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Where you die can affect your chance of becoming an organ donor



WASHINGTON (AP) – If Roland Henry had died in another part of the country, his organs could have been recovered. And life could have been saved.

But the local organ collection agency said no. It gave no reason, no explanation to his family, even though the man in Connecticut seemed to be a well-qualified donor despite a successful age: He died in a hospital, on a ventilator, previously healthy until a car accident that led to a stroke. [19659002] "It was devastating to hear that there was nothing they considered worthy of donation. Nada. Not a kidney, not a liver, not tissue, ”recalled Henry's daughter, Donna Cryer, president of the non-profit Global Liver Institute and self-recipient of a liver transplant.

Henry's case illustrates worrying uncertainty in a transplant system operated by government contractors who are under fire for letting potentially useful organs go to waste.

The Associated Press looked closely at that system and calculated that some of these agencies secure deceased donors to half of others – even when 113,000 people die on the nation's transplant waiting list, and about 20 die each day.

"What we have is broken. We know it costs people's lives, Dr. Seth Karp, Vanderbilt University's transplant manager.

According to American transplant rules, the country is divided into 58 zones, each assigned to an "organ procurement organization" responsible for donation at death. These OPOs are matchmakers with a tough job: get donation consent collect organs quickly and get them to the right transplant center before they deteriorate, even if a hospital calls with a possible donor at 3 o'clock

How good are they doing? It's almost impossible to tell. OPO's self-report to the government is a subjective measure, even they call flawed. That standard offers little way to directly compare OPOs and learn what can do better, or hold bad artists accountable for missed opportunities.

"No one comes up behind them and says, 'You could actually have recovered 20 to 30% more and you didn't,'" said Kevin Longino, a kidney transplant recipient who heads the National Kidney Foundation.

It may change. The Trump administration plans a larger review of stricter standards to make it easier to compare OPOs and drive them to improve. One measure to consider: Using federal death records to determine the entire pool of potential donors that each OPO can deduct.

A study published this summer in the American Journal of Transplantation called that strategy more fair and verifiable than today's standard. AP modeled its own analysis of OPO's results on that research and found that in 2017, even comparing regions with similar pools of acceptable donors, the differences were large. Philadelphia surpassed New York City, for example. OPO serving parts of Kentucky trailed near Missouri.

More importantly, the analysis shows that the greatest effect would be on sites with large populations of potential donors. For example, OneLegacy in Los Angeles returned 487 donors in 2017, the second after Philadelphia's Gift of Life. However, the Los Angeles OPO also had the largest number of potential donors. If OneLegacy had matched Gift of Life's higher donor count, AP calculated that it would have secured 866 donors instead.

OneLegacy CEO Tom Mone warns against measuring overestimates of potential donors, including people who are disqualified after reviewing their medical records. [19659002] It is also considered less than perfect donors – older donors or those with certain medical conditions – which can be difficult for OPOs to manage, Mone added. These organs may be life-saving for the right patient, but too often transplant centers do not take the chance, which prevents the OPO from collecting them.

Still, with the organ failure so severe that transplant centers are fighting over scarce lives in court, a growing number of OPOs say that death record-based standards will stimulate a more aggressive pursuit of donors.

"It's a denominator that can't be manipulated," said Ginny McBride, executive director of OurLegacy in east-central Florida. She was one of the 17 OPO leaders who recently wrote Medicare, which regulates nonprofits and reimburses the costs of organ acquisition, to drive the change.

"That can tell us," Hey, we have to kick a hack. "And it can tell the government who they should and should not certify" to gather bodies, she added.

WHO CAN DONATE?

Only about 2 percent of Americans die in circumstances that allow donation. Die before reaching a hospital, and organs cannot be preserved. Diseases such as cancer or infections may also preclude donation.

While young donors tend to be healthier, there is no upper age limit: Studies show healthy organs from the elderly such as Henry, who was 78, and even octogenarians can still function well, especially if given to an older recipient.

Last year, of about 2.8 million deaths, there were 10,721 dead donors, whose organs led to 29,680 transplants.

But a 2017 study led by University of Pennsylvania researchers investigated deaths, donations and health records and calculated that a better functioning system could produce up to 28,000 more donated organs per year. [19659002] Objective evaluation of OPO is a key to that goal, but even if the estimate is too high, "every single donation we recover is another life saved and worth it," Greg Segal said of the group for transplant lawyer, whose father waited five years for a heart transplant.

SPURRING CHANGE

Recent deaths in drug abuse have increased donors. Some OPOs are aggressively looking for further increases.

