Donation of organs

The donation of organs is the first stage before the realization of a transplantation at a receiver.

A great number of bodies can be given and thus make it possible to save human lives, or to improve quality largely of it. The majority of the Clerc's Offices are carried out starting from bodies taken on died people, in a state of encephalic death (i.e. the heart continuing to beat).

Under certain quite precise conditions (temporal constraints in particular) the bodies (Kidney and Liver) people in cardiac arrest and respiratory final, after failure of reanimation, can be taken. It is known today that the results of the Clerc's Offices of these bodies are as good as those coming from donors in encephalic death, but the first programs of this type are long in being born in France.

A person in good health with the possibility of giving a body of alive sound . It is the case for example Rein, of part of the Foie or very seldom of the Poumon. One can indeed live with only one kidney, part of the liver (because it is a body which is regenerated quickly) or part of the lungs.

This gift is not possible that if the donor is major and very near to the receiver. The law of bioethics in France fixes the list of the people who can give a body of their alive. It is of the father, the mother, the spouse, the brother, the sister, the son, the girl, the grandparents, the uncle, the aunt, (of) the cousin (E) German (E), of the spouse of the father or the mother, or any person being the proof of a common life of at least two years with the receiver

The Clerc's Offices of donor living most frequent relate to the kidney (80%), the risk for the donor being extremely weak. They have moreover much advantages for the receiver: they function in general better and longer than the Clerc's Offices of kidney starting from donor deceased. Moreover, they make it possible to shorten or remove the difficult period of waiting in dialysis, which comprises considerable advantages on the family levels, personal and professional.

Compatibility HLA is less and less essential, taking into account progress of the immunosuppressor treatment. Nevertheless, when it is large, the treatment can be reduced.

The legislation of the donation of organs depends naturally on each country.

The donation of organs is different from the gift of the body to science. The purpose of this last is to make progress medicine as well as knowledge and the know-how of the researchers and the students. One can be, of course, donor of body and give at the same time his body to science.

In France

The donation of organs rests on the principle of the supposed assent: each one among us is regarded as a potential donor after its death unless being itself opposite there of alive sound. In practice, when a taking away of bodies is considered, if the medical team is not informed directly of the will of the late one, it must endeavor to collect from its close relations his opposition to the donation of organs possibly expressed of alive sound, by any means.

The situation is much simpler if the person deceased made known of sound living her will to give her bodies. To relate to oneself a chart of donor is a strong commitment, but not sufficient in general: it is not a legal document, and in practice the charts are found only very seldom when a donation of organs is considered. It is thus paramount to express its wish with its close relations, so that they can testify some. To facilitate this step, the Passeport of Life has been proposed free, for a few months by the Fondation Grafts Life. It comprises a chart of donor, but more especially charts pilot to give to its close relations to inform them of his decision.

In the future, the chart SESAM Vitale II could comprise a field making it possible each and everyone to mention the fact that it was informed of the law on the donation of organs.

In the same way, there exists a national register of the refusal where any person can be registered and who must be obligatorily consulted by the doctors as soon as a taking away is considered.

The gift by definition is not remunerated because the body is not regarded as a patrimonial object with the legal direction. It is completely anonymous: the receiver does not know the identity of the donor and the family of the donor the identity of the various receivers. There exists however a notorious exception: at the time of the Clerc's Office of face, the family of donneuse could only know the identity of the usherette because of her mediatization a posteriori.

In Belgium

Since the law of June 13rd, 1986, any person registered with the Register of the Population or the Register from Abroad for more than six months has been famous being donor of body, except if it is established that an opposition was expressed or if the close relations put forward theirs.

Any person can expressly announce her last wills in this respect in a direction or the other by filling an ad hoc form to the municipal authorities (form of “taking away and transplantation of body after the death”).

The Belgian authorities decided that the municipal authorities would henceforth present systematically this form to any person reaching her 18 years.

