Empower Field at Mile High in Denver seats about 76,000 – a huge space with the population of a small city when filled to capacity.
“But even if you crammed that stadium full of people, you still would not touch the national wait list (of people waiting for donor organs),” said Jennifer Muriett, MSN, chief operating officer for Donor Alliance, during the Department of Surgery Grand Rounds Monday. The presentation was hosted by Jim Pomposelli, MD, PhD, surgical director of liver transplantation and professor of transplant surgery, and Donor Alliance is a supporter of transplant programs at the University of Colorado School of Medicine.
The presentation addressed best practices and evolving concepts in donor science, which enable more organs and tissues to be considered for donation and allow them to be maintained for longer during the time between donation and transplantation. But underlying these innovations and developments is enormous need, Muriett said.
The consistent need and the many lives that can be saved
Currently, there are 106,000 people nationally waiting for organ transplants, Muriett said, and every nine minutes someone new is added to that list. However, she added, 17 people on the waitlist die every day “and we know that if everyone who could donate did donate, we would no longer have deaths on the waitlist.”
In the Donor Alliance service area, which includes all of Colorado and most of Wyoming, there currently are about 1,600 people on the transplant waiting list.
“When you look at the need compared to what’s available, we serve 6 million people,” Muriett said. “Last year, of the 44,000 deaths that we had, if you drill that all down to unique opportunities of organ donation, 1% of deaths were eligible for donation.”
That ended up totaling 215 organ donors in 2020, she added, as well as 1,899 tissue transplants; 4% of all deaths were potential tissue donors.
“One tissue donor could actually heal up to 75 lives,” Muriett said. “In Colorado, there were 77 deaths on the waitlist in 2020, fewer than the 140 in 2016. We want entire deaths on the waitlist to be 0, and we want to make sure every donor family has the opportunity to honor a loved one through donation. We have had many donor families say that donation is the best of humanity.”
Unique challenges from COVID-19 and new developments
COVID-19 has presented unique challenges to organ and tissue donation, said Paul Lange, MD, Donor Alliance medical director.
“As we evaluate many of the patients in Colorado and Wyoming who may be candidates for organ donation, not surprisingly many of them have or had COVID-19,” Lange said, citing ongoing research by the Organ Procurement and Transplantation Network (OPTN) and Centers for Disease Control and Prevention (CDC) to provide guidance for organ procurement organizations and medical teams. “Some can progress to organ recovery and organ transplantation. At Donor Alliance we have recovered organs from four donors with COVID-19.
“This is a dynamic state where we are today and it probably doesn’t represent where we’re going to be in six months.”
He added that every patient who has had or has COVID-19 might be a potential donor, and that Donor Alliance collaborates closely with on-site medical teams to support them through the nuances of donation during a pandemic.
Lange said that the future of organ transplants will include continued advances in ex vivo organ perfusion, a process in which a machine keeps organs warm by continuously pumping blood through them – a process also called normothermic perfusion. This process can help to prevent ischemic injury, or injury caused during the time an organ spends on ice without blood flow.
He added that in the future, organ procurement organizations will become organ repair centers as advances in ex vivo perfusion allow organs that previously would not have been considered transplantable to be rehabilitated for transplant.