A Life-Saving Gift: Understanding Organ Donation

In the United States, approximately 103,000 people are on the national organ transplant waiting list and according to the U.S. Department of Health and Human Services, one organ donor can save eight lives and directly impact 75 additional individuals. However, globally and nationally, there is a donor organ shortage as the demand for organ, eye and tissue donation exceeds the number of registered donors across the nation.

Organ donation is the process of surgically taking healthy organs and tissues from one person for transplantation into another. Most organs are given from deceased donors; however, some organs, such as a kidney or part of the liver, can be given by living donors. 

When a person's organ has failed or has been damaged by injury or disease, organ transplant surgery is needed to help save their life. Every year, the lives of thousands of recipients are saved and improved by the gift of organ and tissue donation.

In this Q&A, we discuss the process of organ donation and the support available for patients in need of transplant surgery with Megan Del Vecchio, MSN, nurse practitioner for the liver transplant program at UC San Diego Health. 

How does organ donation work?

Organ donation always begins with consent, and transplant is not possible without our donor heroes. Many people can register to be an organ donor through the Department of Motor Vehicles when processing a driver's license or identification card, but families and legal decision makers are still involved at the time of death to make sure we are honoring the donor patient's wishes. 

Organs that can be donated include the heart, lungs, liver, pancreas, kidneys and intestines. 

Historically in transplant, programs utilized organs donated after brain death (DBD); however, with the evolution of technology and transplant medicine, programs are able to expand their donor pool to include both donation after brain death (DBD) and donation after circulatory death (DCD). This has shortened wait times for donated organs, has allowed our teams to utilize donor organs from geographically distant regions, and enabled us to give the gift of life to more patients. 

The Center for Transplantation at UC San Diego Health is the only facility in San Diego that offers liver donation from living donors. This lifesaving gift is possible because the liver, unlike other organs, can regenerate and grow back to its normal size. Both the donor's and the recipient's livers will start to regenerate immediately after transplant and can grow to 80% of its original size six weeks after donation and continues to grow for up to a year post-surgery. 

Throughout the donation process, the identity of the organ donor and family is kept confidential. Transplant recipients are able to write anonymous letters of gratitude that the Organ Procurement Organization, or OPO, helps to distribute to donor families.  

What can patients expect before and after surgery?

Before surgery, the patient is evaluated by a multidisciplinary team to ensure they are a good candidate for transplant surgery. The patient is seen by a specialty physician depending on their medical condition, such as a hepatologist or cardiologist, as well as surgeon, nutritionist, social worker, pharmacist, advanced care provider and nurse. The team assesses if transplant will improve the patient's quality of life and educates them regarding the surgery and post recovery process. 

As part of this evaluation, patients can expect a thorough set of tests, including cardiac health testing, cancer screening, blood work, imaging and nutritional assessment. Prior to surgery, we review the possible complications and procedures needed after transplant (such as additional procedures, biopsies or imaging). We also review what types of medications patients will be on for the short and long term, including immunosuppression drugs that help the body "accept" the new organ and potential side effects.

Recovery from surgery is a marathon, not a sprint. Some patients notice improvement in their symptoms right away and others take longer, depending on their unique cases. Strength and conditioning take more time to improve. After surgery, the average length of stay in the hospital is about five to seven days. Patients have frequent clinic visits for the first few months and blood work weekly. 

Post-transplant surgery also involves a multidisciplinary team approach with comprehensive medical, nutritional and social work support. Many patients are starting to resume their normal activities or work after three to four months. We continue to follow patients for the long term and regularly assess their blood work throughout the year.

What support is available at UC San Diego Health after transplant?

Patients are never doing this alone. They are supported by transplant physicians, advanced practice providers, nursing coordinators, pharmacists, dietitians and social workers every step of the way. We also offer transplant classes and support groups for patients and caregivers. 

For patients who travel from outside the San Diego area, we have housing resources including the Bannister Family House in Hillcrest and La Jolla Family House near Jacobs Medical Center at UC San Diego Health to help with recovery. 

Why choose UC San Diego Health for transplant care?

At UC San Diego Health, we provide honest and comprehensive education prior to transplant surgery in the hopes that it will help patients feel prepared and not overwhelmed. In general, the organ transplant process can feel daunting and demanding at the beginning, but it gets easier with time. Additional teaching is given before surgery and when the patient is heading home from the hospital. Recovering from transplant surgery and learning what works best for each individual is a process and we are here to guide each patient we are so proud to serve. 

Our surgeons at the Center for Transplantation have performed thousands of successful transplant procedure since the health system began offering the surgery in 1968. They have extensive experience in heart, kidney, liver, lung and multi-organ transplants from deceased donors, and kidney and liver transplants from living donors. 

Additionally, our transplant programs are first in the nation for patient survival outcomes, with rates exceeding the national average, according to the latest biannual Scientific Registry of Transplant Recipients report. 

It is an amazing experience to follow a patient from surgery to several years out and I am incredibly honored to be a part of this team. Our patients bring us photos of their children's weddings, pictures of new grandchildren, stories of the places they traveled to, updates on their professional achievements and even poetry they have written about their experiences. We get to watch them enjoy and live their lives again.