LifeCenter Northwest – serving the state of Washington, Alaska, Montana and northern Idaho – has doubled the number of organs transplanted from the area's donors to 878 last year, up from 440 in 2009, before CEO Kevin O & # 39; Connor arrived.

It focuses on organs that are often considered too difficult to recover – not those taken from brain dead donors, which are most common, but from people who die when the heart stops beating. O'Connor staged “mock donations” to train donor hospitals and their own employees to handle the complex cases. Nationally, they make up about 19% of donations. at LifeCenter they are 29%.

At LifeGift in Houston, where donors have been up about 40 percent since 2013, CEO Kevin Myer has hired dozens of new employees to reach faster hospitals. Increasing donation "comes down to how good your staff is and how many people you have to come to the hospitals and take care of people who lose someone," Myer said.

And in Hawaii, where lung transplants are not offered, lungs often recover, Legacy of Life tests a new incubator to preserve the organs for long-distance transport. The first pair was successfully transplanted in North Carolina more than 20 hours after donation.

HOW TO MAKE SUCCESS

Today, OPOs report to Medicare how many deaths they classify as "eligible" for donation, the baseline. It is intended to include hospital referrals for brain-dead patients 75 years and younger without disqualifying illness. Comparing the denominator to OPO's actual donor measures success.

"I am always stunned by the variation" in how many justified deaths OPOs of similar sizes report, said Diane Brockmeier, director of Mid-America Transplant Services in St. Louis. Louis, who supports the death record-based standard.

But different OPOs can define justification differently. There are inhibitory measures to pursue each body.

And sometimes there are breakdowns. Dr. Dorry Segev, a transplant surgeon at Johns Hopkins University, described "a very depressing and disappointing case" where several patients were promised that a young donor's body would only have the offers canceled a few hours later. The OPO, in another state, could not find a local surgeon to recover the organs – and did not give the recipient surgeons a chance to fly in and do it themselves.

Then there is the role of transplant centers, which are rated on how well their patients recover after surgery without taking into account how many people die on the waiting list. When local transplant centers refuse less than perfect organs, OPOs may be reluctant to collect them because they may not find a recipient anywhere else.

"The metric drives wrong behavior," said the Kidney Foundation Longino, who says transplant centers must also be held accountable. “If 60-year-olds do not get a 60-year-old kidney that is in good condition and does not get that choice, it is a problem. And they are not. "

A new study suggests that American transplant centers are too picky. Surgeons in France regularly implant lower-quality kidneys from older donors than their US counterparts, with success. Medicare recently took a small step to counteract transplant center resistance.

On the donation side, many OPOs and patient groups see value in reform that bases OPO's success on the largest pool of donors, an easy-to-track number. [19659002] But some OPO leaders are lobbying for another measure, one wired to just people on fans. Some Midwestern OPO is testing this strategy.

"We are worried about some of these broad-based, easy-to-calculate figures that don't show a picture of what a potential donation might be," said Susan Gunderson, CEO of LifeSource Upper Midwest OPO in Minneapolis.

PATIENTS LANGUAGE ON THE WITNESS LIST

More donors cannot come quickly enough to wait for patients, especially those caught in a legal battle on how to distribute scarce lives. In nine days earlier this year, a new national policy meant hospitals that once received first dibs for liver donated nearby, instead saw the organs sent to sicker patients up to 500 miles away, with pediatric donations intended for sick children. Then a federal judge put the new rules in readiness .

In Pennsylvania, toddler Evelyn Yargar got a new liver under that window, from a teenager who died several states away. A few days later, the organ may have gone to an adult instead. And because surgeons from the University of Pittsburgh knew that 14-month-old Evelyn needed just a tiny bit of the liver, which can grow into a functioning organ, an adult in yet another condition got the rest.

"I just don't understand why a child can't have a part of any donor liver," said Evelyn's mother, Bobbi Yargar of Charleroi, Pennsylvania.

But the court battle turns out, only a larger selection will facilitate the fighters if And if Medicare changes performance standards, it won't make OPO collect more organs overnight.

"I don't think there are another 30,000 organs out there that are around to be transplanted," Brockmeier warned, Yet she knows that her own OPO could be improved, and she urged others to "stop fighting about what the metric is and decide what we should do to maximize the donation."

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AP's analysis used a mortality database from the Centers for Disease Control and Prevention database to calculate deaths involving hospital admissions under 75 years from causes consistent with donation for each O PO except Puerto Rico, sharing the actual number of donors with these bills gives a comparable rate of success.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute & # 39; s Department of Science Education. AP is solely responsible for all content.


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