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Challenges of organ shortage for transplantation: solutions and opportunities
R F Saidi1, S K Hejazii Kenari1
1Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
Abstract:
Organ shortage is the greatest challenge facing the field of organ transplantation today. A variety of approaches have been implemented to expand the organ donor pool including live donation, a national effort to expand deceased donor donation, split organ donation, paired donor exchange, national sharing models and greater utilization of expanded criteria donors. Increased public awareness, improved efficiency of the donation process, greater expectations for transplantation, expansion of the living donor pool and the development of standardized donor management protocols have led to unprecedented rates of organ procurement and transplantation. Although live donors and donation after brain death account for the majority of organ donors, in the recent years there has been a growing interest in donors who have severe and irreversible brain injuries but do not meet the criteria for brain death. If the physician and family agree that the patient has no chance of recovery to a meaningful life, life support can be discontinued and the patient can be allowed to progress to circulatory arrest and then still donate organs (donation after circulatory death). Increasing utilization of marginal organs has been advocated to address the organ shortage.
Insights
Addressing organ shortage involves expanding donor options, including donation after circulatory death. This approach allows organ procurement from individuals with severe brain injuries who do not meet brain death criteria, increasing transplant availability.
Area of Science:
- Transplantation Medicine
- Organ Donation Science
Background:
- Organ shortage remains a critical challenge in transplantation.
- Various strategies are employed to increase the organ donor pool, including live donation and expanded criteria donors.
- Donation after circulatory death (DCD) is gaining interest for patients with severe brain injuries.
Purpose of the Study:
- To discuss the growing interest and potential of donation after circulatory death (DCD) as a strategy to mitigate organ shortage.
- To highlight the importance of utilizing marginal organs to improve transplantation rates.
Main Methods:
- Review of current organ procurement strategies.
- Analysis of the role of donation after brain death and donation after circulatory death.
- Discussion on the utilization of expanded criteria and marginal organs.
Main Results:
- Organ procurement and transplantation rates have increased due to public awareness, process efficiency, and expanded donor pools.
- Donation after circulatory death offers a viable option for organ procurement in specific patient populations.
- Increased utilization of marginal organs is advocated to address ongoing organ scarcity.
Conclusions:
- Donation after circulatory death represents a significant opportunity to expand the organ donor pool.
- Optimizing organ utilization, including marginal organs, is crucial for meeting transplantation demands.
- Continued innovation in organ donation strategies is essential to overcome the organ shortage crisis.
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