Improving the approach to organ donation: A review

Organ transplantation continues to be hindered by a limited supply of organ s. A significant percentage of potential organ donors are lost to either me dical failure or inability to obtain consent for donation. In a surgical in tensive care unit (ICU) we have refocused our efforts toward aggressive res uscitation, directed by control of coagulopathy, invasive monitoring, and d edicated ICU management while implementing a rapid brain death determinatio n protocol. Over a 6-year period the length of stay until the legal determi nation of brain death is made has been significantly shortened (12.0 vs. 3. 4 hours; p < 0.05), as have associated charges despite this more aggressive approach. As a result, we have eliminated medical failures prior to donati on (13% vs. 0%) and increased consent rates (44% vs. 71%; p < 0.05). These efforts have significantly improved the number of organs harvested per elig ible donor (1.8 vs. 3.4; p < 0.05). In addition, the number of organs per a ctual donor has increased and is now markedly greater than the U.S. nationa l average (4.7 vs. 3.7). We believe the approach presented, if widely appli ed, could potentially improve the current organ supply shortage.