Chapter 48: Moving Organ Donors from Hospitals to Regional Stand-alone Organ Recovery Centers

DEFINITION

An organ recovery center is a purpose-built (usually nonhospital) location with capacity for an intensive care unit (ICU), operating room, lab analysis, and varying degrees of investigational capabilities where a donor is transported and worked up and procurement performed after consent and brain death declaration have been obtained.

Some locations in the United States use small private hospitals, but Mid-America Transplant constructed a purpose-built facility.

BACKGROUND

Traditional organ recovery:

• Brain dead donors yield 1 to 6 solid organ transplants (heart, lung, liver, pancreas, kidney, intestine) for transplant.¹

• Traditionally, organ recovery occurs in the hospital of origin. Multiple transplant teams drive or fly to many different hospitals to procure organs.

• The organ procurement operation normally involves multiple teams operating in an unfamiliar environment with operating room staff who are unaccustomed with the procedure, leading to inefficiencies in the recovery process.

• Organ recovery is also risky.

There have been over 30 reported fatalities worldwide involving transplant personnel since 1990, including the United States, in 8 separate air related crashes with the risk of death while flying to an organ procurement estimated to be 1000 times greater than flying on a commercial flight. Brain-dead donors receive lower priority in any acute care hospital, resulting in delays in donor workup and access to the operating room if other emergencies arise.

• This leads to family frustration and potential withdrawal of consent for donation.

• Increased cold ischemic time for all organs.

• Long hours for surgeons traveling to recovery.

• Often additional wasted time waiting for an operating room at the donor recovery hospitals.

• Increased cost of organ recovery.

THE CONCEPT OF A DONOR RECOVERY CENTER

As an alternative to donor workup and recovery in acute care hospitals, the concept of moving brain-dead donors to a purpose-built organ procurement organization (OPO)–based facility such as Mid-America Transplant has been put forth.³

• For travel greater than 80 miles, a plane is utilized and can be configured for donor or personnel transfer (Fig. 48-1).

  • For optimal use, the center should be in close proximity to the OPO’s transplant centers (Fig. 48-2).

Features of the Facility

The facility has an ICU, operating room, tissue recovery, hematology and chemistry labs, pathology lab, cardiac catheterization lab, computed tomography (CT) scanner, and the capability to do bronchoscopy, echocardiogram, ...