Organ Donation & Transplantation in the 21st Century (Notes from
Transplantation in 21st Century)
OPTN: Organ Procurement & Transplant Network-(OPTN) the unified transplant network established by
National Organ Transplant Act (NOTA) of 1984.
Links all professionals involved in the donation and transplantation system.
Goals:
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Increase effectiveness and efficiency of organ sharing and equity in the national system of organ
allocation
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Increase supply of donated organs available for transplantation
OPTN responsibilities include:
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Facilitate organ matching & placement process through a computer system and an Organ Center
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Develops policies & procedures for organ recovery, distribution (allocation), & transportation
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Collects and manages scientific data about organ donation and transplantation
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Provides data to government, the public, students, researchers for use in improving the field of
organ allocation & transplantation
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Maintains a secure Web-based computer system, which maintains nation's organ transplant waiting
list & recipient/donor organ characteristics
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Provides professional and public education
UNOS: United Network for Organ Sharing- The United Network for Organ Sharing
(UNOS), administers the OPTN under contract with the Health Resources and
Services Administration of U.S. Department of Health and Human Services
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By Federal Law, organ procurement organizations must be members of the Organ Procurement
and Transplantation Network (OPTN)
Organ Procurement Organizations (OPO)
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Designated by the Centers for Medicare and Medicaid Services (CMS).
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Responsible for procurement of organs for transplantation and promotion of organ donation.
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*OPOs -responsible for identification of donors, retrieval, preservation and transportation of organs
for transplantation. As well as data follow-up regarding deceased organ donors.
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Responsible for public education on critical need for organ donation.
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Originally called “Organ Banks,” the name was misleading. Organs can’t be banked.
*OPO for Central Texas: TOSA (TEXAS Organ Sharing Alliance)
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56 counties; 5.1 million population; 117 hospitals; 6 transplant hospitals
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16 transplant programs; 9 tissue and eye banks
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Accredited by the Association of Organ Procurement Organizations
Organ Donation & Transplantation Process
Getting organs from the Donor > …to the Recipient?
**WHEN TO CALL re Organ donations_
*All “imminent deaths”
1. GCS less than or equal to 5
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Absent 3 Brain Stem Reflexes
2. Intubated/ventilated
3. Brain insult
**Call on ALL patients… regardless of age, diagnosis and/or condition. These patients are potential
organ donors.
**WHEN TO CALL
All Cardiac Deaths
Cardiac arrests that are pronounced.
All deaths regardless of age, diagnosis, family dynamics, or other situations.
Previously referred potential organ donors, that can’t be resuscitated.
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All cardiac deaths even when TOSA rules out- These patient’s are not eligible to donate organs but may
donate tissues/eyes
**Who to Call
DONOR REFERRAL LINE
1-800-275-1744
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Donor referral agency
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Responsible for screening potential donors
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Triage your call to appropriate agency
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May rule out some potentials w/o further follow up
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Operators, not medical personnel, or TOSA staff
*Coordinator Call Back
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Should return your call within 15 minutes
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Neurological status
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Brain death testing
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Family dynamics
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Medications
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Vasopressors
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Sedation
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Lab work
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Medical and Social History
TOSA Coordinator Onsite
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EMS and ER records
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Operative / Invasive interventions
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Family Dynamics Assessment
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Planning with Nursing Staff and Physician
*When Patient Progresses to Brain Death
*Brain Death is the complete cessation of all brain & brainstem function. It is death. (know this
definition)
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Attending MD informs family of death
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Family given time to absorb tragic news
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TOSA will offer family opportunity to make loved-one an organ donor
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Family gives written consent to donation and provides medical & social history
TOSA Takes Over Patient Care
 Account number changed to TOSA
◦
Ensures that TOSA is billed for donation process
 New Admit Orders Written
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Patient discharged from ICU as deceased
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Patient re-admitted as Organ Donor under TOSA’s care
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New admit orders from TOSA Coordinator
 Second TOSA coordinator
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Performs allocation of organs
Donation Process – ICU
Labs & Diagnositics
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Organ specific tests:
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Echocardiogram, EKG, Cardiac Cath
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Bronchoscopy, CXR, ABG
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Multiple sets Labs
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Organ evaluation for transplantation
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Detect & treat chemical/electrolyte /fluid imbalances
Repeat STAT samples allow ORC to anticipate & treat organ deterioration secondary to brain death
Organ Allocation
Donor Registration
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A Donor is registered with the United Network for Organ Sharing (UNOS) using the following:
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ABO
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Height and weight
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Age
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Gender
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Race
UNOS Determines Potential Recipients
ALL ORGANS
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Blood type (ABO)
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Donor/Recipient size
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Level of illness
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Recipient proximity to donor
KIDNEYS
Human Leukocyte Antigen -(HLA)-Substances on cell wall that stimulate production of antibodies.
Potentially rejecting transplanted organs.
Less antigen differences between donor/recipient = less organ rejection (0 mismatch).
Liver MatchTeam Coordination
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Once all organs are accepted by transplant centers:
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OR time is finalized with OR staff
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all accepting transplant centers are notified
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Transplant team transportation arranged
Waypoints in the OR
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Arrival time
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Incision time
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Heparin administered
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Five minutes prior to cross-clamp
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Cross-clamp & Preservative flush
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Simultaneous
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Organ recovery time
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Separate time for each organ
Cardiectomy
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Heart to back table
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Examined
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Trimmed
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Packaged
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Heart team to waiting ambulance
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Must be implanted no more than 4 hours after cross clamp
Pneumonectomy
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Lung(s) to back table
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Examined
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Packaged
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Lung team(s) to waiting ambulance
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Must be implanted no more than 4 hours after cross clamp
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Hepatectomy
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Liver team returns to field to finish liver and kidney procurement.
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To back table for additional flushing, inspection, and packaging
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Must be implanted no more than 16-18 hours after cross clamp
Small Bowel Recovery
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Small bowel is sometimes recovered attached to the liver and pancreas then transplanted to
one recipient
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Must be implanted no more than 16 hours after cross clamp
Nephrectomy
•Kidneys recovered enbloc
•Separated, flushed, measured, packaged
•Must be implanted no more than 48-72 hours after cross clamp
Pancreaectomy

Post Procurement

Donation After Cardiac Death (DCD)
Another way to donate

Help Save Lives, Register to be a Donor
Post Procurement
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•
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Anatomy obtained & recorded for each organ
Organs packaged and transported to transplant center
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Heart , lungs, small bowel & liver with surgeon
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Kidneys & pancreas packaged by TOSA transported by bonded courier
Postmortem care per hospital policy
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Body to morgue, ME or funeral home
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Eye bank may recover in OR during “closing”
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Tissue bank may recover in morgue, funeral home or @ ME
Donation After Cardiac Death (DCD)
Another way to donate
*Patients who meet initial criteria (brain insult, GCS ≤ 5, intubated/ventilated) that do not progress to brain
death may still be organ donors. The patient’s family may decide, independent of any consideration for
donation, that the best choice for their loved-one is to withdraw life support.
With the family’s consent the patient can be moved to a surgical suite where an Attending Physician will
order the withdrawal of life support and administer comfort measures. If the patient expires in a time frame
short enough to prevent ischemic organ damage, the kidneys, and liver may be recovered.
*Help Save Lives, Register to be a Donor
Go to WWW.DonateLifeTexas.org
Fill out the form and in a few weeks you will receive a “donor card.” Have your family witness & sign it.
Then return the form. You will be registered on a secure website. And you may save a life!
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