The main factor limiting organ donation is the imbalance between number of donors and recipients. The number of donated organs from all sources is not increasing sufficiently to keep pace. Brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function before retrieval. In some cases, this prevents successful donation. Donor management programmes with the best results stress the importance of high-quality ICU (Intensive Care Units) management of the potential heart-beating donor. Therefore it is important to look after organizational aspects of donor management (e.g. skilled retrieval teams).

Despite of the donor management protocols, many of the components of ICU have not yet been subjected to controlled evaluation and experienced teams have not been employed. Hence the optimal combinations of treatment goals, monitoring, and specific therapies have not yet been fully defined. Therefore for successful donation of organs more research into recommended techniques is needed and current techniques and therapies should be delivered consistently to a high standard.

brain at right without blood flow as it would be seen in a brain dead patient.

Kidney transplantation - Jaboulay was the first to attempt it in 1906, treating two patients with renal failure by transplanting animal organs. The first use of a human kidney for transplantation was in 1936 by Yu Yu Voronay.

Liver transplantation - Initial attempts were made in 1963 by Starzl in Denver. The results had improved by 1967.

Heart transplantation - Cardiac transplantation was pioneered by the American surgeon Norman Shumway. The first human heart transplant was performed in 1967.

Lung transplantation - The first transplant was performed by Hardy in 1964 and the early lung function was excellent.

* Another challenge is transplant rejection - the rejection of the transplanted tissue by the immune system of the recipient. Research is being carried out on immunosuppression (the reduction of the activity of the immune system) in order to achieve prolonged graft survival.

* Organ preservation is one of the problems faced in organ transplantation, especially due to the rapid increase in DCD donation and the use of more organs from older donors.

After reading the article i studied flow charts and pictograms for further information.

I used google news for latest advancements in the technology used in managing brain dead organ transplants.

I also watched a few videos on YouTube and have posted one of them as a reference.

Finally, I referred to a few statistics based over the last few years to get a rough idea about the trends in organ recipient survival rates.

1. Article - Organ transplantation: historical perspective and current practice    

Authors - C. J. E. Watson and J. H. Dark   

Journal - British Journal of Anaesthasia

    Published by - Oxford University Press   

Year of publication - 2012

2. Online sites:    

http://healthresearchfunding.org/pros-cons-organ-donation/

http://www.who.int/transplantation/organ/en/  

https://en.wikipedia.org/wiki/Organ_transplantation  

http://www.webmd.com/a-to-z-guides/organ-transplant-overview

https://my.clevelandclinic.org/health/treatments_and_procedures/hic_Organ_Donation_and_Transplantation       

http://www.ncbi.nlm.nih.gov/pubmed/15157913

3. YouTube links:  

 https://www.youtube.com/watch?t=256&v=UqB0HfmduSY   https://www.youtube.com/watch?v=HuKx2a5HkIM

1. Article: Management of the heartbeating brain-dead organ donor

Authors: D.W.McKeown,R.S.Bonser,J.A.Kellum

Journal:British Journal of Anaesthesia

Published By: Oxford University Press

Year:2012

2. Online sites:

http://www.ahc.umn.edu

http://www.ualberta.ca

http://www.healthland.time.com

http://ceaccp.oxfordjournals.org/content/early/2012/05/23/bjaceaccp.mks026.full

http://www.ncbi.nlm.nih.gov

http://www.med.or.jp/english/journal/pdf/2011_06/357_362.pdf

3. You Tube links:

"diagnosis of brain death" by Abdelomaniem Elmardi- https://youtu.be/vo8EIjBUgYI

In a survey conducted from December 1, 2011 to January 31, 2012 in Dhahran Military Hospital, Saudi Arabia,  the level of awareness about organ donation and transplantation was found to be satisfactory, with more than 90% of the people aware of the same. From a religious perspective, 68.8% considered it legal to donate, and those who disagreed believed that one kidney is not enough to survive. 15.2% expressed fear of the operation. Overall, religious reasons did not hinder organ donation prospects. Furthermore, 14.5% of the people were in favour of government rewards for organ donation, but the majority (82.1%) was of the opinion that organ donation did not require financial stimulation.

Reference: http://www.ncbi.nlm.nih.gov/pubmed/24314934

Besides some successful transplant stories and good level of awereness as stated below ,there is a dark side to transplantation too.

According to a survey;lured by the promise of finding work,hundreds of people in India have instead lost their kidneys. Some of the victims had been taken to a clinic in Gurgaon, just outside New Delhi, where they were reportedly knocked out by injection, and then learned they were missing a kidney when they awoke. In late January of this year, police raided the clinic as part of an effort to break up an organ transplant racket that authorities believe may have sold as many as 500 kidneys. This illegal ring, one of the most extensive ever uncovered, highlights the desperate need for organs.

In the United States alone, more than 98,000 patients are currently listed with the United Network for Organ Sharing; but only about 26,000 received transplants between January and November 2007.

