Improving the approach to organ donation: a review.
Organ transplantation continues to be hindered by a limited supply of organs. A significant percentage of potential organ donors are lost to either medical failure or inability to obtain consent for donation. In a surgical intensive care unit (ICU) we have refocused our efforts toward aggressive resuscitation, directed by control of coagulopathy, invasive monitoring, and dedicated ICU management while implementing a rapid brain death determination protocol. Over a 6-year period the length of stay until the legal determination of brain death is made has been significantly shortened (12.0 vs. 3.4 hours; p < 0.05), as have associated charges despite this more aggressive approach. As a result, we have eliminated medical failures prior to donation (13% vs. 0%) and increased consent rates (44% vs. 71%; p < 0.05). These efforts have significantly improved the number of organs harvested per eligible donor (1.8 vs. 3.4; p < 0.05). In addition, the number of organs per actual donor has increased and is now markedly greater than the U.S. national average (4.7 vs. 3.7). We believe the approach presented, if widely applied, could potentially improve the current organ supply shortage.
Jenkins
D H
DH
Department of Surgery, Division of Traumatology, Hospital of the University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
Reilly
P M
PM
Schwab
C W
CW
D001778:Blood Coagulation Disorders / Q000517:prevention & control; D001926:Brain Death / Q000175:diagnosis; D003422:Critical Care; D006801:Humans; D007258:Informed Consent; D007902:Length of Stay; D008991:Monitoring, Physiologic; D016377:Organ Transplantation / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D012151:Resuscitation; D014019:Tissue Donors / Q000706:statistics & numerical data / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000379:methods*; D014481:United States / Q000453:epidemiology