CHAPTER 34: 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 capability for intensive care unit (ICU), operating room (OR), laboratory analysis, and varying degrees of investigational capabilities. Organ donors are transported to the center and workup and procurement performed after the consent and brain death declaration have been obtained.

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

BACKGROUND

Traditional Organ Recovery

• Brain-dead donors yield one to six solid organ transplants (heart, lung, liver, pancreas, kidney, intestine) for transplant¹

• 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 to the procedure, leading to inefficiencies in the recovery process

Associated risk

• Since 1990 in the United States there have been 30 reported fatalities in 8 air-related crashes worldwide involving transplant personnel; the risk of death while flying for organ procurement is a thousand times greater than flying on a commercial flight.² Brain-dead donors receive lower priority in any acute care hospital, resulting in delays in donor workup and access to the OR if other emergencies arise.

• Time delays leading to family frustrations and potential withdrawal of consent for donation

• Increased cold ischemic time for all organs

• Long hours for surgeons traveling for recovery

• Often additional wasted time waiting for OR time 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 (Figure 34-1) to a purpose-built organ procurement organization (OPO)-based facility—Mid America Transplant.³

• For optimal use, the center should be in close proximity to the OPO’s transplant centers (Figure 34-2).

Features of the Facility

The facility has ICU, OR, tissue recovery, hematology, and chemistry laboratories; pathology laboratory, cardiac ...