Develop a regionalized infrastructure. In urban areas, particularly those with extensive EMS and trauma centers, a regionalized system of organ donation and transplantation care could be developed that would focus organ retrieval and transplantation efforts in regional transplant centers (Figure 5-1). These regional centers would centralize the expertise and would provide the capacity needed to be prepared for DCDD cases 24 hours a day. This approach is consistent with the current categorization and regionalization of EMS systems currently used in the United States for cardiac care, trauma, neurosurgery, etc. Such a regionalized system would allow EMS workers to reduce the time of transport directly to a regional transplant center or regional hospital that can perform the essential steps needed.
Careful consideration must be given to the economic impact of emphasizing uncontrolled DCDD. There are potential savings in the value of the organs procured. However, because there are multiple healthcare payers, the savings will be seen by multiple entities and would not have a direct impact on any one system. Economic questions to be considered include the