Types of Organ Donation

Live Liver Donation

NHS Lothian carried out the first live liver transplant in Scotland in 2008. The single greatest problem in liver transplantation today is the shortage of donors. As a consequence, patients die on the transplant waiting list. If however, it becomes possible for them to receive part of a liver from a relative or friend, they may not need to wait for an organ from someone who has died. In living donor liver transplant, a section of liver is surgically removed from a living person and transplanted into a recipient, immediately after their diseased liver has been removed. The liver is an unusual organ in that, when part of it is removed the remaining part can regenerate (potentially over 8-12 weeks). It is usually the right lobe (half) which is removed and transplanted into the recipient.

Ten year-old Craig Watt underwent a life saving liver transplant when he was just 10 months old. To hear more from Craig and his family click here.

Who can become a donor?

The donor must have a relative or close friend on the waiting list for a liver transplant and they must be deemed medically and psychologically suitable by the transplant team. This will involve them undergoing investigations including blood tests, scans and meeting with a Donor Advocate Team (DAT). The DAT will typically include a psychiatrist, a physician, a specialist nurse in organ donation and a chaplain. The role of the DAT is to ensure that the donor understands the potential risks of surgery and has given considerable thought to issues such as who will look after their children should they die or require to have a prolonged stay in hospital, do they have a will or how will their bills be paid if they are off sick for a period of time etc.

Heart Transplantation

The Scottish Heart Transplant Unit was opened in December 1991 to provide heart transplantation services for the people of Scotland. Those who need a combined heart and lung transplant must go to Newcastle for their operation.

The heart pumps blood around the body to feed the cells with oxygen and nutrients. Each year in Scotland many thousands of people die from heart disease. Although most of the deaths from heart disease occur in older people, it can affect all ages. Some babies are born with abnormal hearts, a few children and teenagers develop heart muscle weakness, and as people get older they can have heart attacks and sometimes abnormalities of the heart valves.

For the majority, these conditions are treated with pills or conventional operations. When these treatments are no longer an option, then heart transplantation is sometimes all that is left.

Last year only 122 heart transplants were carried out. The number of donor hearts that become available limits this number. The results are good. About 10 years after heart transplantation, more than half will still be alive, which is much better than the outcome if the same severity of heart failure is managed with other forms of treatment.

We also know that the procedure dramatically improves people's quality of life. Some time in the future we may be able to use artificial hearts, or perhaps even hearts developed by biological engineering. Until then, heart transplantation will remain the only treatment option for a small but very sick group of people.

Lung Transplantation

All lung transplants for Scottish patients are undertaken in Newcastle's Freeman Hospital. Their Cardiopulmonary Transplant Service was established over 20 years ago and they performed their first heart transplant in 1985 and first lung transplant in 1987.

What sort of conditions need lung transplant?

Patients with a variety of diagnoses may be treated with a transplant. Many of them have chronic infection of the lungs from either cystic fibrosis or other conditions such as bronchiectasis. Some may have destruction of the lungs from emphysema which in some patients is as a result of smoking. In some older patient's pulmonary fibrosis, scarring of the lung from an unknown cause, may be the reason they need a transplant. Patients with lung cancer are not suitable for transplant: the cancer would rapidly return because of immunosuppression after a transplant.

What sort of lung transplants are there?

Lungs may be transplanted in various configurations.

The Single Lung Transplant, when just one of the two lungs is removed in the recipient and replaced with a single lung from the donor. This is an excellent operation which can return the recipient to a full level of activity. However, because one of the recipient lungs is left in place it can only be performed if that remaining lung does no harm. In particular, a single lung transplant can't be performed when there is infection in the lungs: infection in the lung that was left behind would spill over and damage the newly transplanted lung.

The Bilateral Lung Transplant involves removing both lungs and replacing them with both lungs from the donor. This is the most common lung transplant performed in the UK or anywhere in the world. It is particularly suitable for patients with infection, particularly those with cystic fibrosis.

