Disparities in Deceased Organ Donor Research Authorization: Experience at One Organ Procurement Organization and Call for National Conversations

Contribution of a Single Islet Transplant Program to Basic Researchers in North America, Europe, and Asia through Distributing Human Islets

There has been a steady expansion in islet isolation and transplantation activity worldwide. In addition to preparing human islets for transplantation, we have been providing human islets to basic researchers. The aim of this study was to review the activity of distribution of human islets to basic researchers in North America, Europe, and Asia, and to investigate if there are any differences in utilization rate of islets among three continents. We reviewed our islet isolation batch files, donor records, and documents related to shipping from 2007 to 2023. We have distributed islets to a total of 49 researchers (11 at the University of Alberta campus, 21 in North America, 7 in Europe, 10 in Asia). The yearly average [±SD] of islets distributed was 6,607,443 [±1,782,547] islet equivalents obtained from 28 [±5] pancreases, resulting in 230 [±88] shipments. Standard delivery to Europe or Asia takes at least 2 days whereas researchers in North America receive islets the next day. On top of this fact, we found that delayed delivery occurred more often in Asia (31.9%, 201/631 shipments) and Europe (30.8%, 134/435) than in North America (6.8%, 114/1682). Interestingly, the utilization rate of islets within delayed deliveries was highest in Asia (91.5%, 184/201) followed by Europe (83.6%, 112/134) and North America (77.2%, 88/114). There were disparities in the frequency of delayed deliveries and in the utilization rate among three continents. Our program with a 17-year track record has been actively distributing human islets to researchers in three continents.

The Impact of Ethnicity on Research Authorization at the Time of Organ Donation: A Single-Center Experience Among Deceased Donor Kidney Transplantation

Objective

Research on deceased organ donors is needed to expand the donor organ supply. Little is known about the rate of research authorization among various groups. We aimed to determine the percentage of research authorization by the deceased donor family across different donor characteristics.

Materials and Methods

We performed a retrospective review of deceased donors referred to one U.S. institution for kidney transplantation over a 12-month period. Organs were offered from multiple organ procurement organizations (OPO) across the United States. Stepwise logistic regression was performed to determine the predictors of research authorization.

Results

From 10/2018 to 10/2019, 437 deceased donors were accepted for transplantation. 81.5% came from OPOs outside our donor service area and 18.5% from our local OPO. Overall, research authorization was declined in 24.0% of donors. Declined authorization was highest among Black donors (42.0%) compared to Whites (16.3%) and Hispanics (26.9%); p=0.000006. Donors <35 years had highest declined research authorization at 42.9% compared to older donors. There were no significant differences between individual OPOs.

Conclusion

Deceased donor research authorization declined at the time of organ donation is higher among Black and younger donors. There is an immediate need for the transplant and donor community to develop best-practices to eliminate barriers to research in organ transplantation.

The 20-year paradigm shift toward organ recovery centers: 2500 donors at Mid-America Transplant and broader adoption across the United States

On March 1, 2001, Mid-America Transplant, the organ procurement organization (OPO) located in St Louis, Missouri, performed the first organ recovery of a brain-dead donor in a hospital-independent, free-standing, organ recovery center (ORC), with successful transplantation of a liver. This was the inception of a paradigm shift in donor management and organ procurement, moving away from the traditional method of using the donor hospital. In the last 20 years, many advances have occurred in the ORC. Brain-dead donors are moved within hours of authorization to fully equipped intensive care units. Some ORCs are equipped with computed tomography scanners, portable radiography, laboratory facilities, bronchoscopy, and a cardiac catheterization laboratory. ORCs have dedicated surgical suites, and operating time is frequently during the day and is rarely delayed. Donor management in an ORC is more consistent, efficient, and effective than that in a donor hospital, and studies have demonstrated increased organ yield. Multiple studies have demonstrated a cost benefit of an ORC as well as providing an ideal environment for donor research studies. Currently, there are 24 of 57 OPOs that are using an independent or hospital-based ORC to manage their donors. We review the history and describe the current state of ORCs.