ICU docs key to more transplant organs

U. PITTSBURGH (US) — A small study showed that the number of organs available for transplant as much as doubled when an intensive care physician remained involved with donor bodies after brain death occurred.

Commonly, after a patient who has consented to be an organ donor is declared brain dead, an organ procurement organization (OPO) coordinator takes over, following established protocols to maintain tissues and organs for eventual transplant. Intensive care unit physicians are no longer involved.

“An intensivist at the donor’s bedside who aids and advises the OPO coordinator can result in a greater likelihood of recovering organs that are deemed acceptable for transplant, which would  mean that each donor could help us save more lives,” says Kai Singbartl, assistant professor of critical care medicine at the University of Pittsburgh.

“The gap between the number of people on waiting lists and the number of available organs is growing, so measures that increase the pool of organs are very much needed.”

The research is published in the American Journal of Transplantation.

In 2008, University of Pittsburgh Medical Center Presbyterian implemented an intensivist-led organ donor support team (ODST) approach where after a potential organ donor was declared brain dead, one of six dedicated intensivists, who did not provide care for the donor prior to death, joined the OPO coordinator at the bedside.

Standard protocols were supported by physician interventions, such as adjustments to optimize oxygenation and meticulously balance blood pressure and flow, fluids and other bodily functions to optimize the likelihood of sustaining as many organs as possible for transplant.

“We would care for donors for a few hours or up to a day, depending on medical needs and other factors,” Singbartl says. “The number of donors in our study is not large enough to determine whether a particular medical intervention played a key role, but it’s very clear from our experience that this team approach did make a difference.”

From July 1, 2007 to June 30, 2008, before the ODST approach was used, 31 percent, or 66 out of 210 potentially available organs were transplanted. After the approach was implemented, between July 1, 2008 and June 30, 2009, 44 percent, or 113 out of 258 potentially available organs were transplanted.

Most of the increase was due to a more than 200 percent increase in transplanted lungs and a nearly 50 percent percent increase in transplanted kidneys. Heart and liver transplant rates did not change significantly, says Singbartl.

“Conversion of medically unsuitable donors into actual donors, better resuscitation of unstable donors, optimization of organ function, and improved communication between OPO staff, ICU team and transplant surgeons or the combination of these factors likely contributed to success and should be further evaluated.”

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