A new advