Transplant surgeons report that obtaining organs from deceased organ donors costs much less and leads to a higher number of transplantable organs recovered when brain-dead donors are moved from the hospital to an independent, freestanding facility dedicated to organ recovery. Their study is published online as an “article in press” on the Journal of the American College of Surgeons website in advance of print publication later this year. “These findings suggest the potential to save more lives through organ donation,” said the study’s lead author, Majella Doyle, MD, FACS, a transplant surgeon and associate professor of surgery at Washington University School of Medicine, St. Louis.
Traditionally, when the family of a person declared brain-dead consents to organ donation, the process of checking and maintaining the health of the eligible donor’s vital organs until transplant surgeons are able to remove them occurs in the donor’s hospital.
Brain death occurs due to irreversible loss of all brain function, which results from devastating conditions such as a traumatic brain injury or catastrophic stroke. When the brain stops functioning, life support is necessary to provide oxygen to the vital organs to keep them transplantable, or “viable,” until organ removal can occur. “This new process of moving donor management out of the hospital whenever possible is innovative and more efficient,” Dr. Doyle said. “It takes pressure off busy hospitals, where long waits for operating rooms are common. There is no chance at this dedicated facility that an emergency trauma patient will come in and delay the organ recovery team.”
The study evaluated six years of data from the nation’s first standalone organ recovery facility, located in St. Louis and owned and operated by Mid-America Transplant (formerly Mid America Transplant Services).1 One of 58 federally designated organ procurement organizations, or OPOs, in the U.S., Mid-America Transplant is a nonprofit organization that recovers donor organs in eastern Missouri, southern Illinois, and northeast Arkansas. In the U.S., after obtaining consent for organ donation, all OPOs assume all hospital costs related to the donor, including support in the intensive care unit (ICU), imaging and testing of the organs to determine their health, and operating room (OR) charges during organ recovery.
Mid-America Transplant’s freestanding dedicated organ recovery facility, completed in 2008, has an ICU, two ORs, lab services, and a cardiac catheterization lab to look at donor heart vessels, according to the study authors, who include employees of the St. Louis-based OPO. Specially trained critical care nurses are responsible for donor management, and have access to a critical care physician/medical director and local physician specialists for consultation as needed. Digitally transmitted imaging tests and pathology slides of liver and kidney biopsies facilitate evaluation of the organs by consultants and organ recipients’ transplant surgeons. The study involved 963 organ donors from 2009 to 2014. Of these, 766 donors were transferred by air or ground transportation to Mid-America Transplant’s facility within hours after declaration of brain death.