OVERVIEW OF ORGAN AND



Self-Study Module

for

Organ and Tissue Donation

Goal

The purpose of this module is to provide an overview of organ and tissue donation including the role and contribution of health care professionals.

Review the letter from the hospital liaison concerning the pre and post test and the submission of paperwork for documentation purposes.

Objectives

Upon completion of this module, you will be able to:

• Discuss the need for organ and tissue donation and the nurse’s role in identifying the potential donor candidates.

• Identify the relationship between the New England Organ Bank and the hospital

• Understand the impact of legislation that requires all deaths be reported to the New England Organ Bank

• List the major steps in the donation process

Outline

Overview of organ and tissue donation

Tissue Donation

Organ Donation

Medical Uses of Donated Tissues for Transplantation

Organ Donation: Myth vs. Reality

Stories of Life and Giving

Overview of Organ and

Tissue Donation

A Self-Study Module

Did You Know?

On average, 19 people die each day waiting for an organ transplant

A single organ donor can save up to 9 people’s lives; a tissue donor can improve the quality of life for up to 100 people

Organ and Tissue Donation: What Are the Issues?

Potential organ donors are not identified

Potential organ/tissues donors are not referred to the New England Organ Bank

Families are not offered information on organ/tissue donation and are not offered the option of donation

Why is the Federal Government Involved in Donation?

The Centers for Medicare and Medicaid Services (CMS) predict the regulations will increase the number of available organs by 20 per cent. For example, in 2007 there were:

8,089 Deceased Donors

28,352 organs recovered (includes 6,306 living donors)

There are currently 98,441 waiting recipients on 3/20/2008

What are the CSM Requirements?

Hospitals must inform the New England Organ Bank of all deaths and all impending deaths prior to withdrawal of support

Hospitals must work collaboratively with the New England Organ Bank to discuss the option of donation with the family

Hospitals must comply to participate in Medicare

Who Benefits From Donation?

Donation may offer support and comfort to the grieving family

The hospital staff is able to help both the donor family and recipients through donation

Recipient’s are given the “gift of life” and are very grateful for this opportunity

Tissue Donation

CSM Requirements: All Deaths are reported to NEOB within one hour

24 hour phone number: 800-446-6362

Clinical Coordinators will determine suitability

Clinical Coordinators in collaboration with the hospital, will offer information about tissue donation to the family, communicate to the hospital the outcome of the discussion, and coordinate the recovery. NEOB will discuss donation with the family.

Information Necessary to Make a Referral to NEOB

Caller’s name, hospital, phone number

Patient’s name, age, sex, admission date

Diagnosis, medical history, cause of death, date and time of death

Name and phone number of the next of kin

Referral is made within one hour of death

Medical Examiner Cases

ME cases are not disqualified as potential organ/tissue donors

Follow hospital procedures and policy for notification to the Medical Examiner’s Office

NEOB staff are responsible for obtaining clearance for donation from the Medical Examiner

Funeral Home Participation

Please tell the NEOB coordinator the name of funeral home.

After consent is granted, the NEOB coordinator will call the funeral home to inform them of the scheduled recovery

The funeral home is notified by the NEOB coordinator when the recovery is completed

Facts about Tissue Donation

There is never a cost for donation.

Donation does not affect funeral arrangements.

1. Donation does not prevent an open casket

All major religions support donation.

Signing a donor card will not affect the medical care you receive if you become ill or injured.

Tissue Transplantation

Tissues may include:

Corneas/whole eyes

Heart valves, pericardium, veins

Bone and associated tissues

Skin

Age of donor: newborn to age 90

Uses for Recovered Tissues

Restore sight

Heart-valve transplant

Reconstructive surgery

Limb-saving orthopedic surgery

(Further information on the uses of recovered tissues is in the “Additional Reading” Section

Organ Donation CMS Requirements: Potential Organ Donor Referrals

Refer all patients as soon as there are indications that the patient may meet brain death criteria to determine suitability.

