Organ donation and utilization in the United States, 1996-2005

The success of clinical transplantation as a therapy for end-stage organ failure is limited by the availability of suitable organs for transplant. This article discusses continued efforts by the transplant community to collaboratively improve the organ supply. There were 7593 deceased organ donors in 2005. This represents an all-time high and a 6% increase over 2004. Increases were noted in deceased organ donation of all types of organs; notable is the increase in lung donation, which occurred in 17% of all deceased donors. The percentage of deceased donations that occurred following cardiac death has also reached a new high at 7%. The number of living donors decreased by 2%, from 7003 in 2004 to 6895 in 2005. This article discusses the continued efforts of the Organ Donation Breakthrough Collaborative and the Organ Transplantation Breakthrough Collaborative to support organ recovery and use and to encourage the expectation that for every deceased donor, all organs will be placed and transplanted.

Heart and lung transplantation in the United States, 1996-2005

This article examines the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients data on heart and lung transplantation in the United States from 1996 to 2005. The number of heart transplants performed and the size of the heart waiting list continued to drop, reaching 2126 and 1334, respectively, in 2005. Over the decade, post-transplant graft and patient survival improved, as did the chances for survival while on the heart waiting list. The number of deceased donor lung transplants increased by 78% since 1996, reaching 1407 in 2005 (up 22% from 2004). There were 3170 registrants awaiting lung transplantation at the end of 2005, down 18% from 2004. Death rates for both candidates and recipients have been dropping, as has the time spent waiting for a lung transplant. Other lung topics covered are living donation, recent surgical advances and changes in immunosuppression regimens. Heart-lung transplantation has declined to a small (33 procedures in 2005) but important need in the United States.

Substantial Increase in Cadaveric Organ Transplantation in Greece for the Period 2001–2005

The Hellenic Transplant Organization (HTO), a nonprofit organization sector of the Greek Ministry of Health, was officially established in 1999. Since March 2001, HTO has been responsible for donation and transplantation processes in Greece and organ sharing between Greece and other European countries. The organization's main tasks are: donor referral, charting, donor assessment, organ evaluation, organ allocation and transplantation. Today, the results show increased success rates to previously believed unthinkable levels. Precisely, the percentage of referred versus used cadaveric donors increased by 468% and 134%, respectively. Cadaveric kidney transplantation has also shown remarkable progress with a 126% increase during the same period. Similarly, liver transplantation showed a threefold rise (89%) during the same time. Unfortunately, heart and lung transplantations remain low, thus preventing statistical conclusions to be drawn. Although Greece in previous years had the lowest donor and transplantation rates per million population, its position compared with other European countries is expected to rise significantly this year. Undoubtedly, the numbers and percentages compared to previous years are due to the radical changes implemented by the HTO, by introducing transplant coordination principles and procurement management, which were concepts not previously established in Greece. However, there are still major obstacles, such as intensivists' refusal to disconnect, inaccessible geographical locations, few transplant centers, and society's suspicion of organ donation concept, that still need attention. Nevertheless, the first step has been taken and other European countries standards will hopefully be attained soon.

Liver and intestine transplantation in the United States, 1996-2005

The number of liver transplants performed yearly has slowly and steadily increased over the last 10 years, reaching 6441 procedures in 2005. The number of living donor liver transplants performed rose steadily from 1996 to 2001, when it peaked at 519; since 2003 there have been approximately 320 such procedures performed each year. The continual increase in the size of the waiting list for a liver transplant, which peaked in 2001 at 14 897 patients, was interrupted in 2002 by the implementation of the allocation system based on the model for end-stage liver disease and pediatric end-stage liver disease (MELD/PELD). Activity in all areas of intestinal transplantation continues to increase. One-year patient and graft survival following intestine-alone transplantation now seem to be superior to outcomes following liver-intestine transplantation. Other topics covered here include the recent 'Share 15' component of the MELD allocation system; liver transplantation following donation after cardiac death; simultaneous liver-kidney transplantation and waiting list and post-transplant outcomes for both liver and intestine transplantation, broken out by a variety of clinical and demographic factors.

A recipient risk score for deceased donor renal allocation

BACKGROUND

The current shortage of deceased donor kidneys makes it difficult to design a kidney allocation scheme that balances optimal utility with supply. The aim of this study is to derive a recipient risk score (RRS) that could be used with the deceased donor score (DDS) to maximize the total number of years of renal allograft function as a means to improve allocation.