Donation of organs and religion

Catholic church

In 1996, the Social Committee of the Episcopate launched this call: " We urgently invite you to a personal reflection and these exchanges in family and inside the communities, parochial and different. While launching this call, we do not seek to make pressure on the consciences. Us invite you especially to become aware that death can to strike each one among us and of our close relations of manner unexpected, well before old age advanced, and that so painful that it is for those which love us and which we like, this death can also become the occasion of an act of solidarity of very great value. Yes, the acceptance of the possibility of a voluntary gift of bodies is a form of a true gift of oneself for the other, an authentic act of love. It is one of the unexpected applications of the word of Christ: " No one has love more large only that which gives its life for those which it aime." (Jn 15,13)

Besides several times, the pope Jean Paul II intervened to call with this gift, by pointing out the conditions under which the taking away was to be carried out. " I am certain that the social, political and educational persons in charge will renew their engagement to promote a true culture of the gift and solidarity. It is necessary to insufflate in the heart of the people, and in particular in the heart of the young people, an authentic and major recognition of the need for brotherly love, a love which can find an expression in the decision to become a donor of organes". (Speech with the 18° international Congress of transplantation of bodies - August 29th, 2000).

Benoît XVI has as for him a chart of donor since many years and recently declared with an Italian newspaper that it permanently carried it on him.

Judaism

For the Judaism, the taking away and transplantation can beings carried out on the condition of observing strict conditions like the crowned value of the life. Having to keep hope and faith towards the Creator until the end, the question it is quite out ofit is quite out of to cause the death, which it is a question of shortening of the sufferings or of wanting to take a body to save another human being. One cannot degrade the body which preserves after death its crowned character. It will thus have to be buried with respect what imposes a worthy behavior on behalf of the transplanters. In the same order of idea, one cannot benefit from it.

The thinkers thus reconcile the religious rules with the higher duty to save any person in danger of dead (Pikouah Nefesh): “the major consideration of the rescue of the life supplants all the biblical laws imposing the prohibition of the mutilation of death, the use of the dead organization and the time limit to bury it dead and to return the honors due to him. ”

During a parliamentary hearing, the chief rabbi of France indicated as follows: “The Clerc's Office encounters two prohibitions of the Jewish religion: not to attack the corpse and not to benefit from the corpse. But it was allowed that one will be able enfreindre these two prohibitions when it is a question of saving an human life. ”. This religious duty to act “to safeguard a person” is essential in the name of the supreme value of the life, finality of all the commands.

Islam

the decisions of the Academy of the right Moslem (Al-Majma `Al-fiqhî Al-islâmî) based to Mecque (and which is affiliated with world Islamic League - Râbita Al `alam Al-islâmî) and of the International counsel of jurisprudence based in Jeddah in Saudi Arabia (and affiliated with the Organization of the Islamic conference - OCI) on transplantation of bodies specify that it is allowed to take a body of a death to graft it in the body of an alive person if its survival depends on this operation, or when this one is necessary to provide an essential function of its organization. For this operation, it is necessary to have the assent of late, its legitimate heirs for his death or the agreement to the Moslem authority, if the late one is an unknown and (or) without heirs.

This permission is valid in the only case where the Clerc's Offices are practiced without commercial and lucrative goal. The bodies must be placed free at the disposal of the medical establishments because it is strictly interdict to make the trade of bodies of human origin. In agreement with the current data of science, the concept of encephalic death is recognized, a person being " legally deceased when there is complete stop, and considered to be irreversible by the doctors, either of the cardiac contractions and the respiratory movements, or of the cerebral vital functions with beginning of destruction of the brain”.

