A rapid organ recovery program for non-heart-beating donors.

We report a successful method for rapid organ recovery from the non-heart-beating donor, which can open a new resource of organs for transplantation. The RORP is not controversial, is simple in design and execution, and results in kidneys that are viable for transplantation. Special personnel and equipment are needed but are easily incorporated in the overall budget of an OPO or donor hospital. Clearly more research is needed to rebuild ischemically damaged cells ex vivo and to develop new agents/methods to minimize the reperfusion response. When these processes are better understood and managed, the full potential of the NHBD as a donor resource will be fully achieved. We agree with others that the donor shortage could be entirely relieved by routine organ recovery from NHBD trauma victims.

A new approach for increasing the organ supply.

The donation of organs and tissues for the benefit of another person is an altruistic act and one that is a guaranteed option for the next-of-kin through various national Required Request legislations. At the Washington Hospital Center we have developed an approach that permits organ recovery from non-heart beating donors. The focus is on victims of fatal trauma and assures that each family is empowered with the right to make a donation decision. In October 1993 a consensus conference was held on implementing a program to recover organs from fatal trauma victims. The participants recommended that safeguards be incorporated to assure ethical treatment of both the trauma victim and the next-of-kin. An Office of Decedent Affairs (ODA) was then established and implemented in September 1994. The ODA is staffed by Family Advocates who are on duty continuously and respond to all trauma and death events. Their mission is to consolidate all death events, provide support to decedent families, assure that required request mandates are fulfilled, interact with the local Organ Procurement Organization (OPO) in the consent process, and facilitate the implementation of the Rapid Organ Recovery Program (RORP). The RORP consists of two specific procedures: cannulation of the femoral arterial-venous system for flushing the kidneys with a preservative solution, and intubation of the peritoneum for in situ cooling using an ice/lavage process. In the 1-yr period since the ODA was established, organ and tissue donation has increased by more than 300%.

New profile of cadaveric donors: what are the kidney donor limits?

The need for donor organs is increasing more rapidly than the number of organs available from present resources using today's techniques. While efforts to improve consent rates through education and various incentives should continue, and while recovery and utilization of kidneys from donors at the extremes of age can further improve, we believe that the greatest potential for future expansion of the donor resource lies in the non-heart-beating donor. The combination of effective in situ preservation and ex vivo pulsatile preservation allows donation to occur from uncontrolled asystolic donors and provides a mechanism for both evaluation and resuscitation of the recovered kidneys. This approach, if fully utilized, can double the number of kidneys available for transplantation.