Everything You Need to Know About Organ Donation

Everything you need to know about organ donation
(The Philippine Star) Updated July 06, 2010 12:00 AM

MANILA, Philippines - What is organ and tissue donation?
It is giving a part of yourself so that others may live. About 25 organs and tissues may be donated for transplantation, the most common of which are the kidneys. Others include:

• Major organs: heart, liver, lungs, pancreas
• Tissues: bone and cartilage, bone marrow, corneas, skin
It is a unique opportunity to help save lives by giving a part of yourself so that others may live.

Why is it important to donate an organ or tissue?

Thousands of Filipinos die every year of organ failure and the lack of organ donors. Many lives can be saved if more Filipinos will donate a part of themselves.

The survival rate of organ transplants is quite encouraging. Data gathered by the National Kidney and Transplant Institute (NKTI) show that the survival rates for kidney transplants during the first year were registered at 90-95% for living-related donors and about 80-85% for diseased organ donors. These rates are comparable with the survival rates of similar transplants in other parts of the world.
New drugs, improved surgical techniques, and a deep commitment of today’s team of health care professionals help make transplants safer and more successful.

The Human Organ Preservation Effort (HOPE) is a program of the NKTI that coordinates organ donation.

The Human Organ Preservation Effort (HOPE) of the NKTI was created specifically for the retrieval, preservation, and allocation of organs and tissues for clinical transplantation.

The transplant coordinators are on call 24 hours a day to receive and respond to referrals.

Becoming a donor is a personal and emotional decision, but it may help you to:

• Talk with your family. Explain why you’re thinking of becoming a donor. Let them express how they feel. Keep in mind that helping others by donating organs and tissues could be comforting to the family — a symbolic way for you to help others continue to live.

• Ask your physician for information. He/she can answer many of your questions and can suggest other sources of information that may help you to make a decision. Discussions with your physician are most helpful during times of good health.

• Speak with your friends. Some of them may already be carrying organ donor cards. If so, ask them why they made that choice. If not, share what you know about organ donation as well.

• Consult a member of the clergy. Many of the major religious organizations support organ and tissue donation. If you have any specific questions or concerns about your religious organization’s position on this issue, talk with a member of the clergy.

Why is the organ donor card important?

The organ donor card identifies your wish to become an organ donor.

RA 7170, the Organ Donation Act of 199l, legalizes this through the organ donor card.

In case of a brain-dead patient, the following legal requirements must be met before retrieval surgery is undertaken: Declaration of brain death by the patient’s neurologist, neurosurgeon, or attending physician; and consent for donation from the next of kin, in the absence of a donor card.

Organ donation already in driver’s license?

The organ donor card has been incorporated in all drivers’ licenses. It states that the driver has the intention to become an organ and tissue donor in the event of his/her death. This type of license may make it unnecessary to carry a separate organ donor card.

How does one accomplish the organ donor card?

• Print or type your name.

• Indicate whether you want to donate all organs or tissues or only those organs or tissues you have listed.

• Sign your name in the presence of two witnesses (preferably the next of kin). Request them to sign the card.
Who are qualified to become an organ and tissue donor?
Anyone who is 18 years or older may become an organ donor when he or she dies. A minor may become an organ donor with his or her parents’ consent.

If one wishes to donate his/her organ or tissue, he/she should accomplish an organ donor card and inform the spouse or immediate family about his/her decision.

Neither age nor physical history should stop you from signing an organ donor’s card. The transplant team will decide at the time of the donation whether the organs or tissues are useful.

Can a minor become an organ donor?

A minor or a person under age 18 may become a donor only if a parent or legal guardian gives consent.

What’s involved in transplant surgery?

Recipients are chosen based on whose tissue type and blood type are most compatible with those of the donors. A meticulous search is conducted to find the most suitable recipient.

Who pays for a transplant operation?

The donor family does not pay for any transplant operation. It is usually paid for by the recipient. If he is a service patient, part of the expenses is shouldered by the government. The transplant recipient’s health insurance policy may cover the cost of the transplant.

