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The Donation & Transplantation Symposium
October 15, 2013
The Current State of Organ Donation and Transplantation
Thomas A. Nakagawa, M.D, FAAP, FCCMProfessor and Section Head, Pediatric Critical Care Medicine
Director, Pediatric Critical Care Medicine and Respiratory Care Wake Forest University Baptist Health, Brenner Children’s Hospital
Winston-Salem, North CarolinaAssistant Medical Director, Carolina Donor Services
Durham, North Carolina
• We have achieved and sustained a 75% conversion rate nationally
• We continue to transplant more organs annually• We continue to engage more partners to save
more lives• We have continued to increase organ recovery
from donors following circulatory determination of death
CELEBRATING OUR SUSTAINED SUCCESS
(OPTN Data, September 2013)
Conversion Rate 2009 – 2012 (Jan-Dec)
2009(Jan-Dec)
2010(Jan-Dec)
2011(Jan-Dec)
2012(Jan-Dec)
0%
10%
20%
30%
40%
50%
60%
70%
80%
66% 68%73% 71%
% C
on
ve
rsio
n R
ate
Organs Transplanted Per Donor
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012414262.85
2.9
2.95
3
3.05
3.1
3.15
3.2
3.25
3.16 3.17
3.23
3.15
3.06
3.06
3.05
2.99
2.99
3.03
3.1
3.08
3.02
3.02
Se-ries1
Adults 3.09Pediatrics 4.06All donors 3.08
-DCDD donors-
Organ Donors, Organs Transplanted & OTPD2006 vs. 2013 (Jan-Aug)
2006 (Jan-Aug)
2013(Jan-Aug)
0
100
200
300
400
500
600
700
800
900
1000
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
297 287
922 9483.10 3.30
Donors Transplanted Organs OTPD
OT
PD
2013 (Jan-Aug) Donors – Decreased 3%2013 (Jan-Aug) Transplanted Organs – Increased 3%
Continued Growth of DCDD
UNOS. OPTN data. 2013, Pediatrics patients < 18 years of age
Adult DCDD donors Pediatric DCDD donors
2006 645 adult 77 pediatric
2007 793 adult 66 pediatric
2008 847 adult 73 pediatric
2009 747 adult 81 pediatric
2010 939 adult 72 pediatric
2011 1053 adult 115 pediatric
2012 1102 adult 124 pediatric
(OPTN Data, September 2013)
DCD Donors 2009 – 2012 (Jan-Dec)
2009(Jan-Dec)
2010(Jan-Dec)
2011(Jan-Dec)
2012(Jan-Dec)
0
50
100
150
200
250
300
350
400
450
4%
5%
6%
7%
8%
9%
10%
11%
24 2533 39
382
349
417 391
6%
7%
8%
10%
DCD Donors Total Donors % of Total
# o
f D
CD
Do
no
rs
%
of
To
tal
Growing National Organ Transplant Waitlist
0
20000
40000
60000
80000
100000
120000
140000
1997 1999 2001 2003 2005 2007 2009 2011
Wait list Transplants Deaths Donors
• 120,188 people are currently on the national waiting list.
• 16, 669 organ transplants have been performed from 8,215 donors* through July 2013
• 3,450 people have died waiting for a needed organ*
• 2,973 people were removed from the waiting list because they became too sick to transplant*
Current State of Organ Donation & Transplantation
www.UNOS.org. Data obtained October 14, 2013 * Data through July 2013
• 28,052 organ transplants from 14,013 donors were performed in 2012
• 16, 669 organ transplants have been performed from 8,215 donors* through July 2013
• 3,450 people died waiting for a needed organ*• 2,973 people were removed from the waiting
list because they became too sick to transplant*• 2012: 46,000+ corneas transplanted
Facts About the Current State of Organ Donation and Transplantation
www.UNOS.org. Data obtained October 14, 2013 * Data through July 2013
A National Issue That Continues to Escalate
October 23, 2012 Growing transplant waiting list exceeding 112,000In 2011:• 7,370 died waiting for a
needed organ*• 4,519 removed from wait list
because they became too sick to transplant
• 92 deaths were children*OPTN data accessed October 14, 2013
October 15, 2013 Growing transplant waiting list exceeding 116,000In 2012:• 7,040 died waiting for a
needed organ*• 4,794 removed from wait list
because they became too sick to transplant
• 104 deaths were children
• An average of 18 people die every day in the US waiting for a needed organ
• Although the number of people that died waiting for an organ last year was decreased, more people were removed from the waiting list because their condition deteriorated to a point where they were too sick to transplant
• In California, an average of 3 people die everyday waiting for a needed organ
Waiting for an Organ That Never Came
02004006008001000
1200
1400
1600
*OPTN data. Accessed October 14, 2013 www.OPTN.org
575 deaths through June 2013
2012: 1,109 people died waiting for a needed organ transplant
California Data
The Solution:Recover more organs
for transplantation
Reducing the Number of Deaths Among Those Waiting for a Transplant• Transplant 2 more people every day
2 more organs, 1 additional donor 243 transplant programs Reduce deaths on the waitlist to 6,303 (~10% decrease)
• Continue to improve care with advancing technology for patients with end-organ failure
More time on the waiting list
• Education programs to help keep people off the waitlist
• Ensure we never miss opportunities for donation
• Preserve the option of donation for every person and their family facing end-of-life issues
• EducationHealthcare professionalsPublic
• Donor registries
Recovering More Organs for Transplant
Donor Designation in the U.S.
108,963,103 as of 12/31/12
• 108,963,103 designated donors nationwide• 24 states have signed up more than 2 million
designated donors• In 31 states, donor designation share is at least
50% of the adult population• The number of donor designations
increased 7.5% over the last 12 months
Summary: Donor Designations, Q4 2012
• In the 50 states, DC and Puerto Rico, 41.1% of recovered organ donors, 46.2% of recovered tissue donors, and 50.2% of recovered eye donors were authorized by state donor registries
• Donor designation rate increased year-over-year in 16 of 28 states reporting
Donor Designation Highlights – Q4 2012
Impact on Donation, 2007-2012
Designated Donors Among Recovered Donors
• The process of donation begins when a critically ill or injured patient is identified as a potential donor with a timely referral to the organ procurement organization (OPO)
• Medical management of the potential organ donor requires knowledge of the physiologic derangements associated with this patient population
• This process of donation relies on collaboration between the critical care team and the OPO to optimize organ recovery for transplantation
Donation is a Process
Donation is more than just a question
Donation is a conversation
• Identification of the potential donor• Declaration of death in a timely manner• Consent from the family • Management of the donor• Recovery of organs and tissues
Success in Maximizing Organ Recovery
Tissue Donors2009 compared to 2013 (Jan-Aug)
2009(Jan-Aug)
2013(Jan-Aug)
1150
1200
1250
1300
1350
1400
1450
0%
1%
2%
3%
4%
5%
6%
1,360
1,426
Increased 5%
# o
f T
iss
ue
Do
no
rs
• Be open• Listen, learn, and teach others• Be bold: Share your thoughts and experiences• Focus on what we can do, not what we can’t do• Determine what we as a community of health
care professionals can do to decrease and eventually eliminate deaths on the waiting list
Bold Request
"Sometimes our light goes out but is blown again into flame by an encounter with another human being.
Each of us owes the deepest thanks to those who have rekindled this inner light."
– Albert Schweitzer