How can we increase the number of organ and tissue donors?

Abstract

The success of organ transplantation has led to the primary problem facing transplantation today: lack of sufficient organ donors. Improved results from and expanded indications for transplantation have greatly increased the number of potential transplant recipients. Unfortunately, the number of available donor organs has not kept up with the increased demand. The number of candidates on the United Network for Organ Sharing (UNOS) list continues to outpace the number of donors. The number of individuals awaiting organ transplantation has been growing by 15% per year, but the number of donors has increased by approximately 5% per year. Currently there are more than 60,000 individuals on UNOS lists awaiting organ transplants. Physicians and surgeons can favorably affect organ and tissue donation by discussing the need for organs and tissues with their patients and having information brochures available in their waiting rooms. Those physicians who actually use organs and tissues—transplant physicians and surgeons, orthopaedic surgeons, plastic surgeons, ophthalmologists, and cardiac surgeons—should devote more time and energy to increasing organ and tissue donation. They could help by educating their patients, the public, hospital personnel, and their colleagues to have a more favorable attitude toward organ and tissue donation. They could be a force to get state legislatures to pass laws that would promote organ and tissue donation. They could also foster research investigating barriers to organ and tissue donation, the variables important in determining whether donation occurs, and methods to increase donation. The Texas Medical Association recently began an initiative to have its membership set an example by signing organ donor cards. But until now physicians and surgeons have done little to promote the issue. Extended criteria donors (ECDs) and non-heartbeating donors are donors that formerly would not have been considered by many transplant centers. These donors include those who are very young or old, have abnormal organ function, hypertension, hypotension, infections, certain malignancies, anatomic variations, metabolic abnormalities, or whose hearts are not beating at the time of organ recovery (non-heart-beating donors). Some reports demonstrate that use of organs from these non-heartbeating donors and ECDs can provide outcomes comparable to those of conventional donors and could increase the donor supply by approximately 25%. It is more costly to obtain organs from ECDs than from conventional donors. The final decision to use organs from non-heart-beating donors or ECDs should be made by individual transplant centers, not by organ procurement organizations (OPOs). An OPO will assist in recovering organs from these donors as long as there is a reasonable chance that the organs will be used and that the OPO will be able to recover its costs, even if the organs are not used. Other methods to maximize the number of organ recipients from each donor are split-liver transplantation (dividing the liver into 2 parts and transplanting each part into a different individual) and single lung transplantation. Both of these techniques are currently being used. In England there is a group of physicians who go to the donor hospital and physiologically optimize Received April 29, 1998; Revised September 28, 1998; Accepted October 9, 1998. From the Department of Surgery, University of Florida, Gainesville, FL. Correspondence address: Richard J Howard, MD, PhD, Department of Surgery, University of Florida, PO Box 100286, Gainesville, FL 32610-02.