How does organ donation take place? Part 1 of 2: the process

This weekend, I had the pleasure of catching up with an old friend of mine. We got to talking about our jobs, and being the Apple fan that he is, the conversation quickly turned to Steve Jobs’ liver transplant, which took place in January 2009. He, like many other members of the public, had a few questions about whether or not Jobs “jumped the list” due to his financial status. I then put on my public education hat and explained the transplant process and how Jobs ended up receiving his new liver. Like my friend, most people don’t know a lot about the waiting list, how you get on it, and how organs are allocated to those in need of transplants, so I have decided to create a two-part blog post that explains these things in more detail. This is the first blog of the two-part blog post, and in this post, I will focus on the organ donation process:


In accordance with The William H. Amoss Act, enacted in 1998, all Maryland hospitals are required to report all deaths to the local organ procurement organization so every possible opportunity to offer life-saving organs and tissue for transplantation is realized.  The Living Legacy Foundation is Maryland’s organ procurement organization (with the exception of Prince George’s, Montgomery, and Charles counties, which are supported by the Washington Regional Transplant Community).

1. Medical professionals perform life-saving efforts

If a patient comes into a hospital, or if paramedics respond to an accident, the first and foremost concern of all health care  professionals involved is to do everything medically possible to save the person’s life.

2. Hospital referral to the Living Legacy Foundation

If the patient dies, or if doctors determine the person may have experienced enough trauma to their brain or brain stem to require brain death testing, or if the person is on ventilator support and a family member chooses to remove care, the hospital is legally obligated to call LLF and refer the patient to them.

At that time, LLF will send a clinical staff member to conduct an evaluation to determine if a patient is medically suitable to donate. LLF also checks the Maryland Donor Registry to see if the patient is a registered donor.

Note: There are two legal definitions of death: cardiac death and brain death. Cardiac death is when the heart irreversibly stops beating. Brain death is the permanent and irreversible cessation of brain function including the brain stem.  Brain death is not a coma, and it is not possible to recover from brain death. To be an organ donor, you must pass away while on a ventilator, but if you suffer a cardiac death while not on a ventilator, you may still be eligible to be a tissue donor.

3. Clinical evaluation

The patient is evaluated to see if they are eligible to be a donor. This is also when brain death testing is performed. Brain death must be declared by two physicians not related to the organ donation case.

4. Staff from Living Legacy Foundation approaches family about organ donation

If the patient is eligible to be an organ donor, staff from LLF, sometimes accompanied by hospital staff, will meet with the patient’s family to discuss the option of donation. If the patient is a registered donor, or if they are not registered but the family consents to donation, a full social and medical history on the patient will be obtained.

5. Recovery and transplantation

LLF checks the UNOS waiting list, which is the national list of people waiting for organ transplants, and allocates the life-saving organs to those highest (i.e. sickest)on the list and who are the closest match to the donor. The organs are then recovered and transported to transplant hospitals, where they are then transplanted into the recipients.

I hope you learned something about the donation process by reading this blog post. If you paid attention, you would have noticed organs are allocated to those on the waiting list who are the sickest, not the wealthiest, meaning that Steve Jobs got his liver the same way anyone else would. He was listed, he waited, and when a match became available for him, he was transplanted. Keep an eye out for the second part of this two-part post, where I’ll be explaining the transplant waiting list and the transplantable organs and tissue in more detail.

–  Lauren


About Lauren

Lauren Muskauski is the communications associate at The Living Legacy Foundation. She heads up many community outreach initiatives and projects, with a focus on middle school, high school and college outreach. She also manages The LLF’s and Donate Life Maryland’s presence on social networking sites, such as Twitter and Facebook. Lauren’s commitment to donation started early when she registered as an organ, eye and tissue donor at the MVA upon receiving her first drivers’ license, but was then reinforced a few years later when her father passed away while waiting for a liver transplant. Now, she continues to be inspired on a daily basis by the generosity of donors and their families, as well as the gratitude exhibited by every recipient she meets.
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