Why are organ transplants done sometimes when people's hearts are beating?

Answer 1

Organ transplants should always be performed on the recipient when their heart is beating, otherwise the outcome of the operation is likely to be poor. The exception is heart transplants, when the heart has to be stopped momentarily in order for it to be grafted into the patient. But typically, it's necessary for the patient to have a heartbeat in order to sustain life.

Sometimes organs are removed from the donors when their hearts are beating. These donors are referred to as having suffered "brain stem death", and are sometimes classified as "heart-beating donors".They have suffered irreparable damage to the brain stem, (where the brain attaches to your spine) which is where the brain controls vital actions such as breathing. Usually, this is the result of something such as a car crash, something heavy falling on their head, or sometimes meningitis.

Without a ventilator, these donors would cease to have a heart-beat within minutes, due to lack of oxygen. From MRI images and other thorough medical checks, it is clear that these donors do not have any awareness of their surroundings, or any degree of conciousness. A number of stringent medical checks are made before organ donation is considered.

Brain-stem death is not the same as a "coma", or a "persistent vegitative state", in which the patient may show some conciousness on an MRI or similar. The above are considered, to some extent, "reversible", whereas brain-stem death is not.

To keep the organs in good condition the donor has to be ventilated (and have a heart-beat) until the organs are removed, to prevent the organs from degrading. This means that, to some extent, the donor will still appear pink and feel warm, even though they are, by definition and medical tests, dead.

Non-heartbeating donors (sort of the opposite of "brain stem death" donors) usually die of something like a heart-attack - i.e anything which stops their heart from beating. Because of the lack of heartbeat and hence ventilation, organs have to be prepared and retrieved very quickly to prevent them from degrading. (Usually, the donor would have to die actually in a hospital for this to be achievable). Clearly, non-heartbeating donors are never used to provide heart-transplants.