title: Maximizing thoracic organ transplant opportunities: the importance of efficient coordination.
abstract: 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.
authors.affiliation: Lung and Heart Transplant Services, Alfred Hospital, Commercial Rd, Prahran, Melbourne, Australia.
authors.forename: G I
authors.initials: GI
authors.lastname: Snell
authors.forename: A
authors.initials: A
authors.lastname: Griffiths
authors.forename: L
authors.initials: L
authors.lastname: Macfarlane
authors.forename: E
authors.initials: E
authors.lastname: Gabbay
authors.forename: T
authors.initials: T
authors.lastname: Shiraishi
authors.forename: D S
authors.initials: DS
authors.lastname: Esmore
authors.forename: T J
authors.initials: TJ
authors.lastname: Williams
mesh_terms: 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*