Sunday, May 23, 1999

Organ donation standards could widen at conference


Greater Cincinnati group to help set national policy

BY TIM BONFIELD
The Cincinnati Enquirer

        Greater Cincinnati organ donation experts will travel to Washington, D.C., Monday and Tuesday to help develop nationwide policy on organ donations from non-heart-beating donors.

        If they succeed, their efforts could boost the national supply of donor organs by 25 percent, said David Lewis, executive director of the LifeCenter, the Tristate agency that coordinates organ donations.

        At present, nearly all organ donors must be hooked up to machines and then declared brain dead before their organs can be collected for transplant. Because only a tiny percentage of deaths occur in this manner, the result is a limited supply of donor organs.

        In 1997, more than 60,000 patients were on waiting lists for organ transplants. But the total number of organs donated in the United states was 5,475, according to the United Network for Organ Sharing.

        The supply of donor organs — especially kidneys — could grow 25 percent by including people who are disconnected from life support machines but declared dead through non-heart-beating standards, Mr. Lewis said.

        Nationally, less than 2 percent of all donated organs come from such donors.

        The LifeCenter is one of only six agencies nationwide that collects organs from non-heart-beating donors. Since 1994, the LifeCenter has recovered organs from 33 such donors, about 13 percent of total donors.

        The Washington conference, sponsored by the National Academy of Sciences' Institute of Medicine, seeks to develop standards after a 1997 report that recommended expanded use of the non-heart-beating standard.

        The plan does not call for turning all people whose hearts stop into organ donors, Mr. Lewis said. In many emergency situations, health professionals — even minimally-trained civilians — can revive people whose hearts stop beating.

        Instead, the standard would focus on hopeless situations, such as devastating trauma from a car accident, that do not lead to a brain death declaration.

        For example, many people now have living wills stating they do not want to be kept alive on a ventilator. In such situations, physicians will honor a request to “pull the plug,” but many of those people cannot become organ donors because the doctor declares death when the heart stops beating rather than making a formal declaration of brain death.

        In Cincinnati, James and Christopher Frank — the Glen Este High School brothers who were killed in a car accident last year — became organ donors via non-heart-beating standards.

        If the non-heart-beating standards are adopted, they would add to a series of recent efforts to increase organ supply:

        • Increased marketing campaigns to encourage people to sign donor cards and inform their families of their wishes.

        • Pushing hospitals to inform organ procurement agencies about potential donors through “routine notification” regulations.

        • Increasing use of living donors for kidney and partial-liver transplants.

        • A new program in Pennsylvania to pay $300 toward the funeral expenses of organ donors — the first in the country to offer a payment incentive.

        • And for liver transplants, a recent proposal from the University of Pittsburgh urging medical centers to make a regular practice of splitting the best donated livers so two recipients (adult and child) can benefit.

        • Continued research into xenotransplantation (using organs from genetically-engineered animals) and into human organ tissue regeneration techniques.

       



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