Chapter 96: The Science of Resuscitation Assisting Organ Shortage

EPIDEMIOLOGY

• It has been estimated that advanced resuscitation techniques such as extracorporeal membrane oxygenation (ECMO) might increase by 40% the number of organ donations.

• According to the U.S. Department of Health and Human Services, in 2020 more than 109,000 patients were waiting for a transplant in the United States. In the United States, seventeen human beings die every day because of lack of organs available for transplantation, representing a total annual average of approximately 6,200 deaths.

• The rate of organ demand has increased 5 times in the last 25 years, while the rate of donors has increased only twice. This big disparity between organ needs versus organ availability represents currently one of the most important challenges to overcome in the field of transplantation.

• One donor can save up to nine lives.

CURRENT STATUS

• Ninety-five percent of all U.S. adults support organ donation; however, only 58% of the U.S. adults are signed up as donors. This notorious mismatch between supporters and factual registered donors raises the question of how much longer the United States can endure the opt-in system, which has been pointed out as the most important cause of this disparity.

• The opt-in system assumes every person is a nondonor by default, except if through some administrative process such as the driver's license application, the person voluntary changes their status from nondonor to registered donor. With the opt-out system, by default every person is a donor except if through some administrative process they voluntarily change their status from donor to nondonor. Countries with presumed consent have successfully addressed the organ shortage: more than 90% of people donate their organs. It is a statistical fact that countries with the most prominent opt-out systems have the highest donor rates.

• The organ donation rate varies substantially between different states: 96% of the population in Montana are registered donors, whereas only 35% are registered donors in New York.

INCREASING ORGAN DONATION

• ECMO is a type of advanced life support technique focused on providing blood oxygenation by means of a pump that replaces the heart function and artificial lungs that provide gas exchange. It is used in a spectrum of conditions where proper organ perfusion cannot be warranted. It is commonly used in critical patients with acute heart and/or lung failure when on the list for a transplant. Cardiac arrest is becoming a common indication for ECMO as a part of the resuscitation approach in this setting.

• It has been proposed that patients with cardiac arrest could be a potential source of organs for transplantation. In the United States, 250,000 cardiac arrests occur each year, with an initial survival rate of 30%. Fifty percent of this population of survivors are less than 65 years old and in previously good health, meeting the standards required for transplantation.

• Only 0.3% of deaths are compatible with the current criteria for organ donation. Such criteria ...