Non-Heart-Beating Organ Transplantation Medical and Ethical Issues in Procurement (1997) / Chapter Skim
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2 Transplantation Supply and Demand
2 Transplantation Supply and Demand
Pages 10-19
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From page 10... ...
in some programs, but also donors with diabetes, hypertension, some infections, high-risk social history but negative HIV test, some hemodynamic instability, some chemical imbalances, increased organ preservation time by perfusion or storage using cold solutions, or increased time after death in the body. These expanded criteria are said to have the potential to add 25 to 39°/O to the cadaver donor supply (Briceno et al., 1997; Jacobbi et al., 19974.
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From page 11... ...
is the loss caused primarily by various medical and viability problems in removed organs that makes them unsuitable for transplantation. Greater use of donors accepted under expanded criteria and NHBDs is causing a rising discard rate.
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From page 12... ...
They range from 5 days in the sickest liver recipients to 311 days for those liver candidates in the best condition and, similarly, from 40 to 390 days for the sickest to the healthiest heart recipients. These unpublished data emphasize that waiting times depend largely on candidate medical conditions.
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From page 13... ...
, an equilibrium on the waiting list achieved through increased waiting times and higher death rates, accompanied by increased morbidity and economic and other costs, seems the inevitable, ultimate result of current trends. These adverse effects will occur not only among those on the list, but are likely too among those who receive transplants because they will have waited much longer, will have advanced disability and disease, and will be less medically suitable transplant candidates.
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From page 14... ...
Increasing the pool of living donors through the use of genetically unrelated donors has raised a question for some that commercial considerations in organ procurement may be introduced if donors without spousal or strong friendship bonds are accepted (Hauptman and O'Connor, 19979. Nevertheless, an increase in living donors by primarily affecting the supply of kidneys affects the severest shortage and the largest category of transplants and helps patients with the longest waiting times.
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From page 15... ...
, and a recent survey disclosed that physicians did not recognize or declare brain death in 13% of potential donors, which eliminates the possibility of arranging donations in both situations (Wing and Chang, 1994~. In the past, the organ procurement effort in this country has been criticized for variable and sometimes very low productivity.
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From page 16... ...
, suggested that if organ procurement organizations' donation rates (for livers) could be raised to the level of the higher recovery OPOs (a potentially achievable level of 30 dmp each year and 80% average liver recovery per donor)
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From page 17... ...
, and the stress and confusion of fast-moving medical events may deny them adequate time to consider the merits of donation and resolve questions or misconceptions that are potential barriers to organ donation (Coolican, 1997; Gallup, 1993~. Even after participating in the donation process, about half of donor families, particularly those who do not consent, report an incomplete understanding of brain death (Franz et al., 1997)
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From page 18... ...
Continuing efforts to improve donation within the current structure of the transplantation effort are important. In view of the factors discussed, it is reasonable to assume that real increases in procurement of organs from currently accepted donor categories could be achieved through: better preparation of the public for the eventuality of being confronted with a loved one's death and the possibility of becoming an organ donor; appropriate discussions with potential donors; expanded criteria for cadaver donor acceptance; improved public and professional education; higher request and consent percentages; and expanded governmental and legislative initiatives.
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From page 19... ...
The nationally active Coalition on Donation has generated more than $30 million in donated media time and space in the few years since it was established and, with bipartisan congressional support, generated donor cards that were inserted in 70 million income tax refunds in 1997. A new organization, the Redford Institute for Transplant Awareness, using its access to the media and the entertainment industry, is also beginn~ng campaigns.
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