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Organ Donation
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Transplantation
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Minorities
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Texas'
largest organ donation center, Southwest Transplant Alliance (STA) plays
a pivotal role in the recovery of donated organs and tissues for transplant.
STA is part of a network of agencies nationwide, each responsible for
coordinating the recovery and distribution of organs and tissue in its
federally-designated service area.
Since 1974, STA has been the link between donors and those awaiting transplants
in about half
of the state of Texas. STA's key role involves helping families through
the loss of a loved one, offering the family the option of donation, and
then recovering and distributing the donated organs and tissue for transplant.
Southwest Transplant Alliance is a non-profit corporation, affiliated
with eleven medical centers that perform organ transplants.
STA recovery coordinators work as a team with the staffs of about 170
hospitals in 90 Texas counties, to assist in developing policies and procedures
for donation and to sensitively offer the option of donation to families.
STA is a member of the United
Network for Organ Sharing (UNOS), a non-profit Richmond, VA organization
that maintains the national computerized registry of patients awaiting
transplants.
When organs are donated in STA's service area, STA first attempts to match
them with a local recipient. If no appropriate recipient is found locally,
the organs are then offered to recipients throughout the country through
UNOS. STA serves Abilene, Beaumont, Bryan/College Station, Corpus Christi,
Dallas, El Paso, Galveston, Longview, Midland/Odessa, Sherman/Denison,
Temple, Texarkana, Tyler, Victoria, and Wichita Falls, with a service
population of 7.3 million, and has worked diligently to provide the most
comprehensive organ procurement services available, with consent and recovery
rates consistently among the top in the nation. The organization's advisory
board includes transplant recipients, donor family members, and physicians
and administrators from its affiliated transplant centers and donor hospitals.
Southwest Transplant Alliance also maintains a donor family advisory council
that assists the organization in meeting the unique needs of donor families.
Fact Sheet
Southwest Transplant Alliance collaborates with other organ donation agencies
across the country, local hospitals, medical professionals, other agencies
(such as medical examiners and law enforcement) and the public to make
organs available to patients for transplant. Southwest Transplant Alliance
medical professionals are on call 24 hours a day. Headquartered in Dallas,
Texas, Southwest Transplant Alliance is an independent, non-profit community
service organization. Southwest Transplant Alliance operates under the
authority of the Social Security Act and in accordance with the National
Organ Transplant Act passed by Congress in 1984. Southwest Transplant
Alliance undergoes federal re-certification every two years and is audited
by Medicare each year.
Established
1974
Number Benefitting
One donor can potentially benefit 50 or more people. Organs placed by
STA have resulted in: More than 20,000 life-saving transplants.
The
Donor Process
Education (both public and professional) -- There are 59 organ donation
agencies (Southwest Transplant Alliance is the local agency that covers
about 1/2 of Texas - including Dallas and most of North Texas, Galveston,
Beaumont/Pt. Arthur, Midland/Odessa, Temple, Tyler and most of East Texas,
Corpus Christi, Victoria, El Paso, Bryan/College Station, Abilene and
Wichita Falls). Each agency is responsible for educating both its communities
and its medical professionals about donation.
Community education is done through events (we work with the Rangers,
the Mavericks, Crosby/Stills/Nash, schools, religious communities, corporations,
community groups...), health fairs, speaking opportunities, public service
advertising, media stories, etc.
But the audience is huge (everyone could be a potential donor), and most
people will never actually get the opportunity to donate (a potential
donor has to die in a unique way), so we never know who specifically to
educate, so we have to try to educate everyone.
In reality, however, donation actually takes place (or doesn't take place)
in the hospital, so we also put a LOT of energy and resources into professional
education. Our professional education representatives each have a list
of "client" hospitals that they visit routinely. We do in-services
for nurses and physicians, and visit the ER, the OR, and the ICU units,
as well as anyone else we can get to. We also visit with hospital administrators,
to help them develop policies and procedures related to declaring brain
death, and proceeding with the organ donation process.
Key Message
When we're educating professionals in the hospitals the key message is
to call us whenever someone in the hospital dies (this is called making
a referral). It's now a federal regulation that hospitals do this, because
research showed that too many potential donors were not being referred
by hospitals to their donation agencies, and many potential donor families
were never being asked about donation. Now hospitals are required to call
their local donation agency every time a patient dies in their hospital.
Identification/Referral
In the past, hospitals were required to "identify" potential
donors (people who died of brain death, and were on a ventilator) and
then refer them to their designated organ donation agency. But that meant
hospitals had to know all of the details about what was acceptable and
what wasn't, and those requirements change over time as the waiting
list gets longer (for instance, acceptable ages went up and finally
disappeared), and as transplant success rates increase. So, with the requirements
changing, and with donation not being the primary job of a hospital, many
potential donors were going unidentified and unreferred, which meant that
many families of potential donors didn't know they had the option of donation.
And many potential organs never were transplanted. The system definitely
was not working.
Now, hospitals are not required to identify donors, but just refer every
death. The burden of identifying potential donors has been shifted to
where it should be, the donation agencies.