What about donor care?

Donors are assured of the same high quality of medical treatment that non-donors receive. Medical personnel follow strict guidelines before death can be pronounced and the donor’s organs and tissues removed.

Organ and tissue donation saves lives.

You can help make the donor program successful if you:
• Decide to become a donor.
• Encourage others to become donors.
• Complete and carry this organ donor card.

Where do I go for more information?

Call or visit the HOPE office of the NKTI at the 2nd floor, Medical Arts Building, Annex II, Quezon City. Look for or talk to any of the transplant coordinators. You may attend twice a month (1st and 3rd Wednesday, 9-11 a.m.) the Kidney Transplant Support Team pre-transplant orientation at the Hospital Auditorium II, 3rd floor of the Main Building.

The Human Organ Preservation Effort (HOPE) is an outreach program of the National Kidney and Transplant Institute, in coordination with REDCOP and the Office of the Press Secretary-Philippine Information Agency (OPS-PIA), dedicated to the retrieval, preservation, and distribution of organs and tissues for clinical transplantation.

For potential deceased organ donation, call these hotlines: NKTI trunkline — 924-3601 to 19; NKTI hotline — 926-8940; HOPE telefax (8 a.m. – 5 p.m.) — 924-4673. Also call the HOPE transplant coordinators at cell phone numbers 0906485-4593, 09162582770, 09275980441, and 0916258-9685. E-mail medical@redcop.org.

Hemodialysis in the Philippines: To re-use the Dialyzer or not?

Hemodialaysis centers in the Philippines especially in Manila are plentiful.

Prices per 4 hour session varies from P2,800 to 5,000 depending on the hospital / center and depending whether they re-use the dialyzer or not.

The dialyzer is the filter through which the toxins are passed in the machine. It is actually the "artificial kidney" By re-using, it means that the dialyzer is cleaned and sterilized and re-used for about 2-4 times.

Our family opted for a center that did not re-use (Fresenius in Pasong Tamo extension in Makati) but we also tried other centers which re-used. My father especially liked Fresenius because of its very nice facilities, superb cleanliness and very nice and friendly staff. With Senior Citizen discount, the treatment cost us P3200 back in 2008 (I think it was in promo then). 

Hemodialysis Needs Arterio-Venous FISTULA

Patients with kidney failure are treated with hemodialysis.

In dialysis, blood is withdrawn from an artery or vein, purified, and returned to a vein. The volume of blood is too great for veins to handle, so a vein must be enlarged. An artery and vein, usually in the arm above or below the elbow, are sewn together, to create a fistula, and arterial pressure eventually enlarges the vein. The enlarged vein can accommodate a cannula or large needle.

In the Philippines, more doctors opt for Hemodialysis so they require a fistula done on the patient as early as possible (around stage 3 or 4)  especially if the patient chooses not to go through kidney transplant.

My father had his done at the UST hospital (University of Sto. Tomas) in Manila last 2006 and it cost around P12-15,000.

You know it's a good fistula when the artery and vein actually bulge and touching it, you feel the full forceful pressure of the flow.

If there is a sudden need for dialysis and the AV Fistula was not done, I have seen the doctors gain access on the neck or on the abdominal area which is so inconvenient.

Best to do this earliest possible. All patients with kidney disease will eventually go to dialysis at one point anyway, even while waiting for a donor (if he does opt for a transplant in the future). 

Treatments for Kidney failure: Dialysis

There are 2 kinds of Dialysis treatments. Both basically rely on a particular method (hemodialysis or peritoneal dialysis) where wastes of the body which cannot be removed by the kidneys, are removed by body fluids being cleansed by a machine or  pumped out.

HEMODIALYSIS

When a patient is diagnosed to have failing kidney progressively, he is usually advised to have an Arterio-Venous (AV) fistula (discussed on next blog) on his arm as access point where the machine will be connected to his arm.

