Transplantation

Does the use of pulmonary artery catheters increase the number of organs available for transplantation?

Aggressive donor management, including the placement of a pulmonary artery catheter (PAC) to monitor hemodynamic status and tissue perfusion, has been associated with a significant increase in the number of organs recovered for transplantation. Nonetheless, there has been growing scrutiny over the use of PACs because of their known complications and lack of therapeutic effect. The purpose of this study is to evaluate the use of PACs in the management of organ donors. The records of all patients who successfully donated organs between January 1, 2002 and December 31, 2005 were reviewed. A total of 96 patients underwent successful organ donation during the four-yr study period. Of these, 49 (51.0%) were managed with a PAC. Compared with donors managed without a PAC, there were significantly more hearts recovered from donors managed with a PAC (71.4% vs. 44.7%; p = 0.0079) with no difference in the daily administration of fluids and vasopressors between the two groups. The management of organ donors with a PAC can help maximize cardiac procurement.

Aggressive organ donor management protocol

As of August 2007, 96 900 people are awaiting organ transplantation in the United States, while only 28 930 transplants were performed in 2006. With such a large gap between organ need and organ availability, it is inevitable that many will die while awaiting transplantation. This organ shortage has become a national public health crisis, and as a response, the United States Department of Health and Human Services launched the Organ Donation Breakthrough Collaborative, an ambitious campaign to dramatically increase the number of transplantable organs. One of the suggested strategies involves maximizing the number of organs obtained from the available cadaveric "brain dead'' donor pool by using donor management protocols that optimize and treat the profound physiological disturbances that are associated with brain death. The use of these standardized and aggressive donor management protocols has been shown to increase the number of transplanted organs and prevent the number of donors lost due to medical failures. A protocol-driven approach by a dedicated organ donor management team should be considered a key component of any program designed to bridge the gap between organ supply and demand.

Aggressive organ donor management significantly increases the number of organs available for transplantation

BACKGROUND

The shortage of transplantable organs has become a national crisis. Despite various attempts to expand the donor pool, the difference between organ supply and organ demand continues to widen. With no foreseeable increase in the number of donors, it is necessary to maximize the utilization of organs from the existing donor pool.

METHODS

Records of all patients referred to the regional organ procurement organization for possible organ donation over an 8-year period (1995-2002) were reviewed. A policy of aggressive donor management (ADM) by dedicated physicians was instituted in January 1999 involving intensive care unit admission, pulmonary artery catheterization, aggressive fluid resuscitation, early use of vasopressors, prevention and treatment of complications associated with brain death, and liberal use of thyroid hormone in hemodynamically unstable donors. Data regarding referrals for organ donation, actual organ donors, organs recovered, and donors lost due to cardiovascular collapse before organ donation were compared before (January 1995- December 1998) and after (January 1999- December 2002) ADM.

RESULTS

There were 878 patients referred for organ donation during the 8-year period. Of those, 469 (53.4%) were confirmed as potential donors, but only 161 (34.3%) became actual donors. When compared with the period before ADM, the period after ADM showed a 57% increase in total referrals (p < 0.001), 19% increase in potential donors (p = 0.01), 82% increase in actual donors (p < 0.001), 87% decrease in the number of donors lost due to hemodynamic instability (p < 0.001), and a 71% increase in the number of organs recovered (p < 0.001).

CONCLUSIONS

A policy of ADM increases the referral pool for organ donation and reduces the number of organ donors lost due to cardiovascular collapse. The net result is a significant increase in the number of organs available for transplantation.