Maximizing thoracic organ transplant opportunities: the importance of efficient coordination.
BACKGROUND
In Australia, despite large distances and one of the world's lowest multiorgan donor rates (11.4/million population/year), the thoracic organ transplant (TOTx) rate of 9.6/million population/year is one of the world's highest.


METHODS
As an example of the Australian approach, a system of transplant coordination and organ allocation has evolved at the Alfred Hospital. Donor organs are assigned locally, or between the 4 major TOTx units on rotation. The recipient team then selects appropriate recipients, matching by blood group, size, cytomegalovirus (CMV) status, prospective cross matching and clinical status. An experienced recipient coordinator takes responsibility for organization of the retrieval and transplant process, including all operating room staff, all medical personnel, and transport for the donor team and the potential TOTx recipients.


RESULTS
Between February 1989 and February 1999, 307 hearts, 48 heart/ lung, 124 single and 116 bilateral lung transplants were performed from 452 donor offers (52% beyond 500 miles). This represents 1.74 organs transplanted/thoracic donor and compares favourably to American United Network for Organ Sharing (1.43) and European (1.3) figures.


CONCLUSIONS
The Australia TOTx model has enabled high transplant rates by efficiently using the available donor organs. This has been achieved through an enlarged, experience TOTx team, the optimizing of donor acceptance criteria and improving coordination logistics to allow multiple thoracic procedures simultaneously.
Snell
G I
GI
Lung and Heart Transplant Services, Alfred Hospital, Commercial Rd, Prahran, Melbourne, Australia.
Griffiths
A
A
Macfarlane
L
L
Gabbay
E
E
Shiraishi
T
T
Esmore
D S
DS
Williams
T J
TJ
D001315:Australia; D003625:Data Collection; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D015397:Program Evaluation; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000458:organization & administration*