METHODS

We retrospectively reviewed 47,535 adult recipients of deceased donor renal transplants between 1995 and 2002 from the United Network for Organ Sharing Standard Transplant Analysis and Research Files. Multivariable Cox regression models were used to derive an RRS and estimate recipient and graft survival as a function of RRS. Annual rates of organ supply and recipient demand for deceased donor kidneys were estimated from expectancy data and expressed in renal years (years provided by a functioning kidney allograft). Renal-year analyses were used to optimize allocation.

RESULTS

The strongest predictors of recipient survival after transplantation used in the RRS were recipient age, history of diabetes mellitus, history of angina, and time on dialysis therapy. When used with DDS, RRS provided a utility-based allocation system for deceased donor kidneys that theoretically increased the annual (2002) rate of supply by 15%.

CONCLUSION

The RRS is a practical system that, when combined with a method to assess donor organs, such as DDS, may improve deceased donor renal allocation.

Living donor renal transplantation: recent developments and perspectives

Renal transplantation is the optimal treatment for patients of all ages with end-stage renal disease. Life expectancy of the population in general is increasing consistently, as is the age of the dialysis population. Consequently, the average ages of kidney donors and recipients are rising. The combination of a growing number of patients with end-stage renal disease and a shortage of organs poses a significant challenge to the transplant community. Donor shortage is associated with unfavorable consequences (e.g. prolonged waiting time, and compromised graft and patient survival). As such, multidirectional efforts are required to expand the donor pool. Increasing the frequency of living donation seems to be an efficient solution. Living donation is associated with superior results for the recipient, and relatively benign long-term outcomes for donors. Reluctance to use organs from living donors whose eligibility was previously considered marginal (e.g. elderly donors) is declining. Although increased donor age is associated with reduced graft survival rates, this should not preclude use of older living donors; transplantation is definitely superior to remaining on dialysis. Thorough, standardized evaluation and careful screening for premorbid conditions in both elderly donors and elderly recipients are essential. Here, we present various options for expanding the living donor pool, with emphasis on the utilization of elderly living donors and transplantation in elderly recipients.

Organ donation in Poland 2006

Organ transplantation program has been slowly developing over last 30 years. The number of DD (deceased donors) stabilized on the level of approximately 13/million of population. Multiorgan donation has been 45%, due to some problems with donor management. Polish Transplant Coordinating Center POLTRANSPLANT which is responsible for organization of procurement, organ allocation and providing several registries (registry of objections, registry of transplantation, waiting lists of potential organ recipients etc). National data on organ donation and transplantation are each year submitted to the Ministry of Health and the National Transplantation Council which is the Advisory Committee to the Minister.

Organ Donation in the Basque Country: 18 Years Experience

PURPOSE

We reviewed of the trends in organ donation within a coordinated transplant program over the last 18 years.

METHODS

Two thousand three hundred and fifty five potential donors (PD) were evaluated in 18 years including 1282 who were effective donors (EDs) and the 4081 harvested organs. A retrospective analysis of various parameters was performed comparing four different periods: 1981 to 1986 (P0); 1987 to 1992 (P1); 1993 to 1998 (P2); and 1999 to 2004 (P3).

RESULTS

The potential donor detection rate (PD/PMP) increased from 18 in P0 to 47 in P3. The ED rate (ED/PMP) was 10 in P0 and 47 in P3. Organs donated ED evolved from 2.8 in P1 to 3.3 in P3. Mean donor age increased: 32 years in P1 and 53 in P3. ED/PD rate did not vary significantly in the three periods: P1, 54%; P2, 53%; and P3, 55%. There was a change in the main causes of death among our EDs: 54% head trauma, 36% stroke, and 16% other causes in P1 versus 30% head trauma and 64% stroke in P3. Failed donations due to medical contraindications were in P1 17% and in P3; whereas failed donation due to donor management problems and family denials to donation, both dropped: P1 16%; P3 10% and P1 13%; P3 7%, respectively.

CONCLUSIONS

The ED rate increased almost fivefold since 1981 to 1986. We think that this was the result of a better detection since the beginning of our program. Failed donation due to medical exclusion criteria along with the mean donor age of our donors increased, but we noticed a significant drop in family denials and exclusions secondary to donor management problems. Our donor profile has changed considerably during 18 years: an increase of more than 20 years in the mean donor age along with an increase of more than 28% among strokes as the cause of death, leading to more failed donations secondary to medical exclusion criteria.

