The prevalence of Filipinos suffering from end-stage organ failure is on a steady incline. It is a life-threatening situation that demands an organ transplant for one to survive. Unfortunately, in the Philippines, the number of waiting recipients is more than that of available donors.
It is difficult to consider what will happen to your body once you die, much less donating your organs. However, to be an organ donor is a selfless and worthwhile decision that can save a life. If you have never considered organ donation, this article will walk you through the basics and considerations of being an organ donor.
Why Are Organ Donations Important?
For patients with end-stage organ failure, an organ transplant is the best treatment option. With the steady rise of organ failure in the country, the waitlists for organ recipients remain high, and the number of available transplants remains heartbreakingly low. According to the International Registry In Organ Donation and Transplantation, organ donation in the Philippines has been steadily declining, from 227 in 2012 to 12 in 2020 due to the decreasing number of willing donors.
Every hour, one Filipino is diagnosed with end-stage renal disease (ESRD). This disease causes the kidneys to shut down and stop working to meet the body’s needs. There are only two treatment options for people with this condition: organ transplant or dialysis. Some patients respond well to dialysis, but many do not. The only hope for those people who struggle to adapt to dialysis is kidney replacement. The 2017 Philippine Renal Disease Registry annual report recorded that more than 21,000 Filipinos have started dialysis nationwide. In the same year, only 11 cadaveric transplants (transplants using organs from deceased persons) were done.
What Organs Can Be Donated?
Today, there are 12 different tissues and organs that can be transplanted to heal those in need. A donor can help save eight lives, restore sight to two blind people, and enhance the lives of 75 others.
Deceased donors can donate:
- Kidneys (2)
- Liver
- Lungs (2)
- Heart
- Pancreas
- Intestines
- Hands
- Faces
- Eyes (2)
- Tissues
- Bone
- Skin
Living donors can donate:
- One kidney
- A lung
- A portion of the liver
- A part of the pancreas
- A portion of the intestine
The only organs allowed in the Philippines for transplant from brain-dead patients are vital organs like kidneys, liver, pancreas, and cornea. According to the Philippine Network for Organ Sharing (PhilNOS), these organs cannot be transplanted after the patient has been declared biologically dead. Only the eyes can be harvested for transplantation after death.
How to Become an Organ Donor After Death
For your wishes to be honored, the best way is to put them in writing and let your loved ones know. There are numerous ways to indicate your willingness to share the gift of life.
Sign an Organ Donor Card.
Keeping a signed organ donor card with you will help the medical team honor your wishes for organ donation if you get into an accident. Potential donors can indicate in the card if they would like to donate tissue, organs, or any needed part to be used for transplantation, research, or education.
Tick the "Organ Donor" option on your government-issued ID or license.
Some government agencies are required to devise application forms asking for consent for organ donation in case of death. Such agencies include the following:
- Land Transportation Office (LTO)
- Government Service Insurance System (GSIS)
- Social Security System (SSS)
- Philippine Regulation Commission (PRC)
- Bureau of Internal Revenue (BIR)
- Department of Foreign Affairs (DFA)
- PhilHealth.
Write a will.
You can also state your wish to donate organs or tissues using a living will or advance health care directive. These documents can also provide limitations on how you want your donation(s) to be used.
Let your loved ones know.
In the absence of written legal consent, intentions for organ donation will be asked from your next-of-kin. In some hospitals, your family might still be able to disobey your wishes due to conflicting views. However, discussing this emotionally sensitive matter in advance could help them understand and respect your decision.
Do not leave it up to your family to determine whether or not you want to donate your organs. Let them know your decision.
Make sure your health care provider knows.
You can also express your willingness to be an organ donor through advanced health care plans and directives. These plans can also be shared with your health care providers. You can do this by providing written authorization before your death or employing a power of attorney.
How Deceased Organ Donation Works
Many people have signed to become organ donors, but only a few can donate their organs or tissues after death. Here is what happens before organ donation from dead people can be allowed for transplantation:
Medical Care of Potential Donors
Cadaveric organ donation or deceased organ donation is only possible when the donor has died in a hospital. For example, a patient comes to a hospital because of illness or an accident, such as a traumatic head injury, stroke, or brain aneurysm. Organs will need a supply of oxygen-rich blood to remain suitable for transplantation.
The patient will be placed on artificial or mechanical support to keep blood circulating through their body and continuously supply oxygen to the organs. Even then, the medical team will do everything they can to save the patient's life, whether the patient is a potential donor or not.
Brain Death Testing
If the patient is not responding, physicians will perform a series of tests to identify if brain death has occurred. A brain-dead patient has a pulse but no brain activity and cannot breathe without artificial respiratory support. It is an irreversible and permanent state. Organ donation from brain dead patients can only proceed once all efforts to save the patient have been exhausted and brain death is confirmed.
Referral to an Organ Recovery Organization (ORO)
The hospital will notify PhilNOS and refer potential deceased donors for organ recovery. The Organ Recovery Organization (ORO) will be responsible for carrying out the necessary identification, evaluation, recovery, preservation, and transportation of the transplantable organs from the deceased donor.