When we get a referral now, we ask if the patient is ventilated. This
way, we can see if a patient is a potential organ donor (not ventilated
is still a potential tissue donor, but that's a whole other process, since
the family can more readily deal with the death when the patient is not
ventilated).
If the patient is ventilated, we dispatch a clinical specialist and a
family specialist ASAP. The clinical specialist goes through the patient's
chart to see if he can be a donor. If so, the family specialist visits
with the family, to help them through the loss and to approach about donation.
When our staff is allowed to be involved with the approach, consent rates
increase dramatically. One of our key goals then, is to make sure the
hospitals are calling us early (before the family discusses disconnecting
the vent) and allowing us be there to make the approach.
Consent
When we're involved in the consent process, families consent close to
83% of the time, as opposed to 61% or less when we're not involved. This
is based on our latest available data for consent rates.
Across the country, consent rates average around 50%, but always increase
when the donation agency is involved.
When we approach a family, we don't start out talking about donation.
We first make sure they understand the diagnosis, and that there is no
hope. It's amazing how many families we talk to that truly don't know
and accept this, by the time we get there. So, we have to help them understand
this first. We also just talk with them about their loved one, and help
them get through the initial anger and denial.
Once we are confident they're ready to know about their options, we start
talking about donation. This is probably why donation agency staffers
get higher consent rates. They have time to spend with families, and this
is their job and they know the answers to the questions most families
ask, so it follows that they'd be better at it.
If a family isn't sure and has questions, we stay and answer those until
they come to a decision with which they're comfortable. If it's no, then
it's no. But if they have questions or aren't sure, we stay as long as
it takes. Even if it is a no, we still help the family with all of the
necessary arrangements. When it's yes, then we have to move on to the
medical/social history, where we ask the family members questions to determine
as best we can, the health of the potential donor.
Medical Management
Once consent forms are signed, and the medical/social history is done,
our clinical specialists take blood samples for serology tests. Those
samples are sent to our hospital labs to test for all possible diseases.
This testing takes several hours, during which our clinical specialists
are testing the function of each organ, and determining what needs to
be done to improve and maximize the function of each organ before we try
to place them with the patients who need them. It wouldn't make sense
to call a transplant surgeon with information about an organ that isn't
functioning well, because they wouldn't accept the organ. The goal of
medical management is to maximize the function of each organ (with ventilator
settings, medicines, etc.) so that as many organs as possible can be placed
and transplanted.
Organ Placement
Once we have all of the organ function information, we run the most current
waiting list for our service area, to see who matches the organs that
are available (mostly using blood group and body size). We start with
the first name on the list, and call that physician to offer the available
organ for his patient. The physician has an hour to locate the patient
and accept the organ. While this placing is going on, we're still managing
the patient on the ventilator, to make sure the organs continue to function.
This phase has to happen as quickly as possible, to make sure the patient
doesn't "crash" or cardiac arrest.
The patient is dead, but the organs are only functioning due to the machine
and medications. This is a delicate balance to maintain on a patient whose
brain is dead, because the brain usually regulates all body functions.
Now our clinical specialists are having to do this. Once the organs are
placed with candidates, the clinical specialist starts arranging transportation
for the transplant surgeons to get to wherever we are, with the donor.
This can include Lear jets and ambulances, or just getting a physician
from Plano to Dallas. The logistics are unique to each situation.
Surgical Recovery
Once the surgeons arrive, our staff sets up the hospital's OR for the
recovery. Our clinical specialist visits with the hospital OR staff, and
prepares everything. The surgeons should be able to walk right in, recover
the organs, and leave. Our staff is handling preparing and hanging and
releasing the solutions that will preserve the organs once they've been
recovered. Our staff also packages the organs for transport. Once the
surgeons leave, our staff helps the OR staff close the donor's body and
prepare the body for the wishes of the family (funeral home, cremation...).
Follow-up
Back home at STA, each case folder must be meticulously handled. All paper
work is subject to government review, to make sure the process was handled
correctly. Everything must be in place. We also send letters to thank
every nurse, physician, pilot, ambulance driver, consulting physician,
etc. who was involved with the case. Many of the recipients of these letters
frame and keep them. They acknowledge their part in helping save lives.
We send a letter to each donor family, thanking them and letting them
know a little about each of the lives their loved one saved. We also support
the donor families as much or as little as they need. And we facilitate
the exchange of communication between donor families and recipients if
both sides choose to communicate (and perhaps even meet). We also send
a transplant recipient back to each hospital after a donor case, to personally
thank the nurse and physician on the case, both on our behalf and on the
recipient's behalf.
These personal visits have become a favorite among hospital staff. Many
have never before met a recipient, and didn't know how well donation and
transplant worked. They become more convinced, and personally connected
to the result, and tend to be more committed to referring patients and
helping with cases.
For the Media :
Organ Donation Vocabulary
"Recover" is better than "Harvest"
"Ventilator" or "Mechanical Support" is better than
"Life Support" as donors are dead.
"Deceased Donor" is better than "Cadaver"
*Important -
Donors are not disconnected from "life support" because donors
are
deceased...so there's no life to support.
Organs must have an oxygen supply up until they are recovered for
transplant.
So families of organ donors do not have to disconnect the ventilator.
That
is done in the operating room just before organs are recovered.