Donation and transplantation in Latvia--2006

The 75 kidney transplant operations (32.6 per million population per year) and 2 heart transplant operations were performed in 2006 in Latvia. This represents a slight decrease of 3% compared to 2005. 86 kidneys were procured from 43 deceased donors. There were 46% donors with brain death and 54% non-heart-beating donors among them. During last decade the donor rate increased from 10.9 per million population in 1996 to 18.7 per million population in 2006. In our center patient survival was 93.2% at 1 year and 87.4% at 5 years, and graft survival was 84.5% at 1 year and 72.3% at 5 years. Such transplantation activity ensures mean waiting time of 6-7 months for patients accepted for kidney transplantation.

Ethical issues in critical care and cardiac arrest: clinical research, brain death, and organ donation

Cardiac arrest results in global hypoxic-ischemic brain injury from which there is a range of possible neurological outcomes. In most cases, patients may require a surrogate to make decisions regarding end-of-life care, including the withdrawal of life-sustaining therapies. This article reviews ethical considerations that arise in the clinical care of patients following cardiac arrest, including decisions to continue or withdraw life-sustaining therapies; brain death determination; and organ donation in the context of brain death and cardiac death (so-called non-heart-beating donation). This article also discusses ethical concerns pertaining to the design and conduct of resuscitation research that is necessary for the development of effective therapies to prevent anoxic brain injury or promote neurological recovery.

Changing Donation Pattern in Central Sweden

Since 1990, the Organisation for Organ donation in Central Sweden has registered the numbers of donations at the various hospitals in the area. During this period, a significant decrease in donation rate was observed in the large hospitals, while there was an increase in donation rate in the smaller hospitals. Taken together, the small hospitals are now at least as important as the large hospitals. Possible reasons for the observed change in donation pattern are discussed.

Cadaveric tissue retrieval service for research: one-year review and options for the future

The Tissue Acquisition Unit at Peterborough has an established service for collecting cadaveric human tissue for research. A one-year, on-going, in-house review was undertaken to evaluate the cost- and time-effectiveness of the service. The review identified referrals that failed to result in post mortem tissue retrieval. Only 28.6% of potential donors referred to the Unit led to successful tissue retrieval and the main reason for failure was post mortem time delay in some cases related to distance of location of the body from the Unit. The evolving novel role of the Pathology Liaison Nurses in the Unit is expected to increase the proportion of tissue acquisition from the local population and provide a more efficient service for donors and their families and researchers who use human tissue.

The future of organ replacement: needs, potential applications, and obstacles to application

The supply of organs available for transplantation is already far smaller than the demand, and the demand may grow substantially in the near future. For this reason, it is timely to consider how organ function might be replaced in the future. In this article, we consider new technologies that might be used to replace organ function, the obstacles to applying new technologies, and how those obstacles might be overcome in the development of new strategies for organ replacement.

What is the system failure?

As a result of the increasing use of live organ donors, international conferences have been held in Amsterdam and Vancouver to address the transplant community's concern for the well-being of such donors. Congress has considered arguments to permit a regulated market of organ sales but has rejected such a proposal, in part because of a fundamental ethical principle: selling one's kidney or any other part of one's body violates the dignity of the human person. The "system failure" is not only at the doorstep of organ donation. The expansion of the waiting list for kidney transplants is heavily composed of the elderly who could have benefited by preventive medical care.

New directions in cardiac transplantation

More than three decades of clinical experience in cardiac transplantation resulted in the spread of the procedure worldwide with a wealth of knowledge and advancements. Developments included liberalization of recipient and donor selection criteria, improved surgical techniques, novel immunosuppressive drugs and protocols, new rejection surveillance techniques, and better understanding of the pathophysiology of cardiac allograft vasculopathy to direct interventions for prevention and treatment.