Refer all patients that have a severe neurologic injury prior to withdrawal of support

There is no age exclusion criterion

Individuals trained by the New England Organ Bank will approach families with discretion and sensitivity to their circumstances, views, and beliefs

A coordinator from the New England Organ Bank is available 24 hours a day

Call 800-446-6362

Contraindication to Donation

Documented HIV is the only absolute contraindication to organ donation

All deaths must still be reported

Required Information for an Organ Donor Referral

Caller’s name, hospital, phone number

Patient’s name, age, sex, admission date

Diagnosis, medical history, mechanism of brain injury. Brain death status at time of referral

A donation coordinator will call back and discuss an action plan

Medical Examiner Cases

Follow hospital procedures and policy for notification to the medical examiner’s office

Medical Examiner cases are not disqualified as potential organ/tissue donors

NEOB staff are responsible for obtaining clearance from the Medical Examiner

Funeral Home Participation

Please tell the NEOB coordinator the name of funeral home.

After the consent discussion, the NEOB coordinator will call the funeral home to inform them of the scheduled recovery

The funeral home will be notified by the NEOB coordinator when the recovery is completed

After the Referral

A donation coordinator will respond on-site to:

Review the medical record

Collaboratively work with the hospital staff to introduce the topic of donation

Obtain consent

Coordinate the organ recovery process

Family Options Concerning Donation

We convey simply and clearly to the family that whatever decision they choose to make is the best decision.

Family Concerns about Donation

A person’s resistance or refusal to donate is often rooted in misinformation or lack of information.

Common concerns include: difficulty accepting that death has occurred, fear of expenses to the family, fear of disfigurement, concerns over fair allocation, and the perception that organ donation will cause the decedent pain.

Facts Concerning Organ Donation

The family understands the definition of brain death

The NEOB pays all expenses associated with the organ recovery

The recovery surgery is similar to a surgery to remove a gallbladder

A brain dead person feels no pain

Some information concerning the recipients will be shared with the donor family

The Most Common Fear

“If I am in an accident and the hospital knows that I want to be a donor, the doctors will not try to save my life.”

The medical team treating you is separate from the transplant team. The organ procurement organization is involved only after all efforts to support life have been unsuccessful.

Organ Transplantation

Organs that are transplanted include

Heart

Lungs

Liver

Kidneys

Pancreas

Intestines

Transplant Success

Longest living transplant recipients as of 3/20/08

Heart 23 years

Lung 17 years

Liver 31 years

Kidney (deceased donor) 35 years

Pancreas 18 years

Hospital Staff - The Vital Connection between the NEOB coordinator and the family

As the care provider, you:

Provide medical/nursing/psycho-social/religious support to the patient and family

Provide introduction of the NEOB coordinator to the family

A collaborative approach increases consent rate

The Organ Donation Process

Early referral, suitability is determined

Informed consent is obtained from the patient’s next-of-kin by the NEOB coordinator

The donation coordinator oversees the maintenance of the potential donor in collaboration with the staff

The donation coordinator makes all arrangements for organ placement, recovery and follow-up

Informed Consent Discussion

Includes:

Explanation of organ/tissue donation process

Comprehensive medical history

Comprehensive social history (As required by the Center for Disease Control)

Consent is obtained by the NEOB coordinator. The original of the consent is in the patient chart

Organ Donor Maintenance

Goal is to optimize the potential for organ recovery.

Guidelines include the rule of 100’s.

Oxygenation saturation of 100

Systolic blood pressure of 100 MM of Hg

Urine output of 100 cc per hour

Organ Placement

Organs are placed according to blood type, size, medical urgency, and waiting time.

Donor Family Follow-Up

NEOB coordinator will communicate with the donor family and provide information concerning the recipients’ status after transplant and other social information

Confidentiality precludes the disclosure of recipient names and location

NEOB provides comprehensive follow-up with donor families via the Donor Family Services Program

Communication is Key

Call with any questions or concerns - 800-446-6362

Summary

Early referral will alleviate the disparity between the number of people waiting for a life-saving transplant and the number of available organs.

A collaborative effort between the hospital and the New England Organ Bank will maximize the number of available organs for transplantation.

