Organ Donation
Ὂργανον [organon], 'tool, instrument' (ancient Greek);
Dōnāre, 'to present' (classical Latin)
On the front of your Nova Scotia Health card, "Donor 1" shows your wish to participate in Atlantic Canada's Legacy of Life program by offering all organs and tissues to help others stay alive. Following the guidelines for health care providers, your Intensive Care doctor contacts the Legacy of Life team to start the arrangements. In turn, they contact your next of kin, who confirms this is what you want. It's fortunate you mentioned this earlier.
During the next few days, your body is maintained by the ICU team and medical equipment. Your ICU doctor and Legacy of Life's organ donor coordinator arrange more testing for you: bloodwork, x-rays, CT scans, and even a camera into your lungs. They find that everything looks healthy, so your organ donations can proceed.
Transplants have an impressive history. The first documented skin graft was in 1869 in Switzerland. Organ transplants have been performed since 1954, starting with a kidney in Boston. Other innovations followed.
Transplant statistics for Canada show trends over twenty years. The stats for the four Atlantic provinces are also interesting. Almost all religions either encourage organ donation or have no objection. Organ donors can be any age, although older donors are less likely due to other medical conditions.
Brain death that occurs in a hospital (typically following a stroke, intracranial hemorrhage, or traumatic brain injury) is a prime route to donate organs for transplant. This accounts for only 2% of adult deaths, so you're in a privileged group whose other organs are liable to be in good shape and can be maintained artificially. Circulatory death is another possible route (but not for hearts). Most other causes of death aren't suited to organ donation due to disease, infection, remoteness from a hospital, etc.
The pool of potential tissue donors is much larger, as most people are eligible to donate tissues. In fact, Halifax has the largest tissue bank in Canada. The most common tissues for transplant are corneas, bones, tendons, ligaments, skin, and pericardium. A different surgical team normally would come in later to do that. Because you're headed for an autopsy, and because there are many more eligible tissue donors, Legacy of Life decided not to harvest any of your tissues.
Because you were involved in an accident, you'll need an autopsy later by a Medical Examiner at the Centre for Forensic Medicine in Dartmouth. Legacy of Life's donor coordinator and one of the Medical Examiners discuss your medical history and your injury to determine which organs can be removed without compromising the autopsy. It turns out that you're eligible to donate six organs. To proceed, Legacy of Life books a surgical team and operating room for you at the Infirmary.
To identify potential organ recipients, Legacy of Life notifies the Multi-Organ Transplant Program, which checks its database of Atlantic Canadians on wait lists, as well as the Canadian Transplant Registry for people in other provinces who are hard to match. The first two criteria for matching donor to recipient are blood type and the size of the organ. MOTP's multi-disciplinary team for each type of organ then considers a third criterion: the medical urgency of everyone on the wait list, based on their life expectancy without a transplant. Those who are most in need rise to the top. Legacy of Life (for donors) is independent from MOTP (for recipients) to avoid any conflict of interest. No queue-jumping. No fast lane for billionaires.
After checking the criteria, they decide that your liver and kidneys will be transplanted at the Victoria General Hospital into recipients from St. John's, Charlottetown, and Yarmouth. Your heart will be transplanted at the Infirmary into a recipient from Bedford. A team from Toronto will charter a plane, procure your lungs here, and take them back for a recipient from Scarborough.
Base map: Google Maps
All organ transplants in Atlantic Canada are done at either the Infirmary or the VG. If an organ donor is located in another city, Legacy of Life charters a plane and sends a surgical team there to harvest the organs and bring them to Halifax for different teams to complete the job. On the return trip, taxis from the airport used to get stuck in traffic at the bridges across the harbour, so they now use ambulances with lights and siren.
MOTP's transplant coordinator notifies the Atlantic recipients by phone: Drop what you're doing and get here ASAP. The responses include surprise, delight, and relief. You'd love to hear them.
When your surgical team is ready, you're wheeled out of ICU. With agreement from your next of kin, the ICU staff recognize your upcoming donations by lining the hallway to the operating room for an Honour Walk. When you signed up as an organ donor, you probably didn't expect a parade.
In the operating room, the surgeon opens you up and removes the organs one at a time. Each organ is then perfused in a cold solution, wrapped in plastic, and packed in ice inside a picnic cooler that could have come from Canadian Tire, except for the big cross on the outside.
After being removed, your organs need to be transplanted within a certain time frame: 4–6 hours for a heart, 4–6 hours for lungs, 8–12 hours for a liver, and 24–36 hours for a kidney. The race is on. Elsewhere at the Infirmary, another operating room is booked for the heart transplant. A surgeon and a nurse deliver the liver and kidney coolers via taxi to the VG, which takes just six minutes, despite road repairs. The team from Toronto will arrive at the Infirmary soon to harvest your lungs and fly them back to Toronto General Hospital.
After the two procurement teams have finished, you're sewn up and placed into a white reinforced nylon body bag. Attached to its black zipper is a plastic envelope with your case number and hospital records. The same number appears on your ID bracelet and the outside of the bag, so that you and your paperwork will stay together. You're wheeled down to the Infirmary's cold room to await your trip to the Medical Examiner building in Dartmouth. Meanwhile, your organs are about to be dispersed to different locations. Parts of you will live on in others.
Nova Scotia Health
Doctors throughout Nova Scotia strongly encourage organ donation, as they know what it means for others who have been struggling, sometimes for years. Campaigns do what they can to raise awareness, but there is still a big shortfall.
In 2014, a billionaire in Brazil announced a plan to bury his $500,000 Bentley, so that he could drive it in the afterlife. Brazilians on social media were outraged. As it was being lowered into the ground, he stopped the event and revealed this was part of a campaign to encourage signing up for organ donation, pointing out that we regularly bury things that are much more valuable than a car.