Organ donation and utilization, 1995-2004: entering the collaborative era

Continued progress in organ donation will help enable transplantation to alleviate the increasing incidence of end-stage organ disease. This article discusses the implementation and effect of the federally initiated Organ Donation Breakthrough Collaborative; it then reviews organ donation data, living and deceased, from 1995 to 2004. It is the first annual report of the Scientific Registry of Transplant Recipients to include national data following initiation of the collaborative in 2003. Prior to that, annual growth in deceased donation was 2%-4%; in 2004, after initiation of the collaborative, deceased donation increased 11%. Identification and dissemination of best practices for organ donation have emphasized new strategies for improved consent, including revised approaches to minority participation, timing of requests and team design. The number of organs recovered from donation after cardiac death (DCD) grew from 64 in 1995 to 391 in 2004. While efforts are ongoing to develop methodologies for identifying expanded criteria donors (ECD) for organs other than kidney, it is clear DCD and ECD raise questions regarding cost and recovery. The number of living donor organs increased from 3493 in 1995 to 7002 in 2004; data show trends toward more living unrelated donors and those providing non-directed donations.

Waiting for a thoracic transplant in Eurotransplant*

The prospects of patients on the thoracic waiting list are governed by the chance of receiving an organ in time and by the outcome of the transplantation. The former probability is determined by a triad of disease severity, resource size and allocation rules. The aim of this study was to provide an objective description of the distributional effects of the thoracic allocation system in Eurotransplant. It appears that the interpretation of waiting-list outflow indicators is not straightforward and that it is difficult to assess the fairness of an organ allocation system in the framework of changing donor-organ availability. The timing of listing for heart transplantation can substantially be improved; whether this is also true for lung transplantation cannot be determined from the available data. Allocation schemes cannot solve the problem of organ shortage; a shift of attention toward collaboration with procurement professionals is needed.

Organ exchange in Europe--barriers and perspectives for the future

The situation of organ donation and transplantation is very different among European states. No common roules about criteria for organ donation exist. The only common problem is organ shortage. As there are specific candidates for organ transplantation due to urgency and/or anatomical specifities a transeuropean network for organ exchange should be established, tor help patients on waiting list and improve international cooperation.

National and regional analysis of exceptions to the Pediatric End-Stage Liver Disease scoring system (2003-2004)

Since February 2002, the Pediatric End Stage Liver Disease (PELD) scoring system has been utilized as a means of prioritizing children for liver transplantation. The United Network for Organ Sharing database was queried to assess utilization of PELD in 2003 and 2004; 682 liver transplants were performed in pediatric recipients where the PELD score was potentially the primary determinant of liver allocation. In the majority of circumstances (53%) the actual calculated PELD score was not utilized to determine liver allocation. An exception to the PELD score was utilized in 24% of cases. An additional 29% of the children were listed as urgent (status 1) without having acute liver failure. There was considerable regional variability in the inability to utilize actual PELD scores for liver allocation to children. PELD utilization was higher in regions of the country where pediatric donor organs were more available, presumably because children have some priority for organs from pediatric donors. There were 87 deaths in children awaiting liver transplantation. The mean PELD score in children without acute liver failure or metabolic liver disease (n = 33) near the time of death was 24.2, which has a purported 3-month risk of mortality of less than 10%. In our opinion the assigned 3-month risk of mortality associated with PELD scores is understated. Three-month mortality risk is used to inter-convert the adult and pediatric scoring systems. Therefore exceptions to the scoring system are required when children compete with adults for donor organs. In conclusion, urgent reassessment of the PELD scoring system is needed to avoid morbidity and mortality in children.

Thirty year trend in kidney transplants: UCLA and UNOS Renal Transplant Registry

After the analysis of the UNOS Renal Transplant Registry database, with more than 138,000 cases, we showed that: 1. The important improvement seen in the last 20 years is basically only in the short-term graft survivals, with the best advances in the first 6 months after transplant. Unfortunately, the graft loss rate after the first year post-transplant remains the same as observed 10 years ago. The development of new immunosuppression has not been sufficient in avoiding chronic graft rejection. 2. Ten year graft survival has remained essentially the same in the period after 1996 as the reference period of 1987 to 1995. The year at which the transplant had been performed had absolutely no effect in the past 5. As to trends, there was an important shift to older recipients and older donors which has been notable in the 30 years. Living unrelated and spouse donors have increased 10 years on the long-term survival of HLA identical sibling donor, parental and cadaver donor grafts. 3. The factors which had a small effect before, and continued to have a similar small effect were: regrafts, high PRA, and sex of recipient. 4. The factors which had a large effect before and continued to influence long-term survival were: living versus cadaver donor, age of the recipient, age of the donor, original disease of the recipient, race of the recipient, immediate kidney function and delayed graft function. HLA matching had approximately a 15% difference in best and worst mismatches in the earlier and 10% in the later periods. 6. Cold ischemia time has relatively little effect on graft survival or percent of nonfunctional kidneys in all groups.

