Posted November 30, 2012
Marianna Sandomirsky, MD
Organ transplantation is a scarce, invaluable medical resource that has made tremendous strides in the last several decades. The latest available data shows that in 2007, a total of 27,281 solid organ transplants were performed, with kidney, liver, and heart as the most common.1 The untold sad story is that approximately 18 people die daily waiting for an organ transplant. The current waiting list for organs has over 110,000 people, of which 14,000 wait over five years.2 Before an organ is placed into a recipient, many steps must take place for a successful operation. This article will provide an overview for properly handling organ transplantation requests.
Most hospitals and medical examiners work with specific organ procurement organizations (OPOs) in their region. They ensure the safety of the potential donor as well as evaluate potential donors to ensure that valuable organs reach the many on the waiting list. Approximately 70% of the potential donors fall within the medical examiner jurisdiction, hence donors must give their approval for organ procurement to take place.3 To address this issue, the National Association of Medical Examiners (NAME) published a position paper that strongly advocates for organ and/or tissue release for donation in virtually all cases without detriment to evidence collection, postmortem examination, determination of cause and manner of death, or the conducting of criminal or civil legal proceedings.4 It is best practice to have a close working relationship with your local OPO and to establish effective lines of communication regarding your expectations about the organ procurement protocol. Once the donor is released by the medical examiner, the OPO will approach the family for its consent for donation.
The next step is to evaluate the viability of certain organs, which usually falls upon the hospital pathologist in the facility where the donor is located. Each OPO provides a form, which must be filled out and transported with the organ prior to placement into the recipient by the surgeon. Each center has protocols, which are followed to determine acceptable parameters for the histopathological findings. The liver is evaluated for findings including steatosis, inflammation, and fibrosis. The kidneys are judged by status of glomeruli and vasculature. The additional pretransplant evaluation such as blood typing, HLA typing, and infectious disease screening is done prior to organ retrieval.
A less well-known facet of donation pertains to skin, soft tissues, and corneae. Tissue banks work with medical examiners, coroners, and the families of deceased patients to arrange for procurement of skin, bone, cartilage, tendons, ligaments, dura, pericardium, heart valves, and whole joints up to 24 hours after cardiac death. Pathologists are often involved in these cases in a number of ways, including providing autopsies to rule out infection or neoplasia in donors, developing quality assurance protocols, and managing microbiology and serology laboratories.
The best way pathologists and clinicians can ensure that organ transplantation continues to save lives is through timely and effective communication. Have a candid conversation within your OPO to find out the needs of your community. You can save lives as a physician who specializes in pathology, especially for those pathologists who are in the medical examiner role.
- Health Resources and Services Administration, US Department of Health and Human Services. 2009 US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients Annual Report: Transplant Data 1999–2008. Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2009. http://optn.transplant.hrsa.gov/ar2009/default.htm. Accessed July 11, 2011.
- US government information on organ and tissue donation and transplantation. US Department of Health and Human Services Website. http://www.organdonor.gov. Accessed July 11, 2011.
- Pinckard JK, Wetli CV, Graham MA; National Association of Medical Examiners (NAME). NAME position paper on the medical examiner release of organs and tissues for transplantation. Am J Forensic Med Pathol. 2007; 28(3):202–207.
- Goldstein B, Shafer T, Greer D, Stephens BG. Medical examiner/coroner denial for organ donation in brain-dead victims of child abuse: Controversies and solutions. Clin Intensive Care. 1997;8:136–141.
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