Facts

Transplantation of organs and tissues is a medical activity for which peoples' support and solidarity are very important.

Human body parts can be donated during lifetime and / or after death. This is a humane act, expressing great selflessness and altruism.

 

Living donation

A living donor can  give away those parts of the body that are not indispensable to the body or  have the capacity to regenerate. The only organs that can be donated during lifetime are one kidney and parts of  the liver and the small intestine. Certain tissues and cells, for instance skin and bone marrow, can also be harvested from living donors.

Living organ donation in Slovenia is limited by law to donations to people with whom the donor is genetically, familially or emotionally related. (An exception is haematopoietic stem cell transplantation.) In order to prevent illegal trade and other forms of abuse, each case of living donation of human body parts must be considered separately by the Transplant Ethics Committee.

Donation after death 

After death (provided that the conditions are met), the following organs can be removed  from the donor for transplantation: kidneys, heart, lungs, pancreas and  small bowel. The tissue that can be removed include:  corneas, bones, joints, ligaments, skin, heart valves and vessels. The removal procedure is not always simple. Tissues such as cornea, bone or skin  can be removed also several hours after death, when there is no blood flow in the body. This is different with organs such as kidneys, liver, heart, lungs and pancreas, which cannot function properly in their new owner unless they had good blood supply until they were removed.

Brain death

Brain death is defined as the irreversible end of all brain activity. Modern medicine has accepted brain death as the death of a person. This definition has been adopted also by all major religions of the modern world. 

A: Normal blood flow in the brain

B: Absence of blood flow in the brain

 

The method of establishing death is defined in detail by law. A board of specialists carries out the clinical tests prescribed by a special regulation. A clinical diagnosis of  brain death must be confirmed by an instrumental method. This can be either electroencephalography, which is used to detect any residual electrical activity in the brain, or perfusion scintigraphy, which looks for the presence of blood flow in the brain. The entire assessment procedure is repeated after a fixed period of time to confirm that the condition is irreversible.

 

What can be the cause of brain death?

Brain death can be the consequence of injuries with bleeding or bruising of the brain. The second most frequent cause is spontaneous  cerebral haemorrhage, an emergency condition resulting from vascular changes in the brain. Brain death can  result also from lack of oxygen  in the brain, associated with suffocation, cardiac arrest or with poisoning, when the brain cannot receive oxygen. A cancerous growth in the area of the brain is another possible cause of brain death.

 

Death actually occurred earlier, but it is confirmed by the board only when all investigations have been completed in the prescribed manner.

 

Once brain death has been established, the attending physician must terminate all artificial support of the deceased person's organs, unless the conditions are met for the deceased to become a donor. In this case, artificial organ support is continued until removal.

 

Conditions for the removal of tissues and organs after death:

  • fulfilled medical criteria and confirmed death
  • exclusion of incurable infection in the deceased donor
  • exclusion of malignant disease in the deceased donor
  • appropriate function of organs suitable for removal
  • no objections on the part of the examining judge when a forensic autopsy is foreseen

Removal of organs and tissues

When all conditions for organ and tissue removal from a deceased donor have been met, the selection of recipients for individual organs begins. Recipient selection is not left to chance. A recovered organ also cannot be implanted into any patient. For heart, liver and lung transplants, the donor and the recipient must have a matching blood group and organ size, whereas for a kidney transplant, a close tissue match is also needed. When  recipients for the heart, liver and lungs have been selected,  teams from hospitals where the organs are to be implanted are called in to perform the removal. For kidneys, recipient selection is often still in progress during the removal procedure since tissue compatibility testing takes a longer time.

Storage and transport

During removal, organs are flushed with chilled preservation fluid, and each organ is placed separately in a sterile plastic bag filled with the same fluid.

 

The mode of transport depends on the type of organ and distance from the transplant centre. All transport in Slovenia is by road. Regular airlines are used for longer transport of a kidney, and small business airplanes for a heart, lungs or a liver.