A new Dutch Law regulating provision of identifying information of donors to offspring: background, content and impact

In 2004 a law was introduced in The Netherlands, which gives offspring conceived by semen or oocyte donation the right to know the identity of the donor. The law also regulates the provision of other information concerning the donor to the offspring, their parents or their general practitioner. With the introduction of this law, a choice has been made in which the wish of offspring prevails above others involved. Donors can no longer claim absolute anonymity; they are anonymous at the time of donation, but if a child aged > or =16 years requests information the donor may now be traced. During 15 years of debate on the abolition of donor anonymity the number of donors decreased by >70% and the number of semen banks by 50%. We describe the debate which led to the law, the characteristics of the law itself and note some of the probable and possible consequences for donor offspring, parents, donors and semen banks.

Selected activities in Scandiatransplant

Scandiatransplant is the Nordic organ exchange organization. It has existed for 35 years and it is owned by all organ transplantation hospital departments in the five Nordic countries--Denmark, Finland, Iceland, Norway, and Sweden. The use of living organ donors for kidney transplantation has become a more common procedure not only in Norway but also in Sweden and Denmark. For the first time, in 2003, one transplant center performed relatively more living donor kidney transplantations than with deceased donors. The overall organ transplant activity reveals a remarkably stable situation in the area covered by Scandiatransplant. Scandiatransplant as an organ exchange organization has changed from a solely kidney exchange organization to an organization in which the more immediate vital organs as liver and heart are exchanged more commonly than kidneys.

Adult live donor liver transplantation

The increasing awareness of liver diseases and their early detection have led to an increase in the number of transplant waiting list candidates over the past decade. This need has not been matched by the actual number of orthotopic liver transplantations performed. Live donor liver transplantation (LDLT) is an innovative surgical technique intended to expand the available organ donor pool. Although LDLT offers definite advantages to the recipient, it offers none to the donor except for the possibility of psychological well-being. Clinical research studies aimed at the prospective collection of data for donors and recipients need to be conducted.

[Some problems on the organ transplantation in Japan from the viewpoint of the neurocritical care units]

The authors have referred to several issues encountered in the neuroemergency and critical care facilities in our country through the declaration of brain death to the successful removal of organs for donation. One of the most important is the fact that the legal validity of death in brain dead patients is only assured when the patient shows the advance directive for organ donation in Japan. So far as the selection of the recipient is not started until the brain death is declared legally, longer than 12 hours are to be spent in vain between the declaration of brain death and the beginning of the operation of removing the organs for donation. As there remain such several problems to be solved as mentioned above for organ donation in Japan, so it is suggested that the medical sciences and ethics should be respected and adopted in the rules for the organ donations by the national government.

Evaluation of Organ Procurement in an Area Under the Influence of a Training Program

INTRODUCTION

The procurement of organs was evaluated in an area of 1,450,000 inhabitants. This area provides two international programs and two training courses for transplant coordinators. One of them deals with the entire process of donation and transplantation, and the other is a monographic course about family consent and donation request. One transplantation coordinator manages the area.

METHODS

The results of the last 6 years have been analyzed concerning the procurement of organ donors (related to brain death [BD] donors, exitus at the hospital, and the intensive care unit [ICU]); loss in the process, such as medically unsuitable; problem detection; and family refusals.

RESULTS

During the past 6 years the donor potential increased from 1.67% to 4.06%. The BD by exitus in the ICU increased from 7% to 14.01% (the average in Spain 12.2%); the cases of BD in ICU beds increased from 0.5% to 1.31% (average in Spain 0.8%). The loss for medical exclusion criteria decreased from 27% to 20% and in family refusals from 19.7% to 13.6%. The efficiency of the process in percentage of actual donations by BD increased from 52.4% to 65.3% (average in Spain 49%). The actual donors per million population (PMP) increased from 37 PMP to 59 PMP. The average number of organs obtained from donors increased from 3.1 to 3.6, and the transplants increased from 2.7 to 3.04 per donor. The average waiting period for a renal transplant was reduced from 365 days to 199 days.

CONCLUSION

The training of coordinators and the net system of regional coordinator, area coordinator, and hospital coordinator improved our donation rate.