A small number of patients have disease of both the heart and the lungs, particularly with a condition called pulmonary hypertension. They require a combined heart and lung transplant. That is the two lungs transplanted together with the heart all as one block. This is a complicated operation and only a limited number of donors have suitable organs. It is performed no more than perhaps half a dozen times a year in the UK.

Living donation

It is possible for people to be living donors. The most common type of living donation is kidney donation, when one kidney is removed from a healthy individual and transplanted into a relative or friend who has kidney failure and requires dialysis.

It is a major decision to donate an organ, and every person who comes forward offering to help a member of their family or friend undergoes a rigorous assessment. All live donors and recipients are reviewed by an Independent Assessor, who is responsible for ensuring there is no pressure or coercion involved, and all parties understand the risk of complications. The Independent Assessor submits a report to the Human Tissue Authority as every live donor transplant requires approval to proceed.

In cases where an individual wishes to donate a kidney to a relative or friend but cannot proceed because of compatibility issues, such as blood group or antibody reactions, it can be possible to find another pair who have the same problem and do a kidney 'swap'. This is called paired or pooled exchange. It is also possible now for people to be altruistic donors, when a person wishes to donate a kidney to someone they have never met, but who needs a kidney transplant. Already in the UK over 20 people have been generous enough to go through this operation to help a stranger.

Altruistic donation

A living person who has never met the possible recipient may now be considered to become an organ donor. This is called 'altruistic nondirecteddonation'.

If a person wants to donate an organ, usually a kidney, to an unknown recipient, they need to contact their local transplant centre so that they can be assessed. If they are assessed as a suitable donor and are still willing to go ahead, their name will be put forward to a national allocation scheme and matched to a suitable person. This works in the same way that organs from people who have died are matched to patients on the waiting list.

One of the most frequent concerns of potential living kidney donors is whether the loss of one kidney will hamper them in later life. A healthy person can live a completely normal life with only one kidney, lifestyle should not be affected and normal work can continue.

Living donor kidney transplant

In the UK, almost 40% of the 1,500 kidney transplants performed are from living donors. This number has risen quite dramatically over the past 20 years (in the 1990s only 10% were living donor transplants). This is partly due to the shortage of organs from deceased donors, as discussed, but also due to the very good results with transplants from living donors, which has encouraged more people to donate.

Any person who offers a kidney to a family member or friend undergoes many tests to ensure that they are fit and healthy, and have two well functioning kidneys. Detailed compatibility tests are done, and the whole process can take 3-6 months to complete. Some people who wish to donate a kidney cannot proceed, as the risks may be too great to them.

For the recipient, a living donor transplant is a good option. The transplant can be timed to avoid the need for dialysis, the kidney comes from a healthy person, and the time the kidney is without a blood supply is short, as the donor and recipient operations can be done simultaneously, so the kidney tends to work quickly and well.

For the donor, there are not so many benefits. Although in many cases the kidney removal operation can be done by keyhole surgery, there is still a risk of minor and major complications, and the risk of death is quoted as 1 in 3000. In the long term, living with one kidney should not cause any problems, however follow-up is offered to all donors.

Paired donation

A donor and recipient whose blood groups or tissue types are mismatched (or incompatible) can be paired with another donor and recipient in the same situation. This is called 'paired donation'.

In November 2009, NHS Lothian made medical history by being the first in Scotland to perform a "mis-matched" blood group transplant in Scotland. The successful kidney transplant was carried out on Alexander Proudfoot, 46, and his mother-in-law Ann Watt, 65 at the Royal Infirmary of Edinburgh. To hear more about their story click here.

Sometimes, more than two donors and two recipients will be involved in the swap (called 'pooled donation') but each recipient will benefit from a transplant that they would not otherwise have had. Local transplant centres will assess whether people are suitable to be put forward for paired or pooled donation. If so, their details will be put on to a national register where they can be matched to a compatible pair.