Published in UAB Insight, Winter 2008
Earlier Referrals, Family Support Team Make Difference
UAB has long been a high volume organ transplantation center and is regularly among the top 10 in kidney, heart, and liver transplants. Despite the high transplant volume, demand for organ transplantation outstrips the supply of suitable organs. Currently there are more than 3000 Alabamians waiting for an organ transplant. In 2006, 218 people died while waiting for a life-saving transplant.
Historically there has been an average of 100 families a year in Alabama who generously consented to the donation of their loved one’s organs. An additional source of organs comes from living donors — individuals willing to donate one of their own organs, typically a kidney. These living donors have been responsible for most of the recent increases in kidney transplant volume.
Since 2004 deceased donor donations have increased more than 80%, and the future promises additional growth, says Devin E. Eckhoff, MD, director of UAB’s Division of Transplantation and medical director of the Alabama Organ Center (AOC), the state’s organ procurement organization (OPO).
Eckhoff says former US Department of Health and Human Services Secretary Tommy G. Thompson was the catalyst for a national increase in organ donation. “He directed the OPO community to take a new look at how successful organ procurement organizations achieved their results and to share these best practices among all the OPOs in the country. He directed OPOs to question age-old assumptions about donation. This ushered in a new era of openness and collaboration that resulted in a more cooperative, can-do atmosphere and the best results in years.”
The AOC responded, first by implementing a series of clinical triggers for hospital referrals. Timely referrals allow organ center Family Support Services Coordinators (FSSC) to perform in-hospital evaluations for donor suitability and provide family and staff support. FSSCs are skilled in bereavement support and family care, expertise especially helpful to families who have lost a previously healthy loved one to sudden or traumatic death.
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 AOC also has 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. This is an option for patients who are neurologically devastated but not brain dead. “DCD grew out of families’ desires not to prolong a hopeless situation and to participate in organ donation,” Eckhoff says.
Two technologies may help the AOC pursue all donation possibilities. Extracorporeal membrane oxygenation (ECMO) is available at UAB for DCD cases. Without ECMO, organ removal must begin about 5 minutes after patients arrest and are pronounced dead by their primary care physician. ECMO not only avoids the need to rush organ removal after a patient’s death, but also may improve the function of donated organs after transplantation.
Nucleic acid testing of donor organ tissue detects viruses soon after infection — within 12 days for HIV and 25 for hepatitis C. “Thus, someone who engaged in CDC-defined high risk behavior, such as homemade tattooing, or who spent a night in jail, could become a donor after laboratory testing,” he says. “This test assures potential recipients of our dedication to providing quality, disease-free organs.”
The AOC 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 Eckhoff.
For more information:
Dr. Devin Eckhoff
1.800.UAB.MIST
mist@uabmc.edu