A Mission to Save A Mission to Save More LivesMore Lives

Where we’ve been, where we Where we’ve been, where we are, and where we need to beare, and where we need to be

Thomas A. Nakagawa, M.D, FAAP, FCCMProfessor, Anesthesiology and Pediatrics

Wake Forest University School of Medicine

Pediatric Critical Care Medicine

Wake Forest University Baptist Health, Brenner Children’s Hospital

Winston-Salem, North Carolina

Presenter has no financial disclosures

The current status of a national The current status of a national issue that continues to escalateissue that continues to escalate• The need for organs is clearly evident with

a growing transplant waiting list that has now exceeded 112,000 people

• In 2010• 7,168 people died waiting for a needed organ*• 3,643 were removed from the wait list

because they became too sick to transplant• 109 deaths were children

*OPTN data accessed May 16, 2011

The facts about donation and transplantation

*OPTN data. www.OPTN.org

WAITLIST PATIENT BY ORGAN TYPEOctober 9, 2011

*OPTN data. Accessed October 9, 2011

www.OPTN.org

Source of organs for transplantation

Region 5 data

Region 5 Jan 2010 - June 2010

Jan 2011 – June 2011

Percent Change

Total Donors 513 593 15.6%

Organs Transplanted 1710 1907 11.5%

OTPD 3.33 3.22 -3.5%

Consented Eligibles 69.2% 69.8%

Collaborative Conversion Rate

68.7% 72.1%

Region 5January -

June 2010

January - June 2011

Percent Change

Standard Criteria Donors 380 412 8.4%

SCD Organs Transplanted 1451 1535 5.8%

SCD OTPD 3.82 3.73 -2.4%

% of All Donors 74.1% 69.5%  

       

Extended Criteria Donors 90 113 8.4%

ECD Organs Transplanted 179 224 25.1%

ECD OTPD 1.99 1.98 -0.3

% of All Donors 17.5% 19.1%  

       

Donation After Cardiac Death Donors

43 68 58.1%

DCD Organs Transplanted 80 148 85%

DCD OTPD 1.86 2.18 17%

% of All Donors 8.4 11.5  

A local issue that continues to escalate

• 20,629 people are part of the national waitlist for California

• There were 3,222 transplants performed in the State of California in 2010

*OPTN data. Accessed October 9, 2011

www.OPTN.org

• State of California– 1,164 people died last year waiting for a needed

organ

*OPTN data. Accessed October 9, 2011

www.OPTN.org

DCDD donors

UNOS. OPTN data. 2011

Pediatrics patients < 18 years of age

Adult DCDD donors Pediatric DCDD donors

2006: 645 DCD donors 77 pediatric

2007: 793 DCD donors 66 pediatric

2008: 847 DCD donors 73 pediatric

2009: 747 DCD donors 81 pediatric

2010: 939 DCD donors 72 pediatric

All DCDD donors

• 939 DCDD donors in 2010 impacted 1,797 lives by providing additional organs for transplantation

• Renal and some liver grafts from DCDD donors have graft function and transplant recipient survival rates comparable with organs recovered from SCD donors

• Lungs from DCD donors are being recovered and transplanted with good success

•Many hospitals are working to establish policies and identify donors as we all work to find more organs for the growing number of people on the national transplant waiting list

Success with DCDD organs

The facts about pediatric donation

• 1,766 children are waiting for a needed organ*• Children make up 1.5% of the total national

waitlist• Approximately 150 children die annually waiting

for a needed organ and another 50-60 children are removed from the national waiting list because their condition deteriorates making them ineligible for organ transplantation

• Children less than 1 year of age have the highest death rate waiting for an organ

*OPTN data. Accessed October 9, 2011

www.OPTN.org

Pediatric patients: birth to 17 years of age

Data compiled from OPTN

Pediatric patients: birth to 18 years of age

Pediatric patients: birth to 18 years of age

Data compiled from OPTN

The Current State of Pediatric Donation

• Organs transplanted per donor•Adults 3.09•Pediatrics 4.06•All donors 3.10

• 24% of hospitals with more than 5 eligible pediatric donors had a 50% or less conversion rate

• 73% of hospitals with more than 5 eligible pediatric donors had 0 DCDD donors

PEDIATRIC* WAITLIST PATIENT BY ORGAN TYPEOctober 9, 2011

* Pediatric patients age 0-18 years of age 1,766 Children Waiting

*OPTN data. Accessed October 9, 2011

www.OPTN.org

Important options for neonatal donation

•En bloc neonatal kidney transplants

•Liver cell transfusions as a bridge to transplant for smaller infants with end-stage liver disease

•Use of ABO incompatible hearts for transplantation into infants younger than 1 year of age

•DCD heart transplantation

Our role as champions for donation and transplantation

•The difference between life and death can mean the difference in one organ from one donor

•It’s not all about the “big programs,” it’s about all programs that are designed to save lives

•The impact of many small programs that recover organs from a few donors annually has a significant impact regionally and nationally

•The importance of tissue donation must also continue to be emphasized

Our role as champions for donation and transplantation

•Everyone of us in this room is a champion

•We have the capability to save more lives

•We will save more lives through our hard work dedication to recover more organs and provide better organs for transplantation

• What roles and responsibilities do each of us play during organ donation and end-of-life care for patients and families?

• How can we maximize the opportunity to recover more organs for transplantation to reduce the number of people dying on the national wait list?

• Listen, learn, and teach others

• Be bold: Share your thoughts and experiences

• Focus on what we can do, not what we can’t do

• Remember that our focus is the patient and the family

• We are here to save lives