ABSTRACT
For half a century patients with end-stage (fatal) organ failure have increasingly benefited from organ transplantation. Some types of tissue (as opposed to solid organ) transplantation have been established for many years – notably corneas and heart valves. But tissues transplanted were largely retrieved from organ donors, and for organs to be retrieved, the donor needed to be certified dead while the organs remained perfused. This largely limited donation to people dying on intensive care units. Advances in technique have enabled tissues (not organs) to be retrieved hours after cessation of circulation. This means that patients dying on wards can now become tissue donors, retrieval occurring in the mortuary. Currently, about 400 people on UK waiting lists die each year (Pace, 2006), and the number of patients needing transplants in the UK is expected to rise (Long and Sque, 2007). While many of these people need organs rather than tissues, tissue transplantation can improve quality of life, and may avert death. Yet many ward staff remain unaware of the possibility of tissue donation, so inadvertently deny their patient’s wishes, while depriving those needing tissues of possible donors (Magrath and Boulstridge, 2005). This chapter outlines the main ‘tissues’ that can be donated, with some guidelines for donation; bone is included as, although arguably not ‘tissue’, postmortem retrieval is possible. Most tissues can be retrieved from children as well as adults, as waiting lists include children with end-stage organ failure. Some adult tissues may also be used for children. With most tissues, upper age limits exist for donation. Upper age limits are determined by likely viability of tissue for recipient. However, as technique or knowledge advance, age (and other) limits are frequently revised, and limitations can also vary between regions and countries. So guidelines may be out of date by the time they are read. If in doubt, nurses should always seek advice from the local transplant co-ordinators. The term ‘harvest’ is often used to describe the process of retrieval. However, it does imply a dehumanising process that may deter potential donors or families. This chapter, therefore, uses the equally meaningful, but more humane, term ‘retrieval’. The main tissues that can be retrieved are:
n eye tissue n heart valves n skin n bone n tendons n trachea n pericardium n brain and spinal cord.
