Transplant surgeons at Washington University School of Medicine in St. Louis, MO, claim that performing organ retrievals at a stand-alone facility, rather than a hospital, is more efficient and lowers costs considerably.
Currently, crowded operating room schedules cause delays that make retrieving organs from brain-dead donors in hospitals logistically challenging and time consuming.
Transplant teams travel to donors' hospitals to perform surgery - usually at night, when operating rooms are more likely to be free. As the surgery is time-sensitive, being able to access operating rooms without delay is critical.
"Organ donors often are given low priority in hospitals because of scheduled surgeries or emergency cases," explains the study's senior author, Dr. William C. Chapman, the Eugene M. Bricker Chair of Surgery and surgical director of the Washington University transplant center at Barnes-Jewish Hospital.
Additionally, the transplant team will usually only have assistance from local staff, who may be unfamiliar with organ donation procedures.
But in a study published in the American Journal of Transplantation, the Washington University surgeons report successful results in moving donors from hospitals to a regional stand-alone facility specializing in organ donation.
How do stand-alone organ donation facilities work?
"The magnitude of these changes has been transformative, with no negative effects on the organ donation process," says the study's first author, Dr. M.B. Majella Doyle, a Washington University liver transplant surgeon at Barnes-Jewish Hospital, who also directs the adult liver transplant program.
"Organ donors often are given low priority in hospitals because of scheduled surgeries or emergency cases," claims Dr. Chapman.
"This approach of moving organ donors to a free-standing organ recovery center is one that we believe has great merit and could be implemented more broadly."
The first stand-alone organ retrieval facility was built in St. Louis in 2001 by the nonprofit organization Mid-America Transplant Services, who co-ordinate organ donations and retrievals for eastern Missouri, southern Illinois and northeast Arkansas.
When patients are declared brain dead and their families have consented to organ donation, the donors are transported by air or ambulance (if their hospital is within an 80-mile radius) to the donation facility.
Donors' bodies can be kept stable during transit by ventilators and other medical equipment fitted inside Mid-America Transplant Services' airplane.
The operating room is primarily used by Washington University and Saint Louis University surgeons and can be scheduled as soon as a donor becomes available. The surgical teams still need to travel to the facility but there is no delay in accessing the operating room. The facility is also staffed by critical care nurses who are trained in procedures relating to organ donation.
"We thought moving the donors might be a major obstacle but that has turned out not to be the case," explained Dr. Chapman, a liver transplant surgeon.
"We think this is because the donation process is much more controlled, and the families can reliably know how long the surgery will take and when their loved ones will be returned to them."
Cheaper and more efficient, with no impact on quality
In 2001, 36% of liver organ donations at Barnes-Jewish Hospital were retrieved at Mid-America Transplant Services' facility, but this increased to 93% by 2011.
This move also had an impact on the costs involved in the procedure. By 2011, the average cost of retrieving a liver had dropped from nearly $8,000 to just under $5,000. This reduction in cost of 37% was largely due to cheaper costs offered by the facility, compared with hospital costs.
The study also found that, during this time period of 10 years, surgeons' average round trip for retrieval time was cut from 8 to 2.7 hours. This allows retrieved organs to be transplanted into patients on waiting lists much more quickly.
The researchers claim they have found no difference in the quality of the livers retrieved at the stand-alone transplant facility, compared with those from hospitals.
Dr. Chapman adds:
"In addition to the cost savings, we rarely encounter delays anymore, making organ donation easier on families who have lost loved ones and on transplant teams because we can know when donors' surgeries will take place."
Written by David McNamee