Maximizing thoracic organ transplant opportunities: The importance of efficient coordination

Background: In Australia, despite large distances and one of the world's lo west multiorgan donor rates (11.4/million population/year), the thoracic or gan transplant (TOTx) rate of 9.6/million population/year is one of the wor ld's highest. Methods: As an example of the Australian approach, a system of transplant c oordination and organ allocation has evolved at the Alfred Hospital. Donor organs are assigned locally, or between the 4 major TOTx units on rotation. The recipient team then selects appropriate recipients, matching by blood group, size, cytomegalovirus (CMV) status, prospective cross matching and c linical status. An experienced recipient coordinator takes responsibility f or organization of the retrieval and transplant process, including all oper ating room staff, all medical personnel, and transport for the donor team a nd the potential TOTx recipients. Results: Between February 1989 and February 1999, 307 heart, 48 heart/lung, 124 single and 116 bilateral lung transplants were performed from 452 dono r offers (52% beyond 500 miles). This represents 1.74 organs transplanted/t horacic donor and compares favourably to American United Network for Organ Sharing (1.43) and European (1.3) figures. Conclusions: The Australia TOTx model has enabled high transplant rates by efficiently using the available donor organs. This has been achieved throug h an enlarged, experience TOTx team, the optimizing of donor acceptance cri teria and improving coordination logistics to allow multiple thoracic proce dures simultaneously.