According to the United Network for Organ (UNO) sharing, 30 of the 50 Organ Procurement Organizations (OPO) serving the U.S. were participants in the second phase of a UNOS-led DCD Procurement Collaborative project. The goal is to facilitate effective practices through the sharing and identifying of information. As Organ Procurement Organizations strive to increase procurement and allocation of organs, any improvements made to the organ recovery process can greatly improve access for patients in need of organ transplants.
What is the DCD Procurement Collaborative Project?
OPOs across the country have collaborated on improvement efforts to strengthen relationships with donor hospitals and transplant programs. The purpose is to optimize clinical practices and staffing structures, in hand with enhancing authorization processes. There is a need to increase organ allocation and the number of DCD donor organs recovered and transplanted. The project aims to encourage collaboration to develop effective practices to increase organ donation transplants.
The OPOs participated in monthly collaborative calls and webinars, taking a plan-do-study-act (PDSA) approach. They applied and tested changes and received coaching from the UNOS collaborative improvement team. Findings are currently under evaluation with an analysis of outcomes and data measurement to learn more about the overall effectiveness of the project.
What was Involved in the Second Phase?
The second phase focused on increasing organ donation transplants by finding ways to improve how organs are evaluated and recovered from DCD donors. According to UNO, 75% of all OPOs in the U.S. have now participated in the Organ Procurement and Transplantation Network project. The original 13 involved in the first phase were joined by an additional 17 in phase 2.
Rising Numbers for Allocation
DCD donations have continued to rise year-over-year for the past 10 years, with 4,187 DCD donors recovered in 2021. This represents a 29.9% increase from 2020 which sets a record for donations. However, the project provides an opportunity to build on the upward trend with a goal to increase DCD donor procurement by 28%. Phase one had the following findings:
- During 2021, collaborative participants procured 34% more DCD donors compared to 2020
- The rest of the nation increased by 26%
- Both the cohort and the rest of the nation increased DCD transplants from 2020-2021 by 24% and 17% respectively
An evaluation period will follow and provide the opportunity to determine the overall effectiveness of both phases of the project.
The Current OPO Process
The current OPO process follows several steps that can slow down the delivery of organs and increase the risk for patients waiting for organ transplants. The process begins when the OPO is notified of the death and availability of the organ(s). Donor evaluation is critical to determine potential donations, including organs, eyes, or tissue.
Organ donations can only come from a hospital, while tissue can come from a hospital, funeral home, or being called in by a law enforcement authority. Considerations in the evaluation include cause of death, demographics, and medical history of the donor. Following an initial evaluation, once consent is confirmed, the following steps are required:
- Further Evaluation: The family is questioned about the donor’s health and behaviors to help determine if problems exist that can impact the person receiving the organs. It also determines the type of donation carried out.
- Medical tests: Extensive medical tests on organs, such as biopsies, determine if cancer is present, while further testing discovers infections of the organs.
- Maintaining the organs: The blood and oxygen levels of the organs must be maintained.
- Getting Matched: The organs, tissue, and eyes are matched to a recipient through an extensive process where recipients are given a number according to their factors and background. It is up to their surgeon to accept or deny organs based on the information provided.
Although this is a drawn-out process, it is necessary to ensure the viability of the organs are maintained.
Telepathology and Telecardiology
Telepathology and telecardiology can help expedite the process. Telepathology uses digital transmissions for medical diagnostics, allowing pathologists to share biopsies and other medical images quickly and remotely. Telepathologists can conduct the required tests and share their findings with the surgeons of transplant patients. The three main types of telepathology that can be used in the organ donation process include:
- Static image-based systems allow pathologists to share images captured from a digital camera connected to a microscope through digital transmission.
- Virtual slide systems scan specimen slides in high-resolution to produce high-quality images for digital transmission.
- Real-time systems provide robotically controlled microscopes allowing surgeons to participate during autopsies even when at a different location from the donor. They can adjust the microscope being used during the medical tests.
These systems allow doctors to assess organs for donation much faster. It also allows tests to be conducted in different locations. This is important as it is very common to have the donor in one state or city and the transplant patient and their specialist thousands of miles away. Pathologists can perform a quick autopsy to determine an organ’s viability.
If a heart attack is the suspected cause of death for donors, this must be confirmed before the donation is possible. Telecardiology allows a local physician to confirm the diagnosis quickly using an Echocardiogram (Echo) to provide a remote interpretation. A team of board-certified physicians then either confirms or changes the diagnosis so the donation can either move forward or be rejected.
Telecommunications, remote testing and digital sharing can often provide interpretations in less than an hour following the death of the donor. Depending on the types of tests, this can greatly reduce the waiting time for patients. Testing also increases the viability of the organs and, in turn, saves more lives.
OPO and Specialist Direct
Specialist Direct offers telepathology and telecardiology services to expedite the organ donation process. Throughout the process, testing and analyzing the organ becomes more efficient using technology. Because testing is crucial, medical professionals can understand the condition of the organ before determining its suitability for the recipient. To learn more about medical testing and technology to improve the OPO process, contact our team today.