1. Your participation is essential to our successes both for the family of the deceased and the recipients. Thank you very much.

|Medical Uses of Donated Tissues for Transplantation |

|Many tissue transplants may be life-saving, other transplants may be life-enhancing: |

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|Eye/Corneas |

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|The eye is the most common tissue donated and transplanted. Donated corneas, the clear covering of the eye, may |

|avert or correct blindness. Corneas are used for cornea replacement, sclera patches and even to repair the inner|

|ear. |

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|Musculoskeletal Tissue (Bone, Tendons and Other Soft Tissue) |

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|Donated bone is used after spinal injury in surgeries where fusions (cervical and lumbar) are performed. |

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|Bone and soft tissue (tendons, ligaments) are used for knee repair, total revision of the knee, and in many |

|sports medicine applications, including anterior cruciate ligament (ACL) repair and soft tissue reattachments. |

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|Cartilage and tendon grafts restore function for people with sports injuries or trauma who would otherwise be |

|incapacitated or disabled. |

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|Hand, foot, and ankle surgery, and hip replacement surgery commonly utilize allograft tissue. |

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|Periodontists utilize bone during periodontal surgery for severe gum disease. |

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|Oncologists use bone allografts in cancer surgery for osteosarcomas and other tumors where bone resections or |

|joint transplants are necessary. Patients with cancerous bone tumors once only had the option of amputation. |

|Now, bone allografts can replace the cancerous bone and restore mobility. |

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|Cardiovascular Tissue |

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|Heart valves help repair cardiac defects and are used as replacements heart valves for children born with |

|damaged valves. Many adults develop diseased or damaged valves. Donated valves may be life-saving for these |

|recipients. |

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|Saphenous veins can save a limb from amputation for patients with peripheral vascular disease . They can be used|

|as graft material in heart bypass surgery, helping patients with coronary artery disease avoid heart attacks. |

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|Femoral veins can be used as dialysis grafts enhancing the life of those with end stage renal disease. |

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|Skin |

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|Skin transplants may save live the lives of critically burned patients. Just think about some of the victims |

|from the September 11 terrorist attacks who were burned over much of their bodies yet, through skin grafts, were|

|able to survive. |

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|Donated skin helps to control the patient's electrolyte balance, helps to regulate the burn victim's body |

|temperature, and provides protection from infections. |

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|Full thickness burns (third degree burns), cannot heal unaided. Skin grafts are needed for skin regeneration. |

|Donated skin can cover a burn site and encourage skin regeneration. |

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Organ Donation: Myth vs. Reality

Don't let myths and rumors keep you from saving lives. Learn the facts.

|Myth: | |Doctors will not try to save my life if they know I want to be a donor. |

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|Fact: | |The medical staff trying to save lives is completely separate from the transplant team. Donation takes place only after all |

| | |efforts to save your life have been exhausted and death has been declared. |

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|Myth: | |People can recover from brain death. |

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|Fact: | |People can recover from comas, but not brain death. Coma and brain death are not the same. |

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|Myth: | |Minorities should refuse to donate because organ distribution discriminates by race. |

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|Fact: | |Organs are matched by factors, including blood and tissue typing, which can vary by race. Patients are more likely to find |

| | |matches among donors of their same race or ethnicity. |

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|Myth: | |The rich and famous on the U.S. waiting list for organs get preferential treatment. |

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|Fact: | |The computerized matching system does not select recipients based on fame or wealth. Organs are matched by blood and tissue |

| | |typing, organ size, medical urgency, waiting time and geographic location. |

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|Myth: | |I am too old to donate organs and tissues. |

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|Fact: | |People of all ages may be organ and tissue donors. Physical condition, not age, is most important. Physicians will decide |

| | |whether your organs and tissues can be transplanted at the time of death. |

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|Myth: | |My family will be charged for donating my organs. |

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|Fact: | |Donation costs are not the responsibility of the donor's family or estate. |

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|Myth: | |Donation will disfigure my body. |

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|Fact: | |A surgical procedure is used to recover donated organs and tissue. The body is always treated with great care and respect. |

| | |Donation should not delay or change funeral arrangements. An open casket funeral is possible. |

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|Myth: | |Organs are sold, with enormous profits going to the medical community. |

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|Fact: | |Federal law prohibits the buying and selling of organs in the United States. Violators are punishable by prison sentences and |

| | |fines. |

| | |For more detailed information about donation, visit and . |

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Religion and Organ and Tissue Donation

If you save one life, it is as though you save the world.