Hemodialysis is done 2-3 times a week with each session lasting 4-5 hours.

PERITONEAL DIALYSIS

 The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis). PD is used as an alternative to hemodialysis though it is far less common. It has comparable risks and expenses, with the primary advantage being the ability to undertake treatment without visiting a medical facility. The primary complication with PD is a risk of infection due to the presence of a permanent tube in the abdomen.

Peritoneal dialysis is done everyday at home.Here is a comparison of the 2 in a diagram:

Treatments for Kidney failure: For Acute and Chronic Renal Failure

Specific treatment for renal failure will be determined by your physician based on:

1. your age, overall health, and medical history
2. extent of the disease
3. type of disease (acute or chronic)
4. underlying cause of the disease
5. your tolerance for specific medications, procedures, or therapies
6. expectations for the course of the disease
7. your opinion or preference

Treatment may include:
•hospitalization
•administration of intravenous (IV) fluids in large volumes (to replace depleted blood volume)
•diuretic therapy or medications (to increase urine output)
•close monitoring of important electrolytes such as potassium, sodium, and calcium
•medications (to control blood pressure)
•specific diet requirements

In some cases, patients may develop severe electrolyte disturbances and toxic levels of certain waste products normally eliminated by the kidneys. Patients may also develop fluid overload. Dialysis may be indicated in these cases.

Treatment of chronic renal failure depends on the degree of kidney function that remains. Treatment may include:
•medications (to help with growth, prevent bone density loss, and/or to treat anemia)
•diuretic therapy or medications (to increase urine output)
•specific diet restrictions
•dialysis
•kidney transplantation


reference

How is Kidney Failure diagnosed?

In addition to a physical examination and complete medical history, diagnostic procedures for renal failure may include the following:



•blood tests (to determine blood cell counts, electrolyte levels, and kidney function)

•urine tests

•chest x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

•bone scan - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.

•renal ultrasound (Also called sonography.) - a non-invasive test in which a transducer is passed over the kidney producing sound waves which bounce off the kidney, transmitting a picture of the organ on a video screen. The test is use to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.

•electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

•kidney biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.
 
reference

What does a CKD STAGE 5 or ESRD patient feel?

Stage 5 CKD is also called
1. established chronic kidney disease
2. end-stage renal disease (ESRD)
3. chronic kidney failure (CKF)
4. chronic renal failure (CRF)


What is renal failure?

Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure - acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

What is end-stage renal disease (ESRD)?
End-stage renal disease is when the kidneys permanently fail to work.

What are the symptoms of renal failure?
The symptoms for acute and chronic renal failure may be different. The following are the most common symptoms of acute and chronic renal failure. However, each individual may experience symptoms differently. Symptoms may include:

Acute: (Symptoms of acute renal failure depend largely on the underlying cause.)
•hemorrhage
•fever
•weakness
•fatigue
•rash
•diarrhea or bloody diarrhea
•poor appetite
•severe vomiting
•abdominal pain
•back pain
•muscle cramps
•no urine output or high urine output
•history of recent infection (a risk factor for acute renal failure)
•pale skin
•nosebleeds
•history of taking certain medications (a risk factor for acute renal failure)
•history of trauma (a risk factor for acute renal failure)
•swelling of the tissues
•inflammation of the eye
•detectable abdominal mass
•exposure to heavy metals or toxic solvents (a risk factor for acute renal failure)

Chronic:
•poor appetite
•vomiting
•bone pain
•headache
•insomnia
•itching
•dry skin
•malaise
•fatigue with light activity
•muscle cramps
•high urine output or no urine output
•recurrent urinary tract infections
•urinary incontinence
•pale skin
•bad breath
•hearing deficit
•detectable abdominal mass
•tissue swelling
•irritability
•poor muscle tone
•change in mental alertness
•metallic taste in mouth

The symptoms of acute and chronic renal failure may resemble other conditions or medical problems. Always consult your physician for a diagnosis.