These decisions rest on the following analysis: In Islam, only God gives and takes again the life, we are only the usufructuaries of the life at the time of our passage over Ground. However, the disease is not a fate and it is necessary to choose the least among two evils. The interest of alive thus takes precedence over the respect due to the corpse. In order to guarantee the preeminence and the crowned character of the life, the donation of organs consequently is recognized and developed like a good deed, in condition of an assent, respect of the person and a not-marketing. “Whoever saves the life of only one human being is regarded as having saved the life of very whole humanity! ” (Coran 5/32)

The European Council of the fatwa (head office in Dublin, Ireland) supplemented the resolutions on the donations of organs by the following recommendations relating to the assent and the will of the late one: If, of alive sound, a person expressed in writing her will to make gift of her bodies after her death, this will is sovereign and must be carried out. The heirs to late do not have the right to make modifications to this will because the will of the person deceased takes precedence over that of the close relations. If the law of the country stipulates that the absence of inscription constitutes a presumption of agreement to a taking away of bodies, then, of alive sound, the Moslem must make register, in a register his opposition to a taking away of bodies on his body after death, if not it gives its implicit agreement.

Gift with the Clerc's Office

Unfortunately, the times are often very long, and variable according to the body, but also the area and even the hospital where the patient is registered. In 2006,229 patients died in France fault of having been able to be grafted in time.

The body of the donor

After having checked the absence of opposition of late near its family and her close relations, of the blood samples of checking take place on the body in order to detect possible communicable diseases. These taking away, if possible, are carried out above all transfusion or Hémodilution so that blood is at 100% that of the donor. Then, the taking away of the bodies is carried out: it is an surgical operation complying with the rules of hygiene and Asepsie which occurs to the operating room suite. In the event of multiple taking away the various surgical teams act in concert in order to indicate, amongst other things, that which will have the load of the tegumentary restoration, i.e., to make a body presentable (it is usually the team carrying out the last taking away). After the taking away of the bodies of the donor by the hospital, the body of late is returned to the family. Its appearance is preserved; it is the tegumentary Restauration which is placed under the responsibility of the surgeon. This last ensures:

the muscular joining (essential);
complete, hermetic and esthetic closing cutaneous.

In the event of attack of the integrity of the person deceased (taking away of a member or face for example), the family is informed of the nature of the intervention and must give a specific agreement. A prosthesis is then worked so as to respect the appearance of the body.

Selection of the receiver

The choice of the receiver is done according to medical criteria, of justice and logistics.

In France, it is done according to statutory texts defining the " rules of répartition" , under the authority of the Agency of biomedecine. The waiting list for a Clerc's Office is managed in a transparent way by the Agency of the Biomedecine, which is completely independent of the teams of taking away and transplantation, which guarantees its impartiality. The grafts are allotted to the patients on standby Clerc's Office according to quite precise rules of distribution, which take at the same time into account medical criteria and the principles of justice.

There thus does not exist possibility of “master key right” for the patients. The law of bioethics specifies that “the rules of distribution and attribution of the grafts must respect the principle of equity. ”

One of the factors history of success of the Clerc's Office remains compatibility HLA between donor and receiver: more genetic inheritances of the donor and the receiver are close, less the graft has chance to be made reject. Nevertheless, taking into account progress of the immunosuppresseurs treatments, this rule is less and less true and it is today possible to carry out Clerc's Office without any compatibility HLA.

Compatibility ABO is also important:

a) system ABO.

Like in the case of a blood transfusion, the groups of blood of the donor and the receiver must be compatible:

*Le donor O is the universal donor (it can give its bodies to all).

*Le donor has can give its bodies to the receivers has and AB.

*Le donor B can give its bodies to the receivers B and AB.

*Le donor AB can only give its bodies to the of the same receivers groups (although donor AB is universal recipient).

At the price of more important a immunosuppressor treatment, it is today possible to carry out Clerc's Offices apart from any compatibility ABO, even if this procedure remains experimental. The Rhesus factor (about or Ø) does not have any importance for the transplantation of bodies.

b) physical data.

the size and the weight of the bodies (future grafts) are taken into account in the selection of the receiver in the waiting list especially in the thoracic cases of bodies (heart and lungs) and of transplantations of liver.

c) lymphocytary Crossmatch.

It is a test consisting in making react the serum of the receiver with the lymphocytes of the donor to discover or not the presence of antibody HLA in the donor

* If Crossmatch is positive, transplantation will not be able to be carried out because antibodies HLA of the receiver recognize the antigens which are specific for them in the donor.

