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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on August 24, 2010, 01:10:29 AM
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2007 law has had no effect on organ donations
By DEAN OLSEN (dean.olsen@sj-r.com)
THE STATE JOURNAL-REGISTER
Posted Aug 23, 2010 @ 11:30 PM
Because of concerns about manpower and ethics, Illinois has made virtually no progress in carrying out a state law designed to vastly increase the number of transplantable organs by drawing on a new source — people who die in hospital emergency rooms or outside the hospital.
“This is an enormously underutilized source of kidneys,” said Dr. Stephen Jensik, a transplant surgeon from Chicago’s Rush University Medical Center and one of the law’s chief proponents. “Illinois had an opportunity to be a leader, and it’s discouraging for many in the transplant field that this wasn’t done.”
Jensik said he approached Chicago-area hospitals after the law took effect in 2007 and found them interested but reluctant to be the first to implement the law. The hospitals were worried about the logistics and potentially upsetting dead patients’ families, he said,
“They worried about public backlash,” Jensik said. “Everyone thought it was a good idea for someone else to do first.”
‘Worth looking into’
Springfield hospitals weren’t approached and haven’t ruled out the idea. Dr. Marc Garfinkel, a Southern Illinois University School of Medicine doctor who is surgical director of Memorial Medical Center’s kidney and pancreas transplant program, said he is would consider a potential pilot project in Springfield based on the law.
However, Garfinkel said he won’t have time to work on such a project until next year. He first wants to encourage more kidney donations from living donors by offering laparascopic kidney removal, an option that hasn’t been available before in Springfield.
“I think it’s interesting, and it’s worth looking into,” Garfinkel said last week about the pilot project. “I’m certainly in favor of careful and thoughtful consideration of any method that might enhance donor-organ supply.”
The National Kidney Foundation of Illinois believes the law could give kidney-failure patients more hope for an end to years of dialysis when a living kidney donation isn’t an option.
“We expected that we would be able to move more quickly,” foundation chief executive Kate O’Connor said.
300 more recipients
The law took effect in January 2007, making Illinois one of the few states in the country to explicitly allow doctors to begin organ-preservation procedures in the ER within an hour after someone has been pronounced dead — even if the potential donor’s family can’t be immediately located.
The techniques, which involve administering cooling and anti-clotting agents through a tube inserted into an artery in the dead patient’s groin, give doctors and nurses several hours to find the patient’s family and seek permission for transplantation. The techniques would be stopped if the family said “no,” unless the patient was one of the 5.3 million people in Illinois’ “first-person consent” donor registry.
When the law was passed, Jensik said it could make a big dent in the waiting list for donor kidneys in Illinois, which stands at 3,859 people.
About 250 people in Illinois become kidney donors after death each year. Jensik has estimated that 300 more people, among the 1,200 who die “traumatic deaths” statewide, could become organ donors under the new law.
Across the United States, rules set up by hospitals and organ-procurement organizations make it almost impossible, in most cases, for people to donate organs after their deaths unless they become brain-dead and linger for hours or days on a ventilator in a hospital intensive-care unit. In those cases, organs can be recovered rapidly after the ventilator is disconnected and the patient dies.
No system in place
Dr. John Sutyak, an SIU surgeon and director of the trauma center at both Memorial and St. John’s Hospital, said about 10 of the 20 local residents who die in car accidents, shootings and other trauma cases each year might become organ-donation candidates under the new law.
His estimate doesn’t include dozens of other people who die in the two hospitals’ emergency rooms each year from cardiac arrest and all the people who are pronounced dead outside the hospitals.
Sutyak also remains open to considering a pilot project here.
“Death, especially sudden traumatic death, is emotionally devastating on the surviving family and friends,” he said. “As anyone in the community could be impacted, public discourse, discussion and consensus on details of implementation must occur. This is a daunting and time-consuming task, which may explain the lack of a pilot project at this time.”
Sutyak has had to turn down requests from family members in the past when they wanted their loved one to be considered for organ donation after dying in an emergency room.
He had to say “no” because there was no system in place for starting the process of organ recovery in the ER.
Itasca-based Gift of Hope Organ & Tissue Donor Network supported the law, but found that hospitals and focus groups in the Chicago area worried that it could promote more distrust of the transplant process, Gift of Hope spokesman Dave Bosch said.
One of the biggest misconceptions among the public, he said, is that doctors won’t do everything possible to save someone if they know he or she is a potential organ donor.