—The Talmud

What follows is an overview of the positions and statements of various religions with regard to organ and tissue donation and transplantation.

AME & AME ZION (African Methodist Episcopal)

Organ and tissue donation is viewed as an act of neighborly love and charity by these denominations. They encourage all members to support donation as a way of helping others.

Amish

The Amish will consent to transplantation if they believe it is for the well being of the transplant recipient. John Hostetler, world-renowned authority on Amish religion and professor of anthropology at Temple University in Philadelphia, says in his book, Amish Society, "The Amish believe that since God created the human body, it is God who heals. However, nothing in the Amish understanding of the Bible forbids them from using modern medical services, including surgery, hospitalization, dental work, anesthesia, blood transfusions or immunization."

Assembly of God

The Church has no official policy regarding organ and tissue donation. The decision to donate is left up to the individual. Donation is highly supported by the denomination.

Baptist

Though Baptists generally believe that organ and tissue donation and transplantation are ultimately matters of personal conscience, the nation's largest protestant denomination, the Southern Baptist Convention, adopted a resolution in 1988 encouraging physicians to request organ donation in appropriate circumstances and to "encourage voluntarism regarding organ donations in the spirit of stewardship, compassion for the needs of others and alleviating suffering." Other Baptist groups have supported organ and tissue donation as an act of charity and leave the decision to donate up to the individual.

Bretheren

While no official position has been taken by the Brethren denominations, according to Pastor Mike Smith, there is a consensus among the National Fellowship of Grace Brethren that organ and tissue donation and transplantation is a charitable act so long as it does not impede the life or hasten the death of the donor or does not come from an unborn child.

Buddhism

Buddhists believe that organ and tissue donation is a matter of individual conscience and place high value on acts of compassion. Reverend Gyomay Masao, president and founder of the Buddhist Temple of Chicago says, "We honor those people who donate their bodies and organs to the advancement of medical science and to saving lives." The importance of letting loved ones know your wishes is stressed.

Catholicism

Catholics view organ and tissue donation as an act of charity and love. Transplants are morally and ethically acceptable to the Vatican. According to Father Leroy Wickowski, Director of the Office of Health Affairs of the Archdiocese of Chicago, "We encourage donation as an act of charity. It is something good that can result from tragedy and a way for families to find comfort by helping others." Pope John Paul II has stated, "The Catholic Church would promote the fact that there is a need for organ donors and that Christians should accept this as a 'challenge to their generosity and fraternal love' so long as ethical principles are followed."

Religion and Organ and Tissue Donation (Cont)

Christian Church (Disciples of Christ)

The Christian Church encourages organ and tissue donation, stating that we were created for God's glory and for sharing God's love. A 1985 resolution, adopted by the General Assembly, encourages "members of the Christian Church (Disciples of Christ) to enroll as organ donors and prayerfully support those who have received an organ transplant."

Christian Science

The Church of Christ Scientist does not have a specific position regarding organ donation. According to the First Church of Christ Scientist in Boston, Christian Scientists normally rely on spiritual instead of medical means of healing. They are free, however, to choose whatever form of medical treatment they desire - including a transplant. The question of organ and tissue donation is an individual decision.

Episcopal

The Episcopal Church passed a resolution in 1982 that recognizes the life-giving benefits of organ, blood and tissue donation. All Christians are encouraged to become organ, blood and tissue donors "as part of their ministry to others in the name of Christ, who gave His life that we may have life in its fullness."

Greek Orthodox

According to Reverend Dr. Milton Efthimiou, Director of the Department of Church and Society for the Greek Orthodox Church of North and South America, "the Greek Orthodox Church is not opposed to organ donation as long as the organs and tissue in questions are used to better human life, i.e., for transplantation or for research that will lead to improvements in the treatment and prevention of disease."

