Centralizing organ removal shows promise for transplants

For decades, surgeons have traveled to far-off hospitals to remove organs from brain-dead donors and then rushed back to transplant them. Now an experiment in the Midwest suggests there may be a better way: Bring the donors to the doctors instead.

A study out Tuesday reports on liver transplants from the nation's first free-standing organ retrieval center. Nearly all organ donors now are transported to Mid-America Transplant Services in St. Louis from a region including parts of Missouri, Illinois and Arkansas.

Removing organs at this central location near the four hospitals that do transplants saves money, the study found. The livers spent less time outside the donor's body, which at least in theory improves the odds of success. Doctors also think they are getting more usable organs from each donor, though this study only looked at livers.

Transplant experts say this could become a new standard, and groups in Philadelphia, Pittsburgh, Denver, Chicago and Ann Arbor, Mich., have started or are exploring similar ventures.

"It's kind of a foreign concept so it's taken some time for this to catch on, but I think it will. It makes so much sense," said Dr. William Chapman, a transplant surgeon at Washington University in St. Louis, which uses the Mid-America center.

"There's no question in my mind" this should be done everywhere, said Dr. Majella Doyle, also of Washington University. "It will increase the number of organs that are used and it will increase efficiency and decrease costs." She led the study, published in the American Journal of Transplantation.

About 28,000 transplants were done in the United States in 2012; more than 121,000 people are on the waiting list now.

Organs have a finite shelf life - livers, 6 to 10 hours after removal; hearts and lungs, even less. Kidneys last about a day.

Transplants are not done at every hospital - only a few in any major city have that capability. Surgeons usually travel to wherever the donor is to retrieve organs, performing these hurried, complex operations in unfamiliar settings, often assisted by staffs at hospitals that don't have transplant expertise.

Donors provide three organs on average but can give six or more. Each specialist - lung, heart, kidney - wants to test and inspect an organ to ensure viability before committing to the transplant. Sometimes multiple doctors make the trip to retrieve organs, or there is redundant testing and inspection when an organ that's been removed by one doctor gets to another hospital where it will be transplanted.

Mid-America, the region's organ procurement organization, thought that having a retrieval center - a commercial building with two operating rooms and testing equipment - near the four St. Louis hospitals that do transplants would improve coordination. In 2001, the first year it was open, it handled 36 percent of liver donations in the region. By 2011, it was up to 93 percent.

Two staffers, usually nurses, go to the donor's hospital - by ambulance if within 80 miles and by plane if farther - to bring brain-dead donors on life support to St. Louis. After any organs and tissues are removed, the body is returned, according to the family's wishes.

The study looked at 583 livers donations from 2001 through 2011- 407 procured at the organ retrieval center, 94 at St. Louis hospitals and 82 from flights to other hospitals in the region.

Patient and organ survival rates were similar. Removing livers at the central facility shaved an hour and a half off the time they were outside the donor's body. Costs dropped 37 percent - $7,876 for liver removal at a hospital versus $4,957 at the organ center.

"We can save more lives by doing the management and recovery here," said Diane Brockmeier, Mid-America's chief operating officer. "It's a huge benefit for donor hospitals. We're freeing up resources they can use on other patients" because their intensive care units and operating rooms are not tied up with organ retrieval, she said.

Donor families have not balked at sending their loved ones' bodies out of town.

"At first it bothered us," said Stacey Smith, whose 21-year-old son, Cameron Greenwood, became an organ donor in 2010 after dying of complications from diabetes. But she said Mid-America's staff explained why it was best to move him from the small hospital in Branson, Mo., to St. Louis, a four-hour drive away.

"These people sat down and prayed with us, they cried with us, they treated us like he was their own child, and that just made a huge difference," Smith said.

"They called and let us know when the plane left. They called and let us know when it landed. They called at 2 a.m." to say his heart and both kidneys had gone to three different recipients, plus tissue and bones to help 50 others, she said. "It really made us realize how much organ donors are heroes. We had no clue how many lives one person could save and change."

It's not just transplant recipients' lives that could be saved. Fewer staffers need to make the trip. A report found the risk of dying while flying to retrieve organs is 1,000 times greater than on a commercial flight; there have been at least 30 such deaths since 1990.

In 2007, a plane carrying two surgeons and two transplant donation specialists crashed on its way from Milwaukee to Michigan with donated lungs. All four plus the two pilots were killed. In 2011, a pilot, a doctor and a medical technician on their way from Jacksonville to Gainesville to pick up a heart died when their helicopter crashed. In 1990, a surgeon and an assistant picking up a heart were killed in a plane crash in New Mexico.

"Sadly, our teams are doing a lot of running around like that. We do put team members at risk," said Charlie Alexander, executive director at The Living Legacy, the organ procurement group for Maryland.

"There are clearly benefits" in safety to having a single organ retrieval center and fewer people traveling, he said.