UAB Synopsis, Vol. 27, No. 01, January 14, 2008

Since 2004 organ donation at UAB has increased more than 80% and the future promises additional gains, according to Division of Transplantation Director Devin E. Eckhoff, MD, who also is medical director of the Alabama Organ Center, the state’s federally designated organ procurement organization (OPO).

Prior to 2004 public education efforts by OPOs around the nation failed to increase the number of deceased donors, which in Alabama hover around 100 annually. UAB’s organ transplant volume remained among the nation’s highest, primarily because of a significant increase in kidney donations by living donors.

Dr. Eckhoff cites former US Health and Human Services Secretary Tommy G. Thompson as the catalyst for a national increase in organ donation of deceased individuals. “Secretary Thompson directed the OPO community to take a new look at how successful organ procurement agencies achieved their results and to share these ‘best practices’ among all the OPOs in the country,” Dr. Eckhoff says. Thompson also directed the groups to question age-old assumptions about donations, ushering in a new era of openness and collaboration that resulted in a more cooperative, can-do atmosphere and the best results in years.

The Alabama Organ Center responded, first by implementing a series of clinical triggers for hospital referrals and by creating new staff called Family Support Services Coordinators (FSSC). Timely referrals allow FSSCs to perform in-hospital evaluations for donor suitability and provide family and staff support. FSSCs are skilled in bereavement support and family care, which is especially helpful when families have lost a previously healthy loved one to sudden or traumatic death, Dr. Eckhoff says.

FSSCs offer family support as long as needed regardless of donation decisions. The result is increased consent rates and improved satisfaction for families and hospital staff. The Alabama Organ Center maintains three FSSCs in Mobile and three in Birmingham, including one shared with UAB Hospital.

The Alabama Organ Center also gained additional donors from its Organ Donation after Cardiac Death (DCD) Program. In January 2007 The Joint Commission recommended all hospitals with ventilator capability have a DCD policy, an option for patients who are neurologically devastated but not brain dead. “Organ Donation after Cardiac Death grew out of families’ desires not to prolong a hopeless situation and to participate in organ donation,” Dr. Eckhoff says.

New Technologies Ease Donations
Dr. Eckhoff believes adding two newer technologies at UAB Hospital will help Alabama Organ Center pursue all donation candidates.

Nucleic acid amplification testing of donor organ tissue can detect viruses sooner after infection than conventional testing – within 12 days for HIV and 25 days for hepatitis C virus. “Thus, someone excluded from organ donation because of CDC-defined high risk behavior, such as homemade tattooing or spending a night in jail, could become a donor after nucleic acid testing,” he says. “This test assures potential recipients of our dedication to providing quality, disease-free organs.”

Extracorporeal membrane oxygenation (ECMO) is now available at UAB for DCD cases. Without ECMO, organ removal must begin within 5 minutes after patients arrest and are pronounced dead by their primary care physician. ECMO not only avoids the need to rush organ ­removal following the patient’s death, but also may improve function of donated organs after transplantation.

The Alabama Organ Center attributes its recent achievements to the effective implementation of these efforts and successful partnerships with physicians, hospitals, and nurses across the state. “It takes all of us working together to provide excellent care to the bereaved family and to save the lives of those waiting for an organ transplant in our state,” says Dr. Eckhoff.

Even so, he adds, the need for more organ donors remains high: Last year 218 people died while on the Alabama waiting list.

Donations to Alabama Organ Center
2004 — 79
2005 — 93
2006 — 119
2007 — 143