Hinduism

According to the Hindu Temple Society of North America, Hindus are not prohibited by religious law from donating their organs. This act is an individual's decision. H. L. Trivedi, in Transplantation Proceedings, stated that, "Hindu mythology has stories in which the parts of the human body are used for the benefit of other humans and society. There is nothing in the Hindu religion indicating that parts of humans, dead or alive, cannot be used to alleviate the suffering of other humans."

Independent Conservative Evangelical

Generally, Evangelicals have no opposition to organ and tissue donation. Each church is autonomous and leaves the decision to donate up to the individual.

Islam

The religion of Islam believes in the principle of saving human lives. According to A. Sachedina in his Transplantation Proceedings' (1990) article, Islamic Views on Organ Transplantation, "the majority of the Muslim scholars belonging to various schools of Islamic law have invoked the principle of priority of saving human life and have permitted the organ transplant as a necessity to procure that noble end."

Jehovah's Witnesses

According to the Watch Tower Society, Jehovah's Witnesses believe donation is a matter of individual decision. Jehovah's Witnesses are often assumed to be opposed to donation because of their belief against blood transfusion. However, this merely means that all blood must be removed from the organs and tissues before being transplanted.

Religion and Organ and Tissue Donation (Cont)

Judaism

All four branches of Judaism (Orthodox, Conservative, Reform and Reconstructionist) support and encourage donation. According to Orthodox Rabbi Moses Tendler, Chairman of the Biology Department of Yeshiva University in New York City and Chairman of the Bioethics Commission of the Rabbinical Council of America, "If one is in the position to donate an organ to save another's life, it's obligatory to do so, even if the donor never knows who the beneficiary will be. The basic principle of Jewish ethics - `the infinite worth of the human being' - also includes donation of corneas, since eyesight restoration is considered a life-saving operation." In 1991, the Rabbinical Council of America (Orthodox) approved organ donations as permissible, and even required, from brain-dead patients. The Reform movement looks upon the transplant program favorably and Rabbi Richard Address, Director of the Union of American Hebrew Congregations Bio-Ethics Committee and Committee on Older Adults, states that "Judaic Responsa materials provide a positive approach and by and large the North American Reform Jewish community approves of transplantation."

Lutheran

In 1984, the Lutheran Church in America passed a resolution stating that donation contributes to the well-being of humanity and can be "an expression of sacrificial love for a neighbor in need." They call on members to consider donating organs and to make any necessary family and legal arrangements, including the use of a signed donor card.

Mennonite

Mennonites have no formal position on donation, but are not opposed to it. They believe the decision to donate is up to the individual and/or his or her family.

Moravian

The Moravian Church has made no statement addressing organ and tissue donation or transplantation. Robert E. Sawyer, President, Provincial Elders Conference, Moravian Church of America, Southern Province, states, "There is nothing in our doctrine or policy that would prevent a Moravian pastor from assisting a family in making a decision to donate or not to donate an organ." It is, therefore, a matter of individual choice.

Mormon (Church of Jesus Christ of Latter-Day Saints)

The Church of Jesus Christ of Latter-Day Saints believes that the decision to donate is an individual one made in conjunction with family, medical personnel and prayer. They do not oppose donation.

Pentecostal

Pentecostals believe that the decision to donate should be left up to the individual.

Presbyterian

Presbyterians encourage and support donation. They respect a person's right to make decisions regarding his or her own body.

Seventh-Day Adventists

Donation and transplantation are strongly encouraged by Seventh-Day Adventists. They have many transplant hospitals, including Loma Linda in California. Loma Linda specializes in pediatric heart transplantation.

Religion and Organ and Tissue Donation (Cont)

Shinto

In Shinto, the dead body is considered to be impure and dangerous, and thus quite powerful. "In folk belief context, injuring a dead body is a serious crime . . ." according to E. Namihira in his article, Shinto Concept Concerning the Dead Human Body. "To this day it is difficult to obtain consent from bereaved families for organ donation or dissection for medical education or pathological anatomy . . . the Japanese regard them all in the sense of injuring a dead body." Families are often concerned that they not injure the itai, the relationship between the dead person and the bereaved people.

Society of Friends (Quaker)

Organ and tissue donation is believed to be an individual decision. The Society of Friends does not have an official position on donation.