Bosch has doubts about how big a dent the law could make in the waiting list for kidneys. However, he said, “That is not to say that this is not something that should be looked at and examined … to figure out some way of implementing it.”
Sees both views
Linda Thomas, 62, a retired secretary from Taylorville, is on the waiting list for a kidney at Memorial. But she said she has mixed feelings about whether hospitals should use the state law to help recover organs from people who die in the ER.
She said she might be upset if she walked into an ER, learned a relative was dead and found that organ-preservation techniques had begun without her knowledge.
“I kind of half think it’s right and half not right,” she said. “I can see both views.”
But Auburn resident Susie Corp, 40, who has been on the kidney waiting list for eight years, said hospitals should move ahead on programs to recover organs through the law, as long as they ramp up communitywide educational efforts on the potential benefits.
“The law impacts me personally in a way that it could affect my life,” said Corp, the married mother of five children. She is a kidney-failure patient who goes through daily peritoneal dialysis.
She acknowledged the emotions that relatives go through when an otherwise healthy loved one dies unexpectedly.
“That person’s not coming back, unfortunately, but they could be potentially saving many people,” she said.
Dean Olsen can be reached at 788-1543.
Organ donations rare from people who die outside hospitals
Donations from people who die outside hospitals and in emergency rooms, in a process known as “uncontrolled donation after cardiac death (DCD),” is rare across the country, and there is skepticism about its future prospects.
There have been mixed results from other pilot projects, but many medical officials haven’t abandoned hope.
Jeff Orlowski, president of the Association of Organ Procurement Organizations, said it’s difficult for overworked ER staffs to find the time required to tend to potential organ donors after their deaths, though many of the associated costs would be paid by the federal Medicare program.
He also said there’s “not a lot of scientific data” indicating uncontrolled DCD yields many usable organs. A 2006 Institute of Medicine committee disagreed and said statements such as Orlowski’s perpetuate a “myth.”
The committee’s report said uncontrolled DCD organ recovery is common in Spain and some other European countries. The panel encouraged research into uncontrolled DCD.
The committee said the 335,000 out-of-hospital cardiac arrests each year in the United States could result in 22,000 DCD organ donors — mainly for kidneys — if preparations were made.
Dr. Jimmie Light oversaw a project that recovered kidneys from 19 trauma victims who died from 1995-97 at Washington Hospital Center in Washington, D.C.
Almost all the kidneys worked well for transplant recipients, but he said he wouldn’t recommend a similar program for other hospitals — if it focused only on trauma victims — because the expense and effort weren’t worth the benefits.
The University of Pittsburgh Medical Center, as part of a federally funded pilot project, recovered organs from people who died in its ER for a 15-month period ending this month. However, the project hasn’t resulted in any transplants, in part because of logistical problems, hospital officials said.
“For various reasons, many people who die in the emergency department may not be medically suitable for donation,” said Dr. Clifton Callaway, vice chairman of emergency medicine at the University of Pittsburgh.
A six-month pilot project is about to begin in New York City in which organ-preservation procedures will be started for heart-attack victims who die outside hospitals. They will be brought in a special “organ preservation vehicle” to a designated hospital where organs will be recovered if the dead person’s family consents.
The system, similar to an approach used in Spain and France, could revolutionize the number of organs available for transplant, according to Dr. Lewis Goldfrank, chairman of emergency medicine at New York University Medical Center and Bellevue Hospital. He has spearheaded the effort to start the pilot.
Dean Olsen can be reached at 788-1543.
By the numbers
*3,859 people are on the waiting list for kidneys in Illinois.
*More than 700 people receive kidney transplants each year in Illinois — with more than half of the kidneys coming from deceased donors — but more than 200 people on the waiting list die each year.
*About 300 people die each year in Illinois in situations that allow them to donate kidneys and other organs.
*85,757 people are on waiting lists for kidneys nationwide.
*Between 16,000 and 17,000 people receive kidney transplants in the United States each year. About 10,000 of those transplants involve organs from deceased donors.
*The median wait is more than three years for a kidney coming from a deceased donor.
*There are 120 patients on the kidney transplant waiting list at Memorial Medical Center.
*Memorial has performed 19 kidney transplants since the program was re-activated in August 2009.
*An average of 32 kidney transplants were performed annually at Memorial Medical Center from 2005 to 2008. Two-thirds of those transplants involved deceased donors; one-third involved living donors.
Source: Organ Procurement and Transplantation Network
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