Authorizing Donation
A representative from ORO will identify if the deceased is registered as a donor from a duly signed will or any written document signed by the patient with two (2) witnesses indicating the choice to donate. In the absence of a will, they will check the patient for an organ donor card or a government-issued identification (ID) card and licenses, including the following:
- LTO-Issued Driver's License
- PhilHealth ID
- GSIS Membership ID
- SSS Membership ID
- PRC License Card
- DFA-Issued Philippine Passport
- BIR Tax Number ID
These will serve as legal consent for donation. If the deceased has not registered as a donor and there is no available legal consent for donation, they will request the next-of-kin for authorization in the following order of priority:
- Spouse
- Son or daughter of legal age
- Parent/s
- Brother or sister of legal age
- Legal guardian at the time of death
After authorization, a medical evaluation will occur. This includes checking the deceased's complete medical and social history from hospital records or the family.
Matching Donors and Recipients
The PhilNOS has policies that regulate how donor organs are matched and allocated to patients on the waiting list. Many factors are considered when evaluating and matching organs from deceased donors to the patients on the waitlists. Some of these factors include:
- Age (Donors should be 18 and above. Donors < 18 y/o should be presented to Ethics Committee for approval)
- Blood type
- Body size
- The severity of the patient's medical condition (hypertension, diabetes mellitus, infection)
- Distance between the donor's hospital and the recipient's hospital
- The patient's waiting time
Organ Recovery and Transportation
While medical evaluation is underway, the deceased donor is maintained on artificial respiratory support. Mechanical ventilation will keep the oxygen-rich blood flowing to the organs. The condition of each organ is carefully observed by the hospital medical staff and the ORO procurement representative.
Suppose the patient is deemed fit for organ donation. A transplant surgical team replaces the medical team that managed the patient before death, and harvesting of organs to be donated will be done in an operating room. Organs remain viable only for a short amount of time after removal from the donor. The ORO representative should have the transportation of the organs ready to be received by the hospitals of the intended recipients.
How to Become a Living Organ Donor
You can also donate selected organs while you are still alive. It is an opportunity to spare an individual the long and uncertain wait as a kidney or liver transplant candidate due to a critical shortage of deceased donors. Donors who are still alive can donate a kidney or a portion of their liver to another person and continue to live a normal life with very few restrictions.
Live Kidney Transplantation
Living donors in the Philippines account for more than 90% of kidney transplants from both related and unrelated donors. According to the National Kidney and Transplant Institute, over 7,000 patients are waiting for a new kidney. Learn more about kidney transplantation.
Live Liver Transplant
Liver transplantation is a potentially life-saving procedure for patients with chronic end-stage liver disease. However, only a few tertiary centers in the country are equipped to perform liver transplantation. Learn more about liver transplantation. Transplant candidates generally have better health outcomes when they receive organs from living donors than deceased donors. They are preferred because they carry a lower risk for rejection.
Living donors also have a higher compatibility rate, and organs from living donors work immediately after transplantation. Living-related kidney donors could be parents, siblings, cousins or aunts, and uncles, or anyone closely related by blood to a recipient. Non-related donors, meanwhile, include spouses, friends, distant relatives, and altruist donors.
If you decide on being a living donor, you will undergo a thorough assessment and interview to ensure that you know the risks. You also need to undergo a series of tests to determine if your kidneys or liver are in good shape.
Other Resources
- Human Organ Preservation Effort (HOPE)
- National Kidney and Transplant Institute (NKTI)
- Makati Medical Center
- St. Luke’s Medical Center
Sources:
Ancog AC. Philippine Law on Donations of Human Organs. Journal International de Bioethique = International Journal of Bioethics 3, no. 3 (2021). https://doi.org/.
Bikbov, B., Purcell, C., Levey, A.S., Smith, M., Abdoli, A., Abebe, M., Adebayo, OM., et al. “Global, Regional, and National Burden of Chronic Kidney Disease, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet 395, no. 10225 (February 2020): 709–33. https://doi.org/10.1016/s0140-6736(20)30045-3.
Experts Sound Alarm over Country’s ‘Dismally Low’ Number of Deceased Kidney Donors. Novartis Philippines, 2018. https://www.novartis.com.ph/news/media-releases/experts-sound-alarm-over-countrys-dismally-low-number-deceased-kidney-donors.
IRODaT - International Registry on Organ Donation and Transplantation. Irodat.org, 2019. https://www.irodat.org/?p=database&c=PH&year=2020#data.
NKTI.gov.ph. Kidney/Pancreas Transplant. Nkti.gov.ph, 2021. https://nkti.gov.ph/index.php/services/specialty-centers/health-information/liver-transplant.
Liver Transplant - Services. National Kidney and Transplant Institute, 2021. https://nkti.gov.ph/index.php/11-services/201-liver-transplant-services.
The Deceased Donation Process | Organ Donor. Organdonor.gov, May 2, 2018. https://www.organdonor.gov/about/process/deceased-donation.html.
