Study Finds Shallow Pool of Organ Donors

Only half of brain-dead people provide organs

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, Aug. 13, 2003 (HealthDayNews) -- Fewer than half of brain-dead potential organ donors in this country wind up providing organs to transplant patients, a new study has found.

That figure is compounded by the relatively small number of potential donors who qualify as brain-dead -- between 10,500 and 13,800 out of the 2 million Americans who die each year.

"It's a limited pool. Every opportunity for donation has to be considered precious and important," says study leader Ellen Sheehy, a consultant for the Association of Organ Procurement Organizations.

The study also suggests the current standard for rating the performance of organ collection groups fails to consider demographic differences in donor availability nationwide. The government has been using a ratio of the number of donors per million people to evaluate the efficiency of organ banks -- and has closed down those it deems laggards.

"It's inherently unfair to judge" all organ procurement groups by the government's single standard, Sheehy says. Rather, the government and organ groups should focus their energy on maximizing the efficiency of the thousand-odd hospitals nationally that produce the most actual donors.

Large hospitals with trauma centers are far more likely than smaller ones to have both potential and actual donors. About 19 percent of hospitals accounted for 80 percent of potential donors during the period studied.

Richard Luskin, executive director of the New England Organ Bank and a co-author of the study, says his group and others "strongly" urged the government to reconsider its efficiency rating several years ago. They succeeded in convincing Congress to mandate a change, but the U.S. Department of Health and Human Services, which oversees organ donations, has yet to issue revised rules.

The study, reported in the Aug. 14 issue of the New England Journal of Medicine, looked only at brain-dead potential donors under age 70. Living donors are becoming increasingly common -- the number of living kidney donors now outstrips deceased donors, for example -- and older people are also being considered potential donors more frequently, Sheehy says.

As of Aug. 12, nearly 82,500 Americans were on waiting lists for solid organs such as lungs, kidneys and livers, according to the United Network for Organ Sharing, which tracks the figures. Roughly 6,400 people have died so far this year waiting for organs to become available.

Sheehy and her colleagues used medical records to determine the number of potential and actual organ donors at American hospitals between 1997 and 1999. The hospitals were located in the coverage areas of 36 organ procurement agencies, and included both small facilities and larger clinics with at least 150 beds.

The researchers identified 18,524 potential donors who had suffered brain death -- either from trauma such as a car crash, massive brain bleeding, or another cause. That works out to between 10,500 and 13,800 brain-dead candidates a year nationwide, they estimate.

Slightly more than half of families (54 percent) agreed to donate the organs of their brain-dead loved ones -- but doctors retrieved organs from only 42 percent of potential donors.

States are now turning to electronic registries to record the names of people willing to be organ donors in the event of their death. No such system exists nationally. However, federal health officials have been working to improve organ procurement rates in hospitals with the most promising pool of potential donors.

Dr. J. Harold Helderman, a Vanderbilt University transplant expert and co-author of an editorial accompanying the journal article, calls the 54 percent consent rate "unconscionable."

Much of the problem reflects failure to educate people about the importance of donating their organs. Yet part also involves families overriding the wishes -- expressed on donor cards or living wills -- of potential donors. To deal with this issue, some states have passed laws requiring doctors to honor the stated wishes of patients regardless of what their family desires.

Many countries in Europe have adopted "presumed consent" policies which consider everyone a potential donor if they haven't ruled themselves out beforehand. That's unlikely to happen in this country, Helderman admits, but experts here are looking at other ways of improving the so-called "conversion rate" of potential to actual donors.

Even so, Helderman notes that even if every potential deceased donor gave up their organs, "we would not have a enough organs to take care of the backlog and the new patients."

In other words, he says, the organ community needs to ease its reliance on deceased donors. Live donors are a good start, he says, but more work is needed to help transplants last longer and to preserve grafts by mollifying the immune systems of recipients.

Another promising pool of organs is animals, such as pigs and baboons. "We have to find alternative ways of getting organs beyond just cadaver sources," he says.

More information

Try the United Network for Organ Sharing or the Scientific Registry of Transplant Recipients.

SOURCES: Ellen Sheehy, M.P.P.M., M.A.R., principal investigator, Association of Organ Procurement Organizations, McLean, Va.; Richard Luskin, executive director, New England Organ Bank, Newton, Mass.; J. Harold Helderman, M.D., professor, medicine, and professor, microbiology and immunology, Vanderbilt University, Nashville; Tenn.; Aug. 14, 2003, New England Journal of Medicine

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