The Need: What’s Being Transplanted? n Organs: –in adults & children with end- stage organ failure –Heart –Heart-Lung –Lung n single or double –Liver –Kidney –Kidney-Pancreas –Pancreas only –Intestine

Organ Donor Demographics AGE NOTE: Data subject to change due to future data submission or correction.

Transplant waiting list as of February 24, 2003… 80,432 patients are currently waiting nationwide for a live- saving organ transplant. Over 2,000 patients are waiting here in Virginia. Three Virginians die each week waiting. The Problem: Nearly 2,000 Virginians are waiting for an organ transplant Every week three Virginians die waiting for an organ transplant As of October 8, 2003, 82,808 were waiting for an organ transplant in the United States.

Organ Donor Criteria n Age is generally less than 80, but is based on patient’s current medical history n Dead by Neurologic Criteria –“Brain Dead” n Medical history is examined at the time of death n Free of HIV –all serologies are examined at time of death

Death by Neurological Criteria n An individual with irreversible cessation of all functions of the entire brain, including the brainstem, is dead. JAMA 246: , 1981

Organ Donor Demographics COD NOTE: Data subject to change due to future data submission or correction.

Arrival at Hospital EMS Recognition as Potential Donor Brain Death Referral to LifeNet for Initial Evaluation Authorization Donor Management with LifeNet Organ Resuscitation (Enhance organ oxygenation & perfusion) Organ Placement Serology Lab results OR time Coordinate teams Organ Recovery in OR Transplant Organ Donor Case Overview

Tissue Donor Criteria n Donation occurs after cardiac death n Criteria: –Age < 70 –Recovered within 24 hours after death if body is cooled in the first 12 hours –No active, transmissible disease –No autoimmune disorder

The Need: What’s Being Transplanted n Heart valves n Pericardium n Skin n Bone -Whole or processed grafts n Veins n Fascia n Ligaments/Tendons

Eye Donor Criteria n Donation occurs after cardiac death n Criteria: –No upper age limit –1 year to 68 years n cornea transplant –Less than 1 year or greater than 68 years n research –History of cancer is acceptable –Other research for patients with history of glaucoma, diabetes, etc.

The Need: What’s Being Transplanted? n Eyes: –Cornea, Sclera –Whole Eyes for Research

The Donor Card n A donor card is now recognized as a legally binding document and cannot be overturned by the family. –Amendment is possible n Donation by Donor Designation…

The way to succeed: save7lives.org A new way for Virginians to record their donation decisions A Website where Virginians can learn more about organ donation and make an informed decision An on-line process that is simple and convenient

Common Concerns About Donation n Disfigurement n Funeral Arrangements n Financial Responsibility n Religious Beliefs n “I cannot be a donor because of my medical history.” n “If I want to be a donor, they won’t try and save me!”

Some Donation Controversies n Who should be transplanted? –U.S. Citizens only? –Smokers? Alcoholics? –The very young or old? –The rich or the poor? –Those in prison? –Only those who have agreed to be donors themselves?

Some Donation Controversies n How should organ donation be increased? –Financial Incentives –More Public Education? –Presumed Consent?