Chris McCrory, director of development for the Louisiana Organ Procurement Agency (LOPA) (3501 N. Causeway Blvd., Suite 940, Metairie, 837-3355 or 800-521-4483; www.lopa.org) discusses how organs and tissues are donated and matched with transplant recipients.
Q: Exactly what does LOPA do?
A: LOPA is the federally designated organ procurement agency for the state of Louisiana. Our focus is on education in the hospitals and the community, one of facilitating the donation process and then actual recovery of donated organs and tissues.
Q: How large is the need for organs and tissues?
A: In the state of Louisiana over 1,600 people are waiting for a life-saving organ transplant. Of those, about 1,200 are people waiting for a kidney. Kidneys are by far the No. 1 need. If you break the numbers down even more, of the people who are waiting for a kidney transplant, 70 percent in the state of Louisiana are African American. We know that is a direct correlation to the [quality] of health care they receive. You're often talking about uninsured or underinsured individuals who just don't get the care they need.
Q: How are donated organs and tissues matched to people who need transplants? Is that the function of the Louisiana Donor Registry?
A: We do use the registry as a tool for identifying people who have indicated they want to be organ donors. As far as matching to recipients, however, when we have a potential organ donor, we determine blood type, age and size. What we are attempting to do is match the blood type with a similar-size individual who is a potential recipient waiting for an organ. Once we have that ... then we start looking at whether or not the actual tissue is a match. ... Once you have a good match, we offer it to a transplant center for one of their patients. If there's a match, it's up to the patient to accept the organ for transplant. [If they reject the offer for some reason], then we just go right down the list (of patients).
Q: Do Louisiana residents get first dibs on organs donated locally or is it a national system?
A: It's actually a three-tiered system. We look in Louisiana first, with one caveat. We have an agreement within the southeast region ... that if there is anyone in the region who is a "status I" patient, they get it first. Status I means that if they don't get the transplant they won't survive. If there are no status I patients in the region, we start right here in the state. If there are no patients listed in the state who match the blood type and size, or if for whatever reason the transplant center or the patient turns down the offer, we then start going nationally.
Q: Does signing the "organ donor" line on the back of your driver's license guarantee your organs will be harvested in a timely manner when you die or should people take other steps?
A: We do have [a law that says if you register to be donor at the Office of Motor Vehicles] you are entered into our registry. That is considered consent. ... We tell donors also to tell their family. Even if we have consent, in order for us to proceed we need to have a good social and medical history, which generally will come from someone who will have known that person a long time. The worst that can happen is if when we're trying to get that information, that family member is hearing that the person wanted to be an organ donor for the first time; that can lead to shock. So the more you can talk to your family about it the better. They can also register at our Web site or they can call us and we'll get them the information they need to sign up.
Q: What's the procedure for determining organ donor status when someone suddenly dies?
A: When a patient has had a severe brain injury and there are certain conditions connected with that, we will receive a call from a hospital as a consultant, and we will determine whether there is a potential for organ or tissue donation. Each case and situation is different. It doesn't necessarily matter whether or not [the hospital] thinks the person is a candidate. We handle that process and start making those determinations. If the person's medical condition is such that organ donation is an option, we work very closely with the hospital and with that family. It's important that we get involved immediately to answer their questions and any fears they have we can address. For some people, the decision to be an organ donor is an automatic yes; for others it is not so easy.
Q: What are the time constraints involved in harvesting organs and then getting them to a donor on time?
A: There are two sets of time frames. The first set is from the moment we get consent and the actual recovery of the organ. That time frame is usually 18 hours. In those 18 hours -- it can be shorter or a little longer -- we are running blood tests, we are then treating [the donor, who has been declared brain dead] to optimize the organ function. Then we're also doing placement, offering organs to various transplant enters for various patients and coordinating that activity. ... Once we get into the [operating room] and are actually recovering the organs, each essentially has an amount of time from when they're removed from the donor to when they are transplanted: the heart generally has four to six hours, lungs typically about six hours, livers can go up to about 12 to 18 hours, kidneys can generally go 18 to 24 hours.
Q: Do you take organs only from healthy people who die suddenly, or are some organs harvestable even from people who are not in optimal health?
A: It's a case-by-case basis. If we have a patient who is positive for hepatitis C, there may be a recipient who needs a liver who also is positive for hepatitis C, and the donor's liver is in good health. It doesn't necessarily make sense not to transplant that liver into that recipient, because it is not going to transmit a new disease. You might also have someone who has had a severe stroke and their heart and lungs are severely damaged, but their liver and kidneys are just fine. One thing I do want to stress is that one of the big fears is that people who enter an emergency room with injuries that could lead to organ donation won't get the care they need. That is absolutely not true. If a hospital were in any way to withhold treatment of a patient in that situation, it would absolutely destroy the organs -- beyond any other legal issue that would be there -- it would destroy the organs. When a patient is in that situation, our first hope is that that patient is able to walk out the door. But because that doesn't always happen and because so many people are in need of organ transplants, we have another job to do to save lives.