embalm3 lesson1

Organ and tissue donation

is the process of surgically removing an organ

or tissue from one person (the donor) and placing it into another person

(the recipient)

Federal legislation and regulation for organ donation:

• Uniform Anatomical Gift Act (UAG Act)

• Organ Procurement and Transplantation Network (OPTN)

• US Food and Drug Administration (FDA)

Local participation in organ donation;

• Hospitals – reporting requirements tied to funding

• Organ Procurement Organizations (OPO’s)

There are significant differences between organ and tissue donation

Most decedents will not qualify to be an organ donor – regardless of what their driver’s license may say.

• However, many decedents may qualify as a tissue donor

Organ Donors:

• Must be brain dead

• Must be on a ventilator

• Heart must be beating (to keep

organs viable – then heart is taken

last)

• Time is of the essence!

• Procurement is done surgically in a

medical setting.

Tissue Donors:

• Not on a ventilator

• No cardiac or respiratory activity

• Timeline is more flexible (within

limits)

• Procurement is still done surgically

• Options for procurement

setting/location:

• Hospital

• OPO/Procurement facility

• Funeral home prep room

The decedent

– first person consent

• Donor registry per the UAG

• Documentation signed prior to death

• Legally binding (family cannot decline)

• Think of how this relates to quasi-property

and custody learned in Mortuary Law…

embalming a donor

Donor cases present challenges

• Extra time

• Extra effort

• Sometimes extra skill

• Patience

• Case analysis and post-embalming treatment/monitoring

• Open-casket services with viewing are still possible

Preparation is much like an autopsied

case

• Recovery incisions

• Midline

• U or V (akin to the Y-incision of an autopsy)

• Internal access to vessels for injection

Higher index fluid/stronger embalming solution

• Determine which organs were procured to select best vessels for injection and drainage.

Suggested vessels:

• Subclavian arteries – shoulders and arms

• Common carotid arteries – head

• Common iliac arteries – legs

• Brachiocephalic and abdominal aorta – many areas

• Vena cava or corresponding veins – DRAINAGE

• Raise additional arteries if necessary

• Supplemental treatment – hypodermic and surface embalming

• Cavity treatment

• After suturing – if no filler/cotton/powder is used in the torso

• Before suturing – if filler/cotton/power IS to be used in the torso

• Leakage concerns – use plastic garments

• MONITOR remains

Eye procurements

• Cornea

• Sclera (whole eye = enucleation)

Tissue Donors: Eyes

• Protect the surrounding area (massage cream)

• Treat the orbital cavity and insert cotton with an eyecap (to preserve the natural contour during embalming)

• Use a moderate to strong embalming solution

• Avoid pre-injection and humectants

• Use a restricted cervical injection

• Monitor for swelling

• Allow drainage to occur from the site

• Remove filler/eyecap after embalming and dry the cavity

• Fill the cavity and insert a new eyecap

• Establish proper closure (per RA II material)

• Monitor and evaluate for symmetry

Tissue Donors: Skin

• Partial/split thickness recovery

• Thin layers of skin

• Completed with a dermatome

• Recovered from numerous locations

• Full thickness recovery

• Dermal and adipose layers

• Completed free-hand with a scalpel

• Often recovered from: abdomen, back, thighs

• Inspect remains before embalming – determine where skin was taken

• Dry and treat the area(s) where skin was recovered

• If back skin was taken, then the remains may have facial

discolorations from being in the prone position – treat as needed

• Treat area with phenol-based

liquid or gel

• Use a stronger solution during

arterial embalming

• Supplement with hypodermic

and surface embalming

• Allow the treated areas time to

dry thoroughly

• Once dry, treat and cover as

needed:

• Absorbent pads

• Powders

• Plastic sheeting

• Plastic garments

• Monitor remains

Tissue Donors: Bone

• Procured from both upper and lower extremities

• Prosthetics are used afterward for form and rigidity

• Prior to embalming, remove any/all sutures (put in place by the

recovery team) and open incision sites

• Remove any/all prostheses

• Determine vessel accessibility and disruption

• Pack and treat the area with a cauterant

• Embalm as usual but raise additional arteries when needed

• Clamp leaking vessels to ensure adequate distribution and vascular

pressure

• Supplement with hypodermic and surface embalming

• After embalming, ensure all areas are treated and dry.

• Replace prostheses

• Pack with hardening/preservative compounds and cotton

• Suture all areas and use plastic garments to guard against leakage

Bones recovered:

• Humerus

• Femur

• Tibia

• Fibula

• Iliac crest

• Rib

• Radius

• ulna

Bone/connective tissues recovered:

• Patellar tendons

• Achilles tendons

• Cartilage

• Rotator cuffs

• Saphenous veins and femoral vessels

(often recovered along with lower

extremity bones – due to same location

Tips & Reminders

• Donor cases take extra time, effort, and patience.

• Due to viability, it is MUCH MORE common to see bone/skin donors than organ donors.

• The specifics of each case’s treatment will depend on what was recovered – bone, skin, organs, etc.

• Viewing is still possible (possibly delayed by a day or two).

• Communicate honestly with client families concerning donation.

• Work professionally with OPO’s, as colleagues – not as adversaries