Organ Donation and Utilization in the United States: 1998–2007

Abstract

Organ transplantation remains the only life-saving therapy for many patients with organ failure. Despite the work of the Organ Donation and Transplant Collaboratives, and the marked increases in deceased donors early in the effort, deceased donors only rose by 67 from 2006 and the number of living donors declined during the same time period. There continues to be increases in the use of organs from donors after cardiac death (DCD) and expanded criteria donors (ECD). This year has seen a major change in the way organs are offered with increased patient safety measures in those organ offers made by OPOs using DonorNet C . Unfortunately, the goals of 75% conversion rates, 3.75 organs transplanted per donor, 10% of all donors from DCD sources and 20% growth of transplant center volume have yet to be reached across all donation service areas (DSAs) and transplant centers; however, there are DSAs that have not only met, but exceeded, these goals. Changes in organ preservation techniques took place this year, partly due to expanding organ acceptance criteria and increasing numbers of ECDs and DCDs. Finally, the national transplant environment has changed in response to increased regulatory oversight and new requirements for donation and transplant provider organizations.

A novel rodent model of severe renal ischemia reperfusion injury

“…This is a particular problem in the field of transplantation where changing trends in organ donation have led clinicians to meet demand by utilizing organs from older and less fit deceased donors. 28,29 Such kidneys may be subjected to longer periods of warm ischemia during retrieval and consequently are more susceptible to IRI during implantation. [30][31][32][33] Developing strategies, including pharmacological interventions to improve the outcomes of these 'extended criteria' allografts is of the upmost importance.…”

Expanding the Pancreas Donor Pool

“…Although transplanting pancreata from ideal donors may result in excellent outcomes, the obvious consequences will be the relative underutilization of deceased donor pancreata [46]. Only 13 % of all deceased donors in the US provided pancreata for transplantation in 2011 [2]. Pancreas donors do not benefit from a universally accepted definition for extended criteria like that found in kidney transplantation.…”

“…Factors influencing this trend have been, among others, the expansion of the donor-acceptability limits, in particular with older and DCD (donation after circulatory death) donors. The systematic implementation of best practices has improved donor management and has increased conversion rates [1,2]. Despite the fact that the concept of 'expanded criteria' exists in deceased donor kidney transplantation [3], other solid organs, including the pancreas, do not benefit from the same guidelines.…”

“…This was due, in part, to strict criteria regarding the acceptability of a pancreas donor [2, 4••, 5••]. Different organ procurement organizations (OPOs) in the US report pancreas recovery rates varying from <5 % to 60-70 % of donors [2,[6][7][8]. This widespread variability in pancreas utilization can be explained by the consideration of the following factors [2,[6][7][8][9][10].…”

Kidney Transplantation in the Context of Renal Replacement Therapy

“…The largest increase in living donors in recent years has come from unrelated live donors, both spousal and other emotional connected donors (e.g., friends, coworkers) (6,24). However, this steady expansion of living donation peaked in 2004 and has continued to fall up to the present time.…”