* Contrary, if Crossmatch is negative, there does not exist antibody HLA in the serum of the receiver able to recognize the antigens present on the graft. Consequently, the Clerc's Office can take place.

d) monitoring of the immune system.

Each receiver potential makes control serum monthly belonging to him to the laboratory of immunology in order to determine its degree of immunization.

the situation most favorable to transplantation is the absence of Immunisation. This ideal situation makes it possible to limit considerably the probability of rejection of the graft.

F) the principal logistic criterion.

the time of cold Ischémie corresponds to the duration between the taking away of the body and the restoration of circulation in the body (then grafted) at the receiver. This duration must be shortest possible because the more it lengthens, the more the bodies are degraded and the more the chances of success of the Clerc's Office are compromised.

the time of cold ischaemia is specific to each body:

* the heart and lungs: less than 6 a.m.

* the liver and the pancreas: less than 12 noon.

* kidneys: less than 48 hours.

In order to reduce the time of ischaemia, the choice of the receiver takes account of the distance between the hospital where is the graft and the center of transplantation in which the receiver must go as soon as possible.

When a body is intended to be grafted in a hospital different from that where is held the taking away, two possibilities exist: either the surgeons of the hospital greffor come to carry out the taking away and set out again with the graft, or the graft travels " seul" until the place of the Clerc's Office, by land, ferrovière or air way…

G) multiplicity of the receivers.

If there exist several potential receivers, the priority is given to the receiver for whom the Clerc's Office is most urgent or with that which is registered in waiting list since longest. It should be also noted that the children of less than 16 years have priority.

the choice of the receiver is done obviously other than any financial, social or ethnic consideration, at least in the major part of the world Western.

Conditioning of the graft

Conditioning the purpose of

the conditioning of the graft is to preserve its quality like its sterility: the body is preserved by the cold at 4°C in a plastic containor resembling a refrigerator in which plundered ice floes maintain the good temperature. This conditioning is tight and ensures the body the shock protection. Inside the containor is either a plastic box sterilized (for the blood-vessels and others) or a box out of stainless steel (for the liver).

For the kidney conditioning is very particular because it is in PSE what in fact a container isothermal and strongly resistant to the shocks.

Outside conditioning is affixed a labelling comprising all the necessary informations with the follow-up and the traceability of the graft; it is the card of taking away on which is registered the following information:

* mention “element or product of the human body”.

* its precise nature, its description and its characteristics.

* an identification number of the donor.

* the place and the exact date of the taking away.

* coordinates of the recipient establishment.

* the name and coordinates of the conveyer.

Transplantation

The body is grafted at the time of a traditional surgical operation in which generally several helped surgeons nurses take part. The receiver undergoes a General anesthesia then the surgical team proceeds to the transplantation: the sick body is removed and replaced by the graft. In the case of the kidney, the kidneys " natifs" from the patient are not withdrawn.

To minimize the probabilities of rejection of the graft after the Clerc's Office, the receiver is subjected to life with a anti-rejection treatment, of which the goal is to decrease the activity of its immune system so that it tolerates the grafted body. So the grafted patients are more vulnerable to certain infections and have a cancer risk more raised than the general population.

Today, the results of the Clerc's Offices are in constant improvement, but nevertheless the question of the rejection is not completely solved. The researchers of various pharmaceutical laboratories currently work on new drugs suitable for induce a tolerance of the grafted body, which would hand down possible the judgment of the treatment at the end of a certain time.

The advantages of the donation of organs are undeniable; it makes it possible to save lives and transplantation is possible thanks to a great control of modern medicine and with its constant development. Moreover, the donation of organs remains still too much ignored. It is thus with an aim of sensitizing the public that events such as the " National day of reflection on the donation of organs and the greffe" (June 22nd) or " the world day of the donation of organs and the greffe" (October 17th) exist and that public awareness campaigns are regularly carried out.

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