors decide which organs are suitable for transplants. At that point, the national list of patients waiting for a donor is checked and a decision made as to which candidates are the best fit. Their doctors are contacted and surgeries are quickly scheduled, while the organs themselves are removed and flown to the local hospital.

After all of the screening, organs from only a handful of donors are accepted. In July, for example, there were 29 donors in Tennessee, Grandas said.

The need continues to grow. Fisher pointed to a big increase in the number of kidney patients on dialysis machines and waiting for a possible transplant.

"When I came to Chattanooga in 1989 and started a kidney transplant program, there were 200 people in Hamilton County on dialysis," Fisher said. "Now there are 850."

More patients are seeking kidney transplants than any other type, and while the number of donors has risen, the demand has gone up as well.

"As things become more routine then we're expanding the envelope as to who is a potential recipient," he said. "We had a weight restriction 20 years ago, but now everybody wants to expand the weight criteria because it seems half of America is obese."

Fisher said he believes an important way to get more people to donate organs is for family members to discuss the issue long before anyone becomes ill.

"You're going to get more organs if somebody has talked about the subject a long time before there is a tragedy," he said. "If all my life I have been talking about how I want to donate organs - if Dad always said he wanted to be an organ donor - now the organ bank has an easy job."

Grandas said she can make a good economic argument for organ donation.

"Providing an organ for transplant is far less expensive than having the government paying for a person on dialysis," she said.

But the emotional argument is much stronger.

"Seeing the benefits that someone who lost their loved ones gets from being able to give to someone else never ceases to amaze me," she said. "This is a national crisis, and Tennesseans are dying while people are waiting. We just want people to go on the registry and make their wishes known."

Contact staff writer Steve Johnson at 423-757-6673, sjohnson@timesfreepress.com, on Twitter @stevejohnsonTFP, or on Facebook, www.facebook.com/noogahealth.

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