PITTSBURGH, October 30, 2007 Physicians from the University of Pittsburgh School of Medicine
departments of critical care and emergency medicine have received a nearly $1 million, three-year grant from the Healthcare Resources Services Administration (HRSA) to develop a first-of-its-kind organ donor program specifically developed for the emergency department, where presently organ donation is prohibited.
Michael DeVita, M.D., professor of critical care and internal medicine at the University of Pittsburgh School of Medicine, and associate medical director, UPMC Quality and Patient Safety, and colleagues will develop a new organ donation program known as Condition T (transplant) that will enable those wishing to donate their organs after death be able to do so, should they die after heroic resuscitation efforts fail.
Our goal is to honor patients last wishes, to pass on the gift of life, in the event of their own untimely deaths. As a leader in the field of transplantation and critical care medicine, UPMC is poised to offer a coordinated Condition T program to meet an existing gap in dying patients needs. Because of our vast experience with emergency care, organ donation and rapid response systems, we are able to create and implement a process that can be a template for other hospitals to build upon, said Dr. DeVita. Furthermore, UPMC has always had a collegial and professional relationship with the Center for Organ Recovery and Education (CORE) and this partnership will continue to serve us well as we work together to mobilize a coordinated team in order to help honor the wishes of designated organ donors.
Organ donation is a gift and we will treat it as such, said Susan A. Stuart, president and CEO, CORE. Additionally, we will keep the new Condition T program transparent in order to maintain donor integrity and the general publics trust.
UPMC's new program will help bridge the gap between emergency and critical care medical teams at the hospital, whose focus is to help patients recover from serious injury, and the organ procurement team, whose task is to make sure organ donors wishes are respected. The hope is to enable those who have decided to be considered to be an organ donor to do so. Currently, many organs of patients who die in emergency departments across the United States are not used. To ensure success, UPMC will collaborate with CORE to educate and train hospital staff in order to facilitate this process. The Gift of Life of Michigan, which is partnering with the University of Michigan's transplant program, also is working with Pitt and CORE in this grant to determine whether Condition T can be replicated.
Last year, UPMC received organs from six non-heart beating donors. While organ donation from such donors is only a partial solution, that still could mean more organs available for transplant. UPMC physicians estimate that under the new program, an additional 20 donors organs might be used each year. While not a large increase in the overall donor pool, that still amounts to an extra 40 kidney recipients and 20 liver recipients per year.
The new Condition T program will in no way hamper life-saving efforts of our emergency department physicians. UPMC has long been a leader in successful resuscitation and we will always do everything possible to save a persons life. The transplant surgeons will never be involved in the care of patients undergoing resuscitation in the emergency department. The Condition T program will only be initiated if a person dies in the emergency department and is later found to be a registered organ donor. A separate team will then be called in to honor the wishes of the deceased, said Charissa B. Pacella, M.D., assistant professor of emergency medicine, University of Pittsburgh School of Medicine and chief of emergency services for UPMC Presbyterian.
Background on cardiac death vs. brain death
Death can be diagnosed in either of two ways. Cardiac death occurs when the heart, circulatory and respiratory systems permanently cease functioning. In brain death, the brain ceases functioning even while heart and lung function is supported by machines. Without this mechanical support, the body cannot continue to have heart and lung function. Brain death usually occurs as the result of some type of head trauma or stroke. Organs from brain-dead donors are still the optimal choice for organ donation because the organs are kept viable through mechanical support and often are in better condition for transplantation.
The concept of donation after cardiac death is not new. In the early days of organ transplantation and before brain death laws, donation after cardiac death was the only way to retrieve organs. It wasn't until 1968, when Harvard School of Medicine declared brain death as a legal form of death. As the field of organ transplantation grew, organs from brain-dead donors became the preferred choice among surgeons because this process kept the organs more viable for transplant. Donation after cardiac death was largely abandoned for two decades before UPMC developed an updated protocol for donation in 1992. That protocol has become the international standard for donation after cardiac death. Now, 15 years later, the new process is intended to close a gap in which people who wanted to donate could not.
According to the United Network for Organ Sharing (UNOS), more than 97,000 patients in the United States are awaiting for some type of solid organ transplant. Sadly, the number of people requiring a life-saving organ transplant continues to rise faster than the number of available organs. Last year alone, more than 6,000 patients died while on the transplant waiting list.
To help address this critical organ shortage, in 2003 HRSA initiated a nationwide effort, known as the Organ Donation Breakthrough Collaborative, to challenge medical centers and hospitals to design ways to increase organ donation and procurement. This grant is the result of that effort.
More information about organ donation is available at www.core.org
, or by calling CORE at 1-800-DONORS-7, or 412-963-3550.