Organ Donation & Allocation. Nance Conney Thomas E. Starzl Transplantation Institute

Transcription

1 Organ Donation & Allocation Nance Conney Thomas E. Starzl Transplantation Institute

2 History of Transplantation Dr. Sushruta second century B.C.

3 Solid Organ Transplantation 1954 Living-Related Kidney (Dr. Murray, Boston) 1962 Cadaveric Kidney (Dr. Murray, Boston) 1963 Lung (Dr. Hardy, Mississippi) 1967 Liver (Dr. Starzl,, Colorado) 1967 Heart (Dr. Barnard, South Africa) 1968 First Organ Donor Program (Boston & LA) Uniform Anatomical Gift Act (Donor Card) 1970s Cyclosporine (FDA approved 1983) changed transplant from research to treatment

4 1981 Heart/Lung (Dr. Shumway,, California) 1982 Media Campaign (parents of liver recipient) 1984 National Organ Transplant Act (NATO) passed establishes the Organ Procurement Transplant Network (OPTN) United Network for Organ Sharing (UNOS) operates the OPTN under contract with CMS 1986 Required Request 1988 FDA approves Viaspan 1988 Small Intestine

5 Identification and Referral Evaluation Consent Clinical Management Organ Allocation & Distribution Recovery Follow Up

6 Identification & Referral Identification of potential donor by hospital staff Referral to OPO for initial evaluation

7 Conditions of Participation All Deaths/Impending Deaths are referred to the OPO No Criteria on potential donors by the referring hospital

8 Identification and Referral Evaluation Consent Clinical Management Organ Allocation & Distribution Recovery Follow Up

9 Evaluation On-site chart review and screening work with nursing and medical staff physical assessment review medical & social history determine suitability determine neurological status organ anatomy and function determine acceptability

10 What can be donated? Organs Heart Lung Liver Kidney Pancreas Small Bowel Tissues Skin Bone Heart Valves Connective Tissue Fascia Eyes/Corneas

11 Identification and Referral Evaluation Consent Clinical Management Organ Allocation & Distribution Recovery Follow Up

12 Consent medical examiner/coroner's cases cleared for donation death explained to the family donation options discussed with the family consent forms signed and witnessed

13 Clinical Management Test for transmissible diseases ABO HLA typing Laboratory testing Stabilize hemodynamic functions

14 Identification and Referral Evaluation Consent Clinical Management Organ Allocation & Distribution Recovery Follow Up

15 United Network for Organ Sharing (UNOS) Regulates all phases of procurement, placement and transplantation All potential recipients registered

16 Where do the organs come from? Local Regional National

17 Organ Allocation & Placement donor information needed: name age, weight, height ABO hospital zip code of donor available organs

18 Waitlist Objectives ABO Compatibility Tissue Type Medical Urgency (i.e. MELD/PELD) Height and Weight range Time on Waiting List Distance from Transplant Center

19 The MELD/PELD calculator collects data elements used in both the MELD and PELD score calculations. The MELD score calculation uses: Serum Creatinine (mg/dl)* Bilirubin (mg/dl) INR *For patients who have had dialysis twice within the last week, the creatinine value will be automatically set to 4 mg/dl. The PELD score calculation uses: Albumin (g/dl) Bilirubin (mg/dl) INR Growth failure (based on gender, height and weight) Age at listing

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21 All patients waiting are on the same national list. Blind to celebrity status, race, income, ethnicity Yes celebrities have been listed and transplanted quickly and so have thousands of non-celebrities

22 and so it begins Organ is Donated UNOS Generated List Organs Offered for Transplant Surgeon Determination Acceptance/Rejection Recovery Coordinated Transplant Coordinated

23 UNET

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26 Recipients Waiting List versus Number of donors waiting list donors

27 Identification and Referral Evaluation Consent Clinical Management Organ Allocation & Distribution Recovery Follow Up

28 Recovery Coordinate Recovery Teams Operative Procedure Organ Preservation

29 Preservation Times Organ Hours Heart 4-6 Lungs 6-8 Small Bowel 6-8 Pancreas 6-8 Liver Kidneys 24-72

30 Identification and Referral Evaluation Consent Clinical Management Organ Allocation & Distribution Recovery Follow Up

31 Follow-up Chart completed Recipient Follow-Up Thank You Letters QA questionnaire sent to all staff.

32 What Can You Do? Take care of yourself Communicate with your coordinator Keep your appointments Participate in Support Groups Follow diet and exercise guidelines Make sure you are available Be prepared Transportation Packing

33 Other Options to Consider Multiple Listing Transfer of Waiting Time Living Donation Kidney Liver Lung