"Transplantation currently does not come close to meeting the need for organ replacement," says John Scandling, director of the kidney transplant program at the Stanford University Medical Center in Palo Alto, California. "There aren't enough organs to go around."

1) About 123,000 people are waiting for an organ donation

2)1 organ donor can save up to 8 lives

3)18 people die each day while for a transplant

4)Organs and tissues from 1 donor can benefit 50 people

5)Living donors can donate a kidney; parts of liver, lung, pancreas, intestine

Pathology is the medical discipline that describes conditions typically observed during a disease state, whereas physiology is the biological discipline that describes processes or mechanisms operating within an organism. Pathology describes the abnormal or undesired condition, whereupon pathophysiology seeks to explain the physiological processes or mechanisms whereby such condition develops and progresses.

4)Ischemia: It is also spelled as ischaemia o rischæmia(/ɪˈskiːmiə/), is a restriction in blood supply to tissues, causing a shortage ofoxygen and glucose needed for cellular metabolism(to keep tissue alive).Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue.

5)Cardiovascular: Relating to the circulatory system, which comprises the heart and blood vessels and carries nutrients and oxygen to the tissues of the body and removes carbon dioxide and other wastes from them. Cardiovascular diseases are conditions that affect the heart and blood vessels.

Another application that stems from organ transplantation is xenotransplantation, which is the use of animal organs as substitutes in human organ transplantation. The pig, having similar organ size as humans, is considered as the most likely species to provide donor organs. However, this field faces three major obstacles, namely physiological, microbiological and immunological. Xenotransplantation is thus still some years away from clinical practise.

Therapeutic cloning is yet another developing field that has its roots in the study of organ transplantation, wherein the nucleus from a donor cell is used to extract embryonic stem cells. This technology could be extremely useful for patients with end-stage organ failure.

1. The government should run sustained awareness programs through advertising on television, movies, newspapers, etc.

2. Influential members of society can be roped in as ambassadors for campaigns and advertisements.

3. Tax exemptions or other benefits can be given to people who voluntarily donate their organs and which are actually transplanted.

Xenografts have been proposed as appropriate for infants who are physically too small to accommodate organs retrieved from adult or pediatric donors. Additionally, organs from animal sources could be transplanted into patients currently excluded from the human organ transplantation list. Finally, most patients perceive xenotransplantation as an acceptable bridge to transplantation of human organs in life-threatening situations

2.Nearly 10 percent of the patients currently waiting for liver transplants are young people under 18 years of age.

3.An estimated 12,000 people who die each year meet the criteria for organ donation, but less than half of that number become actual organ donors.

4.Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to 261 transplant centers.

2 Immunosuppression:  is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions.

3.Pathophysiology :The disordered physiological processes associated with disease or injury.

http://www.unckidneycenter.org/25facpdfts.  (facts)

http://emedicine.medscape.com/article/431140-overview (article)

https://www.hta.gov.uk/faqs/living-organ-donation-faqs (FAQs)

http://www.ncbi.nlm.nih.gov/pubmed/1420249 (Survey)

https://www.youtube.com/watch?v=EtZlPHde-lg (Video)

http://www.ncbi.nlm.nih.gov/pubmed/20420628 (survey)

(Video)

A completely different approach enjoying preliminary success involves growing body parts from patients' own cells. 

In early February a team of doctors at the University of Tampere in Finland announced at a news conference that they had replaced part of a man's jaw with one grown inside his abdomen from stem cells taken from his fat.

Also, a team led by Anthony Atala , director of the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina, showed that it's possible to grow a new bladder by seeding a biodegradable bladder scaffold with cells from a patient, placing the cell-seeded mold in an incubator, and then inserting the lab-grown organ into the individual.

But scientists say the biggest advantage that both this technique and the bone marrow transplant approach offer is the promise of sidestepping the threat of organ rejection by the immune system.

If kept chilled in preservation solution, donated organs can remain viable for transplantation for a duration ranging from a few to many hours, although it is best if they are transplanted as quickly as possible after the donation surgery. Typical storage times are 30 hours or less for a kidney, less than 12 hours for a pancreas or liver, and less than 6 hours for a heart or lungs. These times vary because of the relative speed at which deterioration begins in the organs' tissues.

2.Who can't donate? Why can't some organs be used?

At the time of death, the organ procurement organization serving the hospital will review medical and social histories to determine donor suitability on a case-by-case basis. There are a few diseases and conditions that rule out donation. If you are HIV positive, you will not be able to donate organs. If you have active cancer in a particular organ, you cannot donate that organ. If cancer has spread through the body, you will not be able to donate any organs. A history of certain kinds of cancer, particularly brain tumors, may allow for organ donation depending on the particular circumstances and how likely it is that a particular recipient may die if the organ is not used. A history of cancer in the distant past that is likely to be cured may not rule out organ donation.

