This chapter is relevant to all surgeons caring for victims of trauma because traumatic injury is a leading cause of brain death and subsequent organ donation. Because of the severe shortage of organ donors, it is critical that traumatologists recognize potential organ donors as early as possible and care for these patients assuming that organ donation may occur. It is important for physicians to understand the criteria for brain death and the local requirements for the pronunciation of brain death.
This chapter provides an overview of the procurement organization and how organs are allocated. The responsibilities of the local organ procurement organizations (OPOs) are underscored in this chapter (i.e., community education, evaluation and screening of potential donors, local hospital coordination, and family counseling). The trauma team’s role is to resuscitate the patient and maintain perfusion of the organs. Once a potential donor is identified the trauma team must coordinate its efforts with the OPO. Once a patient is declared brain dead the trauma team’s role does not end. Cooperation between the trauma team and representatives of the OPO will help to maximize donation of organs and is important for preserving the function of donated organs.
The combined developments of effective immunosuppressant therapy and sophisticated surgical techniques have made organ transplantation very successful in treating the end-stage failure of most solid organs. Transplantation is now the treatment of choice for end-stage heart, lung, liver, and renal disease for patients who have no contraindications to transplantation. Pancreas transplantation has also proven successful in the treatment of diabetes mellitus. In addition, there is increasing demand for bone, skin, and other tissues used in the treatment of other disease processes. Despite advances in living-related solid organ transplantation,1 the majority of transplant recipients remain dependent on cadaveric organ donors.2 Improved supportive care for patients with advanced organ failure and expanded indications for transplantation have increased the numbers of patients waiting for organs. In contrast, efforts at increasing the pool of suitable organ donors have had comparatively little success in increasing the supply of organ donors; however, there is a slow increase in living donors as noted from 1988 to 2005 (Fig. 50-1). Consequently, the number of patients on the various transplant waiting lists continues to outpace the available donor pool. In the year 2000, an average of 114 patients were placed on waiting lists each day while an average of 63 patients per day received organ transplants.3 During the same year, an average of 16 patients per day died awaiting transplantation.3
Total patients in the United States who underwent organ transplantation from deceased and living donors from 1988 to 2005. (Reproduced with permission from United Network for Organ Sharing website. Accessed February 2005. http://www.unos.org/Data.)
Traumatic brain injury is the most common cause of death leading to cadaveric ...