Improving organ procurement practices in Michigan.

Travel to procure deceased donor organs is associated with risk to transplant personnel. In many instances, multiple teams are present for a given operation. We studied our statewide experience to determine how much excess travel this redundancy entails, and generated alternate models for organ recovery. We reviewed our organ procurement organization's experience with deceased donor operations between 2002 and 2008. Travel was expressed as cumulative person-miles between procurement team origin and donor hospital. A model of minimal travel was created, using thoracic and abdominal teams from the closest in-state center. A second model involved transporting donors to a dedicated procurement facility. Travel distance was recalculated using these models, and mode and cost of travel extrapolated from current practices. In 654 thoracic and 1469 abdominal donors studied, the mean travel for thoracic teams was 1066 person-miles and for abdominal teams was 550 person-miles. The mean distance traveled by thoracic and abdominal organs was 223 miles and 142 miles, respectively. Both hypothetical models showed reductions in team travel and reliance on air transport, with favorable costs and organ transport times compared to historical data. In summary, we found significant inefficiency in current practice, which may be alleviated using new paradigms for donor procurement.

The timing factor in the consent process.

Organ procurement organizations have been educating the medical profession on the importance of timing during the donation request process. Separating the request for donation from the notification of death has been encouraged when approaching families for consent for organ donation. This study evaluated the timing of the family approach and consent rates. A 23-month study was performed on all organ donor referrals in a 1.1 million population base. During the study period there were 203 referrals: 67 were medically unsuitable, next-of-kin was not available in 2 cases, 7 were coroner refusals, and 127 were suitable for donation. In this latter group, families were offered the option of organ donation. No apparent difference when donation was requested before or after the death pronouncement was found. Data indicated, however, that when the family is told of the death and is asked for donation simultaneously, the consent rate decreases 32% to 37%.