Results of a Multilateral Approach to Donation–Transplantation Process in Hungary in the Past 2 Years

Hungarotransplant Public Service Corporation, the national organ exchange organization, was established in 2001. The assessment of donation- and transplantation-related data allows the evaluation of the current situation and future trends. The donor reports show involvement of new hospitals and an increase in reported donors. These results are due to a new centralized organ referral system implemented by Hungarotransplant, employment of donation links in donor hospitals, training for key persons in intensive care units, and implementation of a Donor Action program, generating frequent and positive media attention. In 2002 the number of realized cadaveric donors increased by 21% and remained stable in 2003 despite the further increase in referrals. In 2002 the number of heart transplants remained the same, and liver transplant activity declined. In contrast, in 2003 the heart transplant activity rose by 33% and liver transplant activity by 82%. The multiorgan donation rate and the total number of transplanted organs have increased continuously. Our data demonstrate that organized multilateral efforts resulted in an immediate improvement in donation-transplantation activity in Hungary. However, the role of factors other than the shortage of organs, such as capacity problems and limited financial resources, are also highlighted.

Changing attitude to organ donation and transplantation in university students during the years of medical school in Italy

The shortage of organ donations is a major limiting factor in transplant programs. Since a favorable attitude of health professionals to organ donation can positively influence the decision of families of potential donors, educating physicians early in their careers may become crucial in this setting. The aim of this study was to compare medical student opinions on organ donation and transplantation at different stages in their undergraduate career.

METHODS

Medical students were prospectively surveyed in their first and fourth years by an anonymous 10-item questionnaire.

RESULTS

The 100 of 195 (51.3%) students completed both questionnaires including 29 men, of an overall cohort mean age 23.7 (range, 22-32 years). 91% of the students had attended classical or scientific high school and 83% were Catholic. Their attitude to transplantation remained strongly positive (96% vs 92%, fourth vs first year). 96% of the fourth year students would accept an human donor organ or an artificial organ (vs 95% of first year) and 91% would accept an animal organ (vs 84%). The students showed a positive attitude to organ donation (96% vs 91%, fourth vs first year). Most of them were prepared to donate their organs after death (88% vs 87%). 63% of the fourth year students signed a donor card. In conclusion, medical student attitudes to organ donation and transplantation are highly positive, but do not improve during the first 3 years of Medical School. An educational program is therefore needed.

A review of family donor constructs: current research and future directions

This review addresses research on gamete donors, recipients, and offspring and demonstrates that the foci on all three within the triad are largely directed at disclosure or anonymity; and each in turn centers on the perceived importance of the genetic link. The importance attached to genetics has led some countries to review the ethics of anonymous gamete donation (e.g. New Zealand's 'open system' of information sharing) and has led other countries (Sweden, Austria, Victoria, Australia; the Netherlands, the UK) to change their laws allowing donor gamete offspring the right to obtain identifying information about their genetic parent. This review demonstrates that genealogical inconsistencies between and within members of the triad are common regardless of legislation. A discussion of future trends and concerns, relating to the use of gamete donation and the effects legislation is likely to have on the donor triads in the UK following 2005, is provided. The review also addresses the importance of testing theoretical models within future research, and argues this would lead to a better understanding of the underlying problems encountered at a psychosocial level, such as continued preference for anonymity in donors and denial in large numbers of users of the involvement of a donor in conception. Lack of disclosure effectively prevents true implementation of legislation; if a child is not informed, it is the result of donated gametes, it cannot take up the legally available option of finding out identifiable information about their genetic parent(s).

A 10-year Analysis of Organ Donation after Cardiac Death in the United States

BACKGROUND

The greatest challenge facing transplantation today is how to increase the number of organ donors. Patients with severe brain injury who are not brain-dead can donate organs after they are removed from a ventilator and allowed to die, termed donation after cardiac death (DCD).

METHODS

We analyzed the database of all organs recovered from deceased donors in the United States from 1994 through 2003 to determine DCD trends in the United States. The database was obtained from the United Network for Organ Sharing (UNOS).