In the case of death by injury, sometimes the organs are too damaged by either the original injury, or by the problems caused by the injury, for them to be used in other people. The medical examiner has the legal right not to allow organ donation if they feel that the deceased person may have died in such a way that there will later be a legal inquiry, such as a murder. However, this happens very uncommonly because the removal of healthy organs from a deceased person virtually never affects the legal case.

Sometimes the donor's condition changes suddenly, such as might happen if the donor's blood pressure unexpectedly plummets, and the donation cannot occur quickly enough for the organs to remain viable. Also, there are occasional situations where the donated organs are thought to be viable, but once they are visualized in the operating room, they are found to be damaged or otherwise unsuitable for transplantation due to unsuspected disease. This news can be very disappointing for the donor's family, and for the waiting recipients, too.

All donors are tested for a wide range of diseases and conditions before the donation takes place. Blood tests and other examinations are done to test the function of specific organs, and all donors are tested for HIV, hepatitis, and other viruses that might be dangerous to transplant into a recipient.

Lastly, the donor's family is interviewed carefully in order to obtain the potential donor's medical history. Certain behaviors prior to death can increase the chances that a donor may have (unsuspected) HIV disease. The Centers for Disease Control in Atlanta, Georgia has put together a publication that includes a set of questions that are asked of all donors. A positive response to one or more of these questions doesn't necessarily rule out donation, but it may alert the donation team to potential problems.

3.How are donated organs preserved and transported?

During the donation surgery, just prior to removal of the donated organs, an ice cold preservative solution is flushed into each of the organ. This starts the process of preserving the donated organs. Sterile ice is also placed in the body cavities to aid in the cooling. Once the organs are removed from the donor's body, they are packed in several layers of sterile containers and further cooled when these sterile containers are surrounded with an icy slush mixture. The goal is to cool but not freeze the organs.

Commonly used preservation solutions include ViaSpan (University of Wisconsin) Solution and Eurocollins solution, Custodial, and others.

All organs except kidneys are stored using simple hypothermia, in other words they're just kept cold in the preservative solution. Kidneys may be placed on a machine that continuously pumps preservation solution through them. This machine, known as a pulsatile perfusion device, may allow transplant surgeons to better assess the suitability of some questionably transplantable kidneys. Work to develop methods of perfusing other organs, including the liver, the lungs, and the heart is ongoing.

4.Who decides who gets the donated organs?

Under the National Organ Transplant Act, organ transplantation in the United States is overseen by the U.S. Department of Health and Human Services (DHHS). Specifically, the Division of Transplantation (DoT), which is part of the Health Resources and Services Administration (HRSA), is in charge of a federal contract that established and maintains the national waiting list and distributes cadaveric organs fairly. This organization is called the OPTN (Organ Procurement and Transplantation Network) and the contract is currently held by the United Network for Organ Sharing (UNOS).

Organs are allocated (given) according to strict rules that take into account physical matching, tissue and blood type matching, medical criteria, waiting time, severity of illness, etc. The allocation system is blind to name, race, sex, and wealth. The allocation rules have been developed over many years of deliberation by physicians and other transplant professionals, transplant candidates and recipients, donor families, and representatives of the federal government. To review the policies refer to the Policy Management section on the UNOS website at http://www.unos.org.

They are periodically adjusted, as medical knowledge grows and the field of transplantation changes in the U.S. Any proposed changes are open to public comment through the Policy Management section of the UNOS website at http://www.unos.org.

5.Who pays for the costs of donation?

The donor's family (or their insurance company) is only responsible for paying for medical care up to the point of death. Once death occurs, any expenses related to organ or tissue donation are covered and there will be no charges to the donor's estate or the donor's family.

Occasionally, the hospital's billing system may make an unfortunate mistake and the donor's family may be accidentally billed for services related to the donation. If this occurs, the donor's family should contact the hospital and/or the organ procurement organization to rectify the mistake.

6.How many extra years of healthy life do transplant recipients usually receive?

A successful transplant nearly always provides both an improvement in quality of life and an increase in quantity of life. For many recipients, getting a transplant means not just preventing immediate death, but having many additional years of feeling dramatically better than when they were sick. Some transplant patients have been sick nearly all their lives, and having a transplant means that they can finally lead the active life they've never had before. For those with kidney failure, a transplant frees them from dialysis - a very time consuming treatment on which they often feel exhausted. On average, patients that have had a kidney transplant will live about twice as long as patients that are kept alive on dialysis.

Some patients do experience life-threatening sudden organ failure, especially liver failure, and face rapid death without a transplant. For these patients, the transplant is immediately life-saving.

This is not to say that transplant recipients are freed from all medical concerns. All people who receive a transplant must take immunosuppressive (rejection-preventing) and other medications daily. They must monitor themselves for signs of rejection or other health problems, and in general take good care of themselves and the transplanted organ. But this is a small price to pay for the extra years of healthy life that they gain.