A stand-alone organ harvesting facility may be a model for the future

A stand-alone organ harvesting facility may be a model for the future

Last Updated: 2014-03-05 12:45:17 -0500 (Reuters Health)

By Rob Goodier
NEW YORK (Reuters Health) - When a small hospital in Missouri was unable to perform an organ harvest, the brain-dead donor was transferred to the larger Barnes-Jewish Hospital in St. Louis for successful procurement surgery. The experience triggered the idea of creating a facility exclusively designated for organ harvesting, and in 2001 the first free-standing organ procurement facility in the U.S. began accepting brain-dead donors for operation.

The facility, on the premises of the Mid-America Transplant Services (the regional organ procurement organization for eastern Missouri, southern Illinois, and northeast Arkansas) has helped save money and reduced the time that surgeons have to travel to procure organs, a new study shows.

In its first 10 years, donor liver costs dropped 37%, the travel time of surgeons at Barnes-Jewish dropped from an average of eight hours to 2.7 hours, and flight costs dropped by 93%, according to the research.

"There are many benefits to this shift in management, including improved efficiency for donor work-up and recovery, reduced cost, reduced surgeon travel, and shorter organ cold ischemia. The magnitude of these changes is dramatic with no negative effects for the organ transplant process," Dr. Maria Doyle, the director of adult liver transplantation at Washington University School of Medicine in St. Louis, who led the study, told Reuters Health by email.

Dr. Doyle and her team published their results February 25 online ahead of print in the American Journal of Transplantation.

The researchers analyzed liver transplantation at one hospital near the procurement facility in its first ten years of operation. They included 583 recipients who received 568 liver grafts, 25 of which were split for partial grafts.

Patient and graft survival was similar at five and 10 years for livers from the facility and from outside medical centers.

The cold ischemic time was significantly shorter for organs from the facility. The facility's median time was 5.2 hours, compared to 6.6 hours for organs from other centers.

The use of livers from the center was 90.2%.

Future study may show that the facility allows for more aggressive donor management, which may improve the organ yield, Dr. Doyle says.

"For example, surgeons are more likely to consider the extended criteria donor liver if the donor is at the OPO facility, and the liver biopsy has been reviewed by our center's liver pathologist, as opposed to having to fly out to look at a similar organ, often without expert pathology support," Dr. Doyle says.

She also points out that OPO personnel can perform repeated bronchoscopy, liver biopsies, retrieve lymph nodes from the donors (to have HLA cross-matching done for kidney recipients before the donor operation begins) - "and the workup can be efficiently completed at the in-house facility with cardiology and radiology MD support from the local transplant centers."

Families of donors do not seem to oppose transportation to the facility, and those that do always have the option to carry out the procurement at the hospital, said Dr. Elizabeth Davies, a transplant surgeon at Ohio State University and Chair of the US National Organ Donation Research Consortium, who was not involved in the study.

"The investigators demonstrated that opposition to moving the donor by the family has not been a barrier to the development of a free-standing organ recovery facility," Dr. Davies told Reuters Health in an email. "Even when the distance was greater than 80 miles, in the last year reported, only one donor of a liver required a fly-out by the local transplant center. Additionally only 3 local donors of livers required that surgeons recover at the hospital."

The main barrier to widespread implementation may be its cost. The facility is a small acute-care ICU with an upfront investment and regulatory costs that require minimum patient volumes. It may not be suitable for all organ procurement organizations, Dr. Davies noted.

"An alternative employed by one OPO has been to lease an ambulatory surgery center after hours. The OPO (in this study) should be commended for taking a leading role in exploring new strategies to reduce costs in the process," she added.

SOURCE: http://bit.ly/MNKjsM

Am J Transplant 2014.