RESULTS

There were 57,681 deceased donors reported from 1994 through 2003. Of these, 1,177 were donors without a heartbeat (DWHB), 55,206 were brain dead donors, and 1,298 were unspecified donors. At least one organ was transplanted from 1010 of the 1177 DWHB. Organ procurement organizations (OPOs) reported 0-212 DWHB accounting for up to 12.3 percent of deceased donors. There was a steady annual increase in the number of DWHB, but in 2003 there were still 19 of 59 OPOs that recovered no DWHB. A total of 2,231 organs were transplanted from the 1,177 DWHB donors, and another 665 organs were recovered for transplantation but not transplanted. The transplanted organs included 1,779 kidneys, 395 livers, 54 pancreata, 2 lungs, and 1 heart. Organs from DWHB can be successfully transplanted.

CONCLUSIONS

Wider use of DWHB has the potential to greatly increase the number of organ transplants performed each year in the United States.

[Practical aspects and current perspectives of liver transplantation for the general practitioner]

Orthotopic liver transplantation (OLT) has become the method of choice for many forms of endstage liver disease and is generally associated with a good long-term outcome. Morbidity and mortality for this routine procedure have become acceptable provided the procedure is carried out with a correct and timely indication. It is important for the general practitioner to recognize the various early clinical signs of liver failure and portal hypertension in due course in order to reach a comprehensive planning of all necessary medical steps ahead. The most frequent indications for OLT such as chronic hepatitis C related cirrhosis, cholostatic forms of liver disease, limited liver tumours and metabolic disorders (haemochromatosis) are discussed in detail and major practical problems that a general practitioner might encounter in the follow-up of patients with OLT are highlighted in this review.

The impact of changes in practice in organ procurement on the satisfaction of donor relatives

In the past decade several interventions have been undertaken to close the gap between demand and supply of donor organs. Family refusal is an important factor contributing to the shortage of donor organs. The importance of the quality of communication between staff and relatives has been underestimated. It is in the frontline of practice where decisions are made and behaviour of staff is critical. The current study, undertaken to explore if any changes had occurred in the behaviour of professionals involved in organ donation, took satisfaction ratings of relatives of donors in 1995, 1998 and 2001 as outcome measures. Our results show that relatives in 2001 are significantly more satisfied than those in 1995 and 1998 about staff behaviour. Changes all relate to specific interactions between key professionals and relatives. Results indicate that future interventions may be more effective if macro-oriented and regulatory policies are combined with competence-based educational programmes.

Nierentransplantation

Die Nierentransplantation wurde in den 50er Jahren des letzten Jahrhunderts in die klinische Medizin eingeführt. Sie hat sich als Nierenersatzverfahren der Wahl etabliert. Der vorliegende Artikel gibt eine Übersicht über Indikationen, Resultate, notwendige Abklärungen, Ablauf und mögliche Komplikationen einer Nierentransplantation. Ein besonderes Augenmerk wird auf die Möglichkeit der Lebendnierenspende und die sorgfältige Nachbetreuung und Beratung von Lebendspendern durch das Schweizer Lebendspender-Gesundheits-Register (SOL-DHR = Swiss Organ Living Donor Health Registry) gerichtet.

Organspende in der Schweiz

Seit 1985 koordiniert Swisstransplant die Allokation für die Organtransplantation in der Schweiz. In diesen 20 Jahren hat die Anzahl der Leichenspender tendenziell ab- und die der Lebendspender zugenommen. Gleichzeitig hat die Anzahl Patienten auf Wartelisten für eine Organtransplantation zugenommen, aktuell sind es über 1000. 412 Personen wurden 2004 transplantiert, 43 (= 4%) sind auf der Warteliste verstorben. Im Vergleich zum übrigen Europa ist die Spendefrequenz für die Leichenspende in der Schweiz mit 13 Organspendern/ Mio Einwohner relativ niedrig. Um die hohe Anzahl Patienten auf Wartelisten mit einer Organtransplantation behandeln zu können, müssen in Zukunft zusätzliche Anstrengungen unternommen werden. Diese betreffen die Entwicklung von alternativen Therapien zur Verhinderung oder Behandlung von Organversagen, die Verbesserung der Rahmenbedingungen für die Transplantation durch das neue Transplantationsgesetz, vermehrte Ressourcen und Kenntnisse zur Spenderevaluation und Ausweitung des Spenderpools in den Spenderkliniken, weitere Optimierung des Organallokationsprozesses, verstärkte Information und Motivation der Bevölkerung durch die Patientenorganisationen, die Ärzteschaft, Swisstransplant und allenfalls öffentliche Mittel.