Organ Donation and Utilization in the United States, 1997–2006

Abstract

Deceased organ donation has increased rapidly since 2002, coinciding with implementation of the Organ Donation Breakthrough Collaborative. The increase in donors has resulted in a corresponding increase in the numbers of kidney, liver, lung and intestinal transplants. While transplants for most organs have increased, discard and nonrecovery rates have not improved or have increased, resulting in a decrease in organs recovered per donor (ORPD) and organs transplanted per donor (OTPD). Thus, the expansion of the consent and recovery of incremental donors has frequently outpaced utilization. Meaningful increases in multicultural donation have been achieved, but donations continue to be lower than actual rates of transplantation and waiting list registrations for these groups. To counteract the decline in living donation, mechanisms such as paired donation and enhanced incentives to organ donation are being developed. Current efforts of the collaborative have focused on differentiating ORPD and OTPD targets by donor type (standard and expanded criteria donors and donors after cardiac death), utilization of the OPTN regional structure and enlisting centers to increase transplants to match increasing organ availability.

ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and Transplantation

“…organs (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). DCD shall not be viewed as an equally acceptable alternative to DBD because DCD on average yields fewer organs and the organs probably have more risk than organs recovered from DBD donors (7)(8)(9)(10)(11)(12)(14)(15)(16)(17)(18)(19) (1)(2)(3)(23)(24)(25)(26)(27) …”

Donation after Cardiac Death Liver Transplantation: Predictors of Outcome

“…In addition to the proliferation of organ donor recruitment initiatives, transplant providers have been encouraged by the Institute of Medicine and the Health Resources and Services Administration (HRSA) to use grafts from higher risk donors to decrease the burden of a growing waiting list (1)(2)(3). The utilization of liver allografts from donors after cardiac death (DCD) has increased over the last decade, and now comprises more than 5% of all liver transplants (4).…”

Expanding the Pancreas Donor Pool

“…In an attempt to address the issue of more effective pancreas utilization, improved methods of communication and dissemination of donor information (such as with United Network for Organ Sharing [UNOS] DonorNet 2007) have been implemented in recent years. In order to facilitate organ sharing and reducing preservation time, transportation by charter aircraft may also play a role [25].…”