Increasing the Supply of Cadaveric Kidneys for Transplantation

Bart, Kenneth J.; Macon, Edwin J.; Humphries, Arthur L.; Baldwin, Robert J.; Fitch, Terry; Pope, Randall S.; Rich, Michael J.; Langford, Dorothy; Teutsch, Steven M.; Blount, Joseph H.

doi:10.1097/00007890-198105010-00016

Cited by 75 publications

(23 citation statements)

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“…A donor availability study by Bart et al [7] showed that 3.8% of all potential donors consisted of newborns. For a relieve of shortage of cadaveric kidneys for transplanta tion use of newborn kidneys might be advocated.…”

Section: Discussionmentioning

confidence: 99%

Focal Glomerulosclerosis in Neonatal Kidney Grafts

Leunissen

Ft²,

Kootstra³

et al. 1989

Nephron

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Section: Discussionmentioning

confidence: 99%

Focal Glomerulosclerosis in Neonatal Kidney Grafts

Leunissen

Ft²,

Kootstra³

et al. 1989

Nephron

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“…It has been estimated that 12,500 to 27,000 potential organ donors die each year in the United States [1,4]. Despite what seems to be an adequate donor pool, only 15% to 20% of potential donors become actual donors [5,6]. Unfortunately, the number of patients waiting for transplants continues to outpace the number of donors.…”

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confidence: 99%

Improving the Approach to Organ Donation: A Review

1999

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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.

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“…The process of obtaining consent from next of kin is often a pivotal step in the organ procurement process and a frequent cause for procurement failure [7,22]. In cases in which the wishes of a potential donor regarding organ donation are known, the UAGA provides clear guidelines for honoring these wishes and specifically states &dquo;... the rights of the donee created by the gift are paramount to the rights of others....&dquo; When a properly signed organ donor card exists, physicians and hospitals may legally harvest organs over any objections of next of kin.…”

Section: Legal Aspects Of Organ Procurementmentioning

confidence: 99%

“…Many studies have noted Table 4. Medical Problems Encountered in the Management of Potential Organ Donors that most patients with brain death will die within 24 hours [7,63,64]. The success of organ procurement under these time constraints will depend on rapid mobilization of resources and an aggressive approach to monitoring and treatment.…”

Section: Management Of Potential Organ Donorsmentioning

confidence: 99%

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Analytic Reviews : Organ Procurement and Brain Death in Trauma Patients

Mackersie

1989

J Intensive Care Med

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Mackersie RC Organ procurement and brain death in trauma patients. J Intensive Care Med 1989;4:137-148. The success rates and effectiveness of transplantation programs continue to increase, as does the need for cadaveric organs. Increasing organ procurement is a worthwhile goal that can be fully justified on economic, humanistic, and ethical bases. Although a great deal of progress has been made in terms of public and political awareness of organ procurement problems, additional changes and further education will be necessary before the number of cadaveric organs that are needlessly wasted can be reduced.Management of patients with unsurvivable head injuries or patients who are candidates for organ donation is a complex task involving critical care management, the declaration of brain death, and the identification of, and request for, organ donation from next of kin. This process involves the coordinated efforts of neurosurgeons, critical care specialists, social workers, and the transplant team coordinators in organ procurement programs. Patients are best managed in tertiary centers that have staffs with the expertise and interest in performing these tasks. The time to cardiac death in brain-dead patients is frequently short and is hastened by the development of rapidly progressive derangements in gas exchange, fluid and electrolyte homeostasis, temperature regulation, coagulation, and cardiovascular function.Premature death under these circumstances continues to be a major reason for organ-procurement failure. Aggressive monitoring and treatment of the multiple medical problems encountered, however, may reduce the number of patients who die prematurely and thus increase organ procurement rates.Organ transplantation, as a result of immunological and technical advances, is a therapeutically desirable means of managing a variety of acute and chronic organ failure states. Cadaveric renal transplantation has proved to be both cost effective and successful in prolonging the life of chronic dialysis patients [1]. Cardiac transplantation is no longer considered an experimental procedure, and the projected 10-year survival for cardiac transplant recipients is more than 25% [2]. The availability of liver transplantation programs and the projected survival of liver transplant recipients is increasing as well [3].The need for organs far outweighs the current supply [4,5] (Table 1), and potential recipients for hearts and livers often succumb to their underlying disease before organs can be found for them. Donor organ availability is frequently the &dquo;ratelimiting step&dquo; in most transplantation programs and may even be the major determinant in the viabilitv of either a heart or liver transplant program [6].The degree of disparity between organ supply and demand has been addressed by several studies. Bart and colleagues [7] reported a 16.1 % organ retrieval rate on the basis of potential donors identified by review of medical records. They estimated a potential donor rate of 2.3% of all in-hospital deaths in 37 ac...

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Increasing the Supply of Cadaveric Kidneys for Transplantation

Cited by 75 publications

References 0 publications

Focal Glomerulosclerosis in Neonatal Kidney Grafts

Focal Glomerulosclerosis in Neonatal Kidney Grafts

Improving the Approach to Organ Donation: A Review

Analytic Reviews : Organ Procurement and Brain Death in Trauma Patients

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