'In-house recovery' aimed at preserving organs with minimal damage
By DEAN OLSEN | PJ Star.com
Springfield, Beginning next year, hundreds of deceased organ donors from Peoria, Springfield and other parts of central and northern Illinois will be transported by ambulance to operating rooms in a suburban Chicago building where their organs will be removed for transplant.
This will be a big departure from the current system, in which doctors procure organs at the Illinois hospitals where patients die, then pack the organs in cold storage and carry them to hospitals where the transplants take place.
The new system, known as "in-house organ recovery," already is being used by organ-procurement organizations based in St. Louis, Philadelphia and Ann Arbor, Mich. It's about to start in Indianapolis and is being considered in other parts of the country.
In-house recovery involves moving brain-dead organ donors to a single procurement location while their blood circulation and breathing are maintained by a respirator to preserve the organs with minimal damage.
One of the main reasons for the switch is to reduce the time organs are stored outside the body before being transplanted, according to officials from the Gift of Hope Organ & Tissue Donor Network.
Reducing the storage time results in less organ deterioration and makes it more likely the organs will work, and work for a longer period, for recipients of life-changing transplants, Gift of Hope officials said.
'Maximizing the gift'
Shorter storage time and a single, dedicated site for procurements will allow doctors to transplant some organs that in the past wouldn't have been removed from donors because of logistical hurdles and fears that the organs wouldn't hold up, according to Dr. Martin Jendrisak, Gift of Hope's medical director.
The families of donors, above all else, want transplants with their loved ones' organs to be successful, Jendrisak said.
"We're trying to maximize the gift from the perspective of the donor family and all the potential recipients on the waiting list," he said. "The organ shortage is getting worse and worse, and we feel an obligation at our end to use every potentially transplantable organ."
In-house procurement also benefits deceased donors' families by reducing the likelihood of delays in funeral arrangements, Jendrisak said.
That's because doctors ready to remove organs sometimes must wait hours for operating rooms at busy hospitals to open up, causing delays at several points in the transplant process, he said.
Donor families will go through less stress by not having to wait - sometimes until the middle of the night - for an operating room to become available for organ procurement so they can say their "final goodbyes" to the donor, said Dr. Forrest Dodson, a transplant surgeon at Chicago's Rush University Medical Center.
"In many ways, this is going to be a much better system," he said.
Consent still needed
Consent from families will be needed before a loved one's body can be transported to Gift of Hope's new headquarters in Itasca - 160 miles from Peoria - even if the donor is listed in Illinois' "first-person consent" registry.
But Jendrisak, 57, who worked for St. Louis-based Mid-America Transplant Services when that not-for-profit organization pioneered the in-house procurement method in 2001, said donors' families consented to the transfer of relatives' bodies in more than 90 percent of MTS' cases.
Those families knew that they would see their relatives again when the body was returned for the funeral. Jendrisak said he expects donor families in Gift of Hope's territory to show the same level of support for in-house procurement.
"It doesn't really matter that your loved one is being moved down the hall, three floors down, to the next building or to another facility . . . because the next time you are probably in the presence of the donor is at the viewing," he said.
When families don't consent to the transfer to Itasca, the procurement will proceed at the hospital where the donor is pronounced dead, he said.
Gift of Hope, a not-for-profit organization with more than $40 million in annual revenues, spent $400,000 to outfit its new $16 million headquarters in Itasca for in-house organ and tissue procurement when the group moved from Elmhurst in late 2009.
Gift of Hope now plans to launch in-house organ recovery in late January or February with deceased donors at several Chicago-area hospitals, including Rush, Libertyville's Advocate Condell Medical Center and Oak Lawn's Advocate Christ Medical Center, Gift of Hope communications director Dave Bosch said.
Within about a year, Jendrisak said, organ donors who are declared brain dead at any of the 179 hospitals in Gift of Hope's territory in Illinois and northwest Indiana will be brought to Itasca for procurement, with their families' consent.
Dr. Timothy O'Connor, a kidney transplant surgeon at Peoria's OSF Saint Francis Medical Center, said he agrees with the potential benefits of the new system and hopes those benefits are demonstrated in the Chicago area before it expands to downstate hospitals.
He said he wonders whether regional biases will reduce the consent rate among families of downstate donors.
"A lot of people don't want to go above Interstate 80 for their care," said O'Connor, a former Southern Illinois University School of Medicine doctor who was part of Memorial Medical Center's kidney and pancreas transplant program in Springfield.
"I don't know how people will respond to their loved ones' bodies going up to Chicago," he said.
Dr. Marc Garfinkel, an SIU physician who is surgical director of Memorial's transplant program, said some donor families want to be at the side of their brain-dead loved ones until those donors are wheeled into an operating room for organ recovery.
He said he doesn't know whether that desire will result in local families giving consent less often for the transfer to Itasca.
Bosch said family members wouldn't be barred from accompanying their loved one's body to Itasca.
"We don't expect that families would choose to do so, but I guess we would work it out with the family if the request was made," he said.
Overall, the new system appears to offer more benefits than drawbacks, Garfinkel said.
Between 275 and 300 people become deceased donors for Gift of Hope each year, Bosch said. Almost all of those people would be eligible for in-house procurement.
About one-third of the donors come from central Illinois, Bosch said, with 30 to 40 organ donors declared dead each year at OSF Saint Francis Medical Center, Methodist Medical Center and Proctor Hospital in Peoria.
It will be up to donor families, not hospitals, whether donors are transported to Itasca, though Bosch said he expects hospitals to support the new system.
Hospitals benefit because they no longer will have to free up space for procurement procedures and accommodate organ-procurement teams from transplant centers throughout the state and nation, Jendrisak said.
Moving deceased organ donors to Itasca also will free up beds in intensive-care units in hospitals, he said.
Shorter storage time
Under the current system, most organ donors are pronounced dead at larger hospitals, including those in Peoria, Springfield, Normal and Urbana, because of the specialized care offered there.
In the Gift of Hope region, because most of the nine transplant centers are in the Chicago area, it can take hours to transport organs removed at the donor's hospital to the transplant hospital, Jendrisak said.
Removing all of the organs at the Itasca facility will reduce the storage time for organs, sometimes by hours, and result in swifter transplants, he said.
One donor often becomes the source for multiple organ transplants. Hearts, livers and lungs are damaged more than kidneys by storage time outside the body, but state-of-the-art equipment at the Itasca facility will reduce the storage time for the kidneys most vulnerable to deterioration outside the body, Jendrisak said.
The costs of organ transplants, including Gift of Hope's costs in procurement, are covered by organ recipients' health insurance, with Medicare providing most of the coverage in the case of kidney transplants.
Even with ambulance costs included, in-house organ procurement saves health-care dollars by eliminating operating-room charges at hospitals, Jendrisak said.
Medical studies haven't determined whether organ recipients live longer or have a better quality of life with organs obtained through in-house procurement.
But Jendrisak said studies have documented that shorter organ-storage times lead to more successful transplants.
Studies examining in-house procurement by Mid-America Transplant Services found reduced delays in transplanting organs, lower costs and more organs recovered per donor.
Diane Brockmeier, chief operating officer of Mid-America Transplant Services, said: "It's been an incredibly positive experience for our physicians and our donor families. There's no downside."