RESOURCE: Understanding Organ, Tissue, and Eye Donation

Beyond the checkbox on your driver's license...

I think I’m a donor, right?

It’s my privilege to be an administrator behind the Florida End-of-Life Doula Alliance (FEOLDA) here in the Sunshine State, an organization that helps families find professional end-of-life (EOL) doulas and others in the ecosystem of EOL expertise (green burial cemeteries, for example).

This organization hosts a free Zoom discussion each month on a topic critical to aging and dying with agency, most recently on organ, tissue, and eye donation. I invite you to watch the recording (free) and visit the resources cited. ⬇️

Here are some things I didn’t know about donation:

1. Hospitals that accept Medicare or Medicaid for patient care are federally obligated to refer eligible patients to their designated Organ Procurement Organization (OPO). (That’s nearly all of us, north of age 65.) NOTE: This referral does not automatically result in donation. First, a patient must be eligible, meaning that their death (in most cases, declared brain death or cardiac death) has or will occur in a hospital, where the affected organs or tissues can be optimally preserved and transported.
   
   If the patient has not given consent — by registering through the Department of Motor Vehicles (DMV), their state’s registry, or registerme.org, the federal master list for donation — the OPO, a federally regulated and accredited nonprofit, will follow your state’s order of surrogate consent to ask the surviving family if their loved one would want to become a donor. NOTE: Even if a donor is registered in their state, loved ones might still need to give consent if the decedent dies outside of that state’s jurisdiction. This is where confirming your registration at the federal level is helpful: your wishes transcend state lines. ALSO, if you have registered as a donor, know that your consent surrogates may not override your wishes, even if they disagree.

2. Your corneas may be “universally” donated. The eight human organs eligible for donation include: heart (1), lungs (2), kidneys (2), liver (1), pancreas (1), and intestines (1-ish) and are subject to several eligibility criteria for successful donation and transplant: your condition at time of death, your medical history, your blood type, etc. Your corneas, however, are avascular and may restore sight in a person of any blood type. Older donors and donors with cancer or other diseases might still donate corneal tissue. It doesn’t even matter whether your eyesight was good!

3. Tissue, bone, tendons, heart valves and more can extend your body’s gift of life to 75 recipients or more. This one really got me. According to the Donate Life website (the national umbrella for state-based Donate Life chapters): Skin is used as a temporary dressing for burns, serious abrasions and other exposed areas. Bone is used in orthopedic surgery to facilitate healing of fractures or prevent amputation. Heart valves are used to replace defective valves. Tendons are used to repair torn ligaments on knees or other joints. Veins are used in cardiac by-pass surgery.
   
   This extrapolation of a single person’s donation is made possible in part by advanced preservation (freezing, freeze-drying, and cryopreservation).

4. The fastest-growing need in donation is actually living birth tissue and cord blood. These natural byproducts of birth require extra layers of consent—entirely separate from your organ, tissue, and eye donation consent—and pose no risks to either the mother or baby.

   
   Specifically, birth tissue is used in:

   1. Wound care: Used as coverings for burns and wounds, including diabetic ulcers and difficult-to-heal wounds.

   2. Sports medicine: Supports tissue repair and recovery.

   3. Ophthalmology: Helps treat eye injuries and conditions.

   4. Spine and dental procedures: Facilitates healing and recovery.

5. Donation does not pay for auxiliary funeral expenses—in fact there is no money or leverage exchanged in donation—but all costs of a donor’s necessary surgery (to remove or sustain donated organs) and cosmetic reconstruction of a person’s body for subsequent burial are covered.
   For families for whom burial expenses are a concern or for anyone wanting to donate in the name of science, there is also an option to donate an entire body for research, teaching technique, and more.

   
   The Medical Education and Research Institute (MERI) Genesis program, based in Memphis, Tennessee, accepts whole-body donations from the following states: Alabama, Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia. If you live in a state not listed here, get in touch with other in-state medical schools about whole-body donation.

6. The days of ‘body snatchers’ are long gone.

   The donation world is hypersensitive to accusation of predatory “organ harvest” and for-profit peddling of decedents’ donated bodies. However, as a precaution, industry specialists recommend vetting any organizations or information through the American Association of Tissue Banks, an accrediting organization widely recognized for enforcing stringent standards.

   Finally, here’s a good primer from Donate Life America on how and when donation is set in motion.

So, am I a donor?

I had to pull out my driver’s license to check, and, the answer is, “No.” I’m not sure why. I’m pretty confident that my previous licenses, issued over the years in the Midwest and Mountain West, did designate me as a donor. Why had I overlooked it here, most recently, in Florida?

I think I hedged because, like many people, I didn’t expect or want to think about my own death there at the formica counter at the DMV, separated from the teller by plexiglass and breathing in the stale legality and procedure that perfumes the place. When my daughter faced the same question, while applying for her learner’s permit, she turned to me, stunned by the mention of her possible death, and quickly said, “No,” as well.

This is unfortunate. ALL the literature leads with the need for donation. Every day, for example, 13 of the more than 100,000 Americans awaiting a lifesaving donation will die for lack of a match, and every 8 minutes a new recipient is added to the national transplant waiting list.

I think the time has come to pry the point of organ donation registry out of the DMV, where it’s easy to overlook, and lift it up where more people can see it in the context of their life’s meaning and legacy.

It’s equally important to share your decision to become an organ donor (or not) with your family, friends, and any medical professionals who might be asked to verify or clarify your decision.

If you’re already versed in end-of-life advance planning (topic of another good FEOLDA recording, by my doula friend Meghan Maher), this conversation sits squarely in the fifth of the Five Wishes, a digital or paper booklet (legally valid in nearly every state) specifying: (1) Who should make care decisions when you cannot; (2) Kinds of medical treatment you do or don’t want; (3) How comfortable you want to be; (4) How you want people to treat you; and (5) What you want your loved ones to know. (Additional free advance care planning resources are available at CaringInfo.)

Finally (finally!), if circumstances change and you ever need to amend or revoke your registry for organ, tissue, and eye donation, these are the steps to follow. There is no shame here, only choice. Thank you, all, for becoming informed.

As for me, I’m heading over to RegisterMe as soon as I press post. It’s time. And I’m glad to have all of you, reading here, as witness. ❤️