Abstract
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.
Résumé
Objectif
Déterminer pourquoi des cœurs et des poumons de donneurs d’organes adultes consentants ne sont pas transplantés et présenter les changements de pratique envisagés pour accroître leur taux d’utilisation. Au Canada, le taux d’utilisation sous-optimal comparatif des cœurs et des poumons pourrait être meilleur : le rein, 85 % ; le foie, 84 % ; le cœur, 35 % et le poumon, 23 % en 2001.
Méthode
Quatre services d’approvisionnement en organes ont participé à l’étude. Tous les cas adultes de don d’organes de 2002 ont été revus et inclus s’ils comportaient l’obtention d’un consentement. Une grille d’analyse du don d’organe a été établie pour reconnaître les situations où les organes échappent au circuit de la transplantation. Les cas des donneurs ont été analysés.
Résultats
Un taux d’utilisation de donneurs de 39 % (42/107) pour le cœur et de 28 % (29/105) pour le poumon a été trouvé, taux comparable aux taux canadien et international. Un problème organique fonctionnel était cité le plus souvent pour la non-utilisation, puis les caractéristiques du donneur et des questions logistiques. Une gestion différente a été suggérée, pouvant permettre l’utilisation de l’organe, pour 20 des 65 (31 %) cœurs et 28 des 156 (18 %) poumons. Des pratiques variables, sur le consentement au don d’organe spécifique et l’offre d’organes consentie, demeuraient des barrières significatives au succès de la transplantation.
Conclusion
Les changements de pratique ciblés touchent le consentement et l’offre reliés à tous les organes. Le traitement d’organes «marginaux» devrait inclure la réanimation et la réévaluation pour permettre le sauvetage de l’organe et son utilisation. Malgré l’immense pression pour augmenter le nombre d’organes transplantés, tout mécanisme ne sera jugé fructueux que si le taux de survie des greffons chez le receveur demeure acceptable.
Article PDF
Similar content being viewed by others
References
Badovinac K. Canadian review of organ utilization (1992–2001). Edmonton: The Canadian Council for Donation and Transplantation, 2004 Available from URL; http://www.ccdt.ca/english/publications/back-ground.html#mm.
Zaroff JG, Rosengard BR, Armstrong WF, et al. Maximizing use of organs recovered from the cadaver donor: cardiac recommendations. J Heart Lung Transplant 2002; 21:1153–60.
Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant 2000; 19:1199–204.
United Network for Organ Sharing. Deceased organ specific donors by gender. Available from URL; http://www.optn.org/latestData/rptData.asp.
Pierre AF, Sekine Y, Hutcheon MA, Waddell TK, Keshavjee SH. Marginal donor lungs: a reassessment. J Thorac Cardiovasc Surg 2002; 123:421–7.
Herbertt K, Russ GR , eds. Australia and New Zealand Organ Donation Registry (ANZOD Registry) 2003 report. Adelaide, South Australia; 2003.
Cooper DK, Keogh AM, Brink J, et al. Report of the Xenotransplantation Advisory Committee of the International Society for Heart and Lung Transplantation: the present status of xenotransplantation and its potential role in the treatment of end-stage cardiac and pulmonary diseases. J Heart Lung Transplant 2000; 19:1125–65.
Ross H, Hendry P, Dipchand A, et al. 2001 Canadian Cardiovascular Society Consensus Conference on cardiac transplantation. Can J Cardiol 2003; 19:620–4.
Canadian Council for Donation and Transplantation. Medical management to optimize donor organ potential: a Canadian forum, 2004. Available from URL; http://www.ccdt.ca/english/publications/final.html.
International Society for Heart and Lung Transplantation. ISHLT Transplant Registry Quarterly Reports. Available from URL; http://www.ishlt.org/ registries/quarterlyDataReport.asp.
Author information
Authors and Affiliations
Corresponding author
Additional information
We gratefully acknowledge the financial support provided by the Canadian Council for Donation and Transplantation enabling this study and the resulting manuscript.
Rights and permissions
About this article
Cite this article
Hornby, K., Ross, H., Keshavjee, S. et al. Non-utilization of hearts and lungs after consent for donation: a Canadian multicentre study. Can J Anesth 53, 831–837 (2006). https://doi.org/10.1007/BF03022801
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03022801