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Non-utilization of hearts and lungs after consent for donation: a Canadian multicentre study
Karen Hornby1, Heather Ross, Shaf Keshavjee
1Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada.
Insights
Canadian organ donation rates for hearts and lungs are suboptimal. Improving organ utilization requires changes in consenting and offering practices, and better management of marginal organs to increase transplantation success.
Area of Science:
- Medical research
- Transplantation science
- Organ donation and procurement
Background:
- Canadian organ donation rates for hearts and lungs are comparatively suboptimal.
- Kidney and liver utilization rates are significantly higher than those for hearts and lungs.
Purpose of the Study:
- To identify reasons for non-transplantation of consented adult donor hearts and lungs.
- To propose practice changes to increase heart and lung utilization rates in Canada.
Main Methods:
- Reviewed adult organ donation cases from four Canadian organ procurement organizations in 2002.
- Utilized an organ donation framework to analyze organ loss points.
- Analyzed donor characteristics, organ function, and logistical issues affecting utilization.
Main Results:
- Heart utilization rate was 39% and lung utilization rate was 28%.
- Organ function was the primary reason for non-utilization, followed by donor characteristics and logistics.
- Variable practices in organ consent and offering presented significant barriers.
Conclusions:
- Key areas for improvement include consenting for all organs and offering all consented organs.
- "Marginal" organs may be utilized through resuscitation and reevaluation.
- Increased organ utilization must be balanced with acceptable recipient graft survival rates.
Purpose:
To identify reasons why hearts and lungs from consented adult organ donors are not transplanted and identify changes in practice aimed at increasing their utilization rates. A greater potential may exist in Canada to improve utilization rates for hearts and lungs given their comparatively suboptimal rates (kidneys 85%, livers 84%, hearts 35% and lungs 23% reported in 2001).
Methods:
Four Canadian organ procurement organizations participated. All adult organ donation cases for the calendar year 2002 were reviewed and included if consent for organ donation was obtained. An organ donation framework was established to highlight key areas where organs are lost from the transplantation stream. Organ donor cases were analyzed through this framework.
Results:
A utilization rate of 39% (42/107) for heart and 28% (29/105) for lung donors was found, comparable to Canadian and international rates. Organ function was the most frequently cited reason for non-utilization, followed by donor characteristics and logistical issues. Suggestions for alternate management, potentially resulting in organ utilization, were made in 20 of 65 (31%) hearts and 28 of 156 (18%) lungs. Variable practices, around consent for individual organs and offering of organs consented, remained significant barriers to successful transplantation.
Conclusion:
Target areas for changes in practice included consenting and offering of all organs. Management of "marginal" organs should include resuscitation and reevaluation thus allowing potential organ rescue and utilization. Although there is considerable pressure to increase organs for transplantation, any such mechanism will not be judged successful unless recipient graft survival rates remain acceptable.