Unitarian Universalist

Organ and tissue donation is widely supported by Unitarian Universalists. They view it as an act of love and selfless giving.

United Church of Christ

Reverend Jay Lintner, Director, Washington Office of the United Church of Christ Office for Church in Society, states, "United Church of Christ people, churches and agencies are extremely and overwhelmingly supportive of organ sharing. The General Synod has never spoken to this issue because, in general, the Synod speaks on more controversial issues, and there is no controversy about organ sharing, just as there is no controversy about blood donation in the denomination. While the General Synod has never spoken about blood donation, blood donation rooms have been set up at several General Synods. Similarly, any organized effort to get the General Synod delegates or individual churches to sign organ donation cards would meet with generally positive responses."

United Methodist

The United Methodist Church issued a policy statement regarding organ and tissue donation. In it, they state that, "The United Methodist Church recognizes the life-giving benefits of organ and tissue donation, and thereby encourages all Christians to become organ and tissue donors by signing and carrying cards or driver's licenses, attesting to their commitment of such organs upon their death, to those in need, as a part of their ministry to others in the name of Christ, who gave his life that we might have life in its fullness." A 1992 resolution states, "Donation is to be encouraged, assuming appropriate safeguards against hastening death and determination of death by reliable criteria." The resolution further states, "Pastoral-care persons should be willing to explore these options as a normal part of conversation with patients and their families."

Reprinted with permission from:

SEOPF/UNOS, Organ and Tissue Donation: A Reference Guide for Clergy, 4th ed., 2000. Cooper ML, Taylor GJ, eds. Richmond, VA

|Stories of Life and Giving |

|Christopher Duffy - Donor |

|Chris passed away from an aneurism in August of 2000.  He was thirty-five years old when he had died in his sleep.  Chris was a pro wrestler and a baseball coach in |

|his town.  He was not able to donate his major organs; however, he was able to help approximately forty-five people through tissue donation.  |

|We know that if there truly is a reward for a "job well done" down here, then Chris (Pud) is reaping it, and we hope, praying for us to do half as well as he did! His |

|favorite song was Sinatra's (Yes, Sinatra!) "My Way". Well, his way was the right way! He was a model son, a great role model to his students, and all the young people|

|who knew him. I hope he knows how much I miss our morning "Stove League" sessions, and is willing to renew them when I get to where he is! |

|Love, Mom and Dad |

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|Patrick Michaud - Heart Recipient |

|Patrick Michaud, now a healthy eight year old boy, received the gift of life when he was three years old.  His heart was failing, and had been for over two years of |

|his young life.  Once listed for an organ, Patrick waited 40 days for his life saving heart.  Thanks to someone's decision of organ donation, my son has life!  I thank|

|God for the life of my son, and for the family who gave that gift of life to us. |

|If you're an organ donor, you're a hero to me! |

|Stacey Michaud, Mother of Patrick |

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|Allison Lindgren - Heart Recipient |

|Allison was diagnosed at the young age of 15 months with a rare and incurable form of heart disease called restrictive cardiomyopathy.  Growing up, she could not |

|partake in sports or similar activities as it would cause her to become extremely fatigued and drained of energy.  The summer after 6th grade, at the age of 11, she |

|became increasingly ill and was admitted to the hospital in the fall.  She received her heart transplant in October of 1998 and has since stayed in good health.  In |

|addition, she is an active volunteer for the New England Organ Bank in hopes that she will be able to educate others on the importance of organ donation.  Today she is|

|twenty years old and in her third year of college studying communications.  Although she has never met them, remains ever thankful to her donor family and strongly |

|encourages organ donation. |

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|Herbert Ronald Knight III - Donor |

|"Champion" |

|Herbie died February 26, 2005 at the age of 12.  During his life he was active in many groups and programs at his school, church, and in his community. |

|Though his life ended, Herbie continued with his daily practice of sharing and giving, donating his organs and tissue so that others, both children and adults, would |

|enjoy a better life.  |

|Herbie served as student tech advisor at his middle school when all of the students were issued a computer and performed with both the jazz band and concert band |

|playing his trombone.  He was a member of the Junior Youth Group at his church and even played the hand bells in the choir.  Herbie proudly held rank of Scout, Second |

|Class in the Boy Scouts.  One of the greatest joys he took from scouting was the opportunity to be involved in community service projects and striving to accomplish “a|

|good turn daily”.  He had great fun playing in his town’s NFL Flag Football League, as well as on the Little League team.  He loved to talk with people and no day |

|passed where he didn’t bring a smile to somebody’s face by sharing one of the new facts he’d learned and or an interesting story that he had to tell. |

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|Amanda Paro - Donor |

|Mandy was a beautiful person. She had a smile that could make anyone feel welcome and at ease. Mandy chose to go into a profession where she could help heal people; |

|she was to be a nurse. Sadly, three months prior to her college graduation, Mandy passed away on a snowy February morning while driving to her student nursing |

|assignment. As a child, Mandy wanted to be a part of everything, nicknamed “Mandy-touch-touch”, she carried that into her adult life. Mandy was involved in many |

|activities including Habitat for Humanity and president of her college student nursing association. Because our family had discussed organ and tissue donation and |

|because of the kind and giving person Mandy was, it was an easy decision for our family. Mandy would have wanted her last gift to the world to be to improve and save |

|the lives of others. The saddest day in our family’s lives turned into the happiest for another family’s. Knowing this fact brings our family comfort and reassurance |

|that Mandy lived and died helping people. |

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|Dan Caredeo - Liver Recipient |

|My name is Dan. I was a normal healthy five-year-old when I became very sick. The exact cause of my illness was never discovered, but the end result was I needed an |

|emergent liver transplant. I received that liver transplant on October 28th 1994, at the New England Medical Center Floating Hospital for Children. After a stay in the|

|hospital I returned home to continue my recovery. I was able to participate in Pop Warner football, baseball, wrestling, and track and field. I also enjoy boating on |

|Lake Winnipesaukee in N.H.. I am now a senior at Salem High School. I gave up football and wrestling to concentrate on cross-country running. I have been a member of |

|the cross-country team all four years at SHS. I have been an active member of the student government, holding such positions as class treasurer, class vice-president |

|and this year I am the senior class president. I am a member of the National Honor Society and the National Vocational Technical Honor Society. I work part-time as a |

|produce clerk at the local Market Basket and I volunteer for different organizations, one being the New England Organ Bank. |

|Ever since my transplant, I knew I wanted to be a physician. More specifically I want to be a pediatric transplant surgeon and return the favor to other young kids. I |

|have recently have been accepted into college for biology and pre-medicine. I hope to continue to make the best of my future. Each new day brings promise, and I will |

|always embrace it and cherish my gift of life. |

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|Randy Ramos - Kidney & Pancreas Recipient |

|My name is Randy and the story in which you are about to read has to do with giving the gift of life to those who are in need of an organ and tissue transplant. A |

|transplant can save a child, a teenager or an adult. |

|Everything started when I was 7 years old when I was diagnosed with diabetes.  It was very hard for me to understand what diabetes meant, but day by day I was taught |

|to learn about it and to learn about certain restrictions that I had to follow to live a normal life. Those restrictions were to follow a strict diet and the other was|

|to prevent eating any kind of sweets. The other step was to check my blood sugar and inject myself with insulin. All of that was great and dandy until I turned 12 |

|years old. After that this is when I chose to start breaking the restrictions and all the steps I had to follow.  For example, I chose to break the diet I had to |

|follow, eat sweets like crazy and worst of all not inject myself with insulin like I was suppose to. I did received good advice from my doctor, my family and friends, |

|but I didn't care to listen. By the age of 24 I started losing my vision very gradually, and before I turned 26 years old, I started having kidney failure and had to |

|start dialysis. My life was no longer a life, it was just filled with pain and disappointments, and still my family was there to give me all the support I needed. By |

|the age of 26 I lost my vision completely. Seven month later after I lost my vision, I was able to receive the gift of life. This gift of life I call it "The kidney |

|and pancreas of life", which I received on March 2, 1995. |

|After I recuperated and got my strength back, I decided to go back to college in 1997 and get my Associates Degree in Human Services with my seeing guide dog Omni. |

|After that I continued moving forward by getting my Bachelors Degree in Social Rehab, which I was able to complete in May 13, 2006. I am beginning my career as a |

|social worker helping the homeless population and individuals struggling with substance abuse. |

|There is not a day that goes by that I don't thank God for giving me a second life and thank the family who made the decision to donate the kidney and pancreas of |

|their son who was diseased. I would like to encourage every human being to sit down and communicate with your family members and friends about the importance of |

|donating a tissue and organ transplant to those who would love to have a second life. This gift of life has made me start writing a book about life and the importance |

|of life, which I hope will help individuals that are really struggling with health and how tissue and organ transplant can save many lives. |

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|Suellen Canfield - Donor |

|Suellen had a special warmth and gracious Southern style that helped her forge instant, lasting friendships.  Her caring nature was the basis for insight to people |

|that changed the lives of many who sought her counsel. Playing bridge, mahjong, bowling, and attending shows from Broadway to community theater were frequent |

|activities, particularly if family members were part of the cast.  She was a fan of all sports but passionate about the St Louis Cardinals..  But the greatest joy of |

|her life was her grandchildren.  In their eyes she was the eight wonder of the world and she relished that role. We thought of her as the ultimate grandmother. |

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|Bill Slinsky - Donor |

|On October 23, 2003 my best friend and husband of 20 years passed away at far too young an age due to a brain aneurysm. Bill was a warm and gentle man, yet the pillar |

|of strength that we all depended upon. Bill was a terrific father, setting an example of hard work, trustworthiness, patience and kindness for his sons to follow. Bill|

|was a friend to all that knew him, as his steady demeanor was comfortable to be near. Bill wasn’t given to boasting, but rather spoke volumes through his actions. As |

|someone said in a letter after his death, Bill was a quiet man, and when he had something to say, people would listen because they knew it would be something well |

|thought out and worth hearing. Bill was a nationally published photographer, but would never brag about it. Bill loved to spend the early dawn hours, late night hours,|

|or snow filled days taking photos of nature and trains when everyone else was sleeping or staying indoors, away from the elements. Bill had a great sense of adventure |

|as well, enjoying exploring backroads and quiet waterways in our kayaks. During the summer months, Bill also enjoyed competitive sailing with my dad, wishing only that|

|he had more time to devote to it. |

|Bill felt strongly about organ and tissue donation, and carried his NEOB donor card in his wallet to his last day. I carried out his wishes, and am very comforted |

|knowing that there are three people that received life saving organs and many more that had their lives improved through tissue donation. That knowledge has helped us |

|get through the darkest period of our lives, and helped us move toward the future. We wish all the best to the recipients and hope they continue to thrive! |

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|Katie McCarthy - Donor |

|On a sunny winter afternoon, our beloved daughter, Katie, was taken from us in a tragic automobile accident. She was the older of our two children. |

|Katie was a loving, smart, intelligent college freshman honors student, who had planned on a teaching career. Katie was a happy, young woman, who always had a positive|

|outlook on life; this was a wonderful quality that she was able to pass on to those around her. |

|Katie was also an accomplished musician, a clarinet player, for ten years and had won many awards, medals, and competitions around the United States and Canada. Katie |

|had a genuine love for life and was successful in just about anything she did. She always loved a challenge. Travel was one of her passions, and she was fortunate to |

|travel to England and France. |

|Katie leaves behind her parents, sister, grandparents, aunt, uncles, a cousin, and her boyfriend, Jeff, along with her best friend, Megan. Everyone misses her so very |

|much. |

|Organ donation was something we always discussed openly in our home. Both of us are organ donors, and Katie felt the same way should something ever happen to her. |

|Since Katie left us that cold winter day, we feel an emptiness and a loss so great that our lives are forever changed. |

|We are all so proud that Katie was able to help four individuals who were in desperate need of vital organs in order to live. These people are truly blessed to have |

|received such a wonderful gift from our “perfect” daughter, granddaughter, sister, girlfriend, friend, cousin, and niece. |

|We all love you and miss your warm laughter, sense of humor, and most of all your beautiful smile. |

|We love you forever, |

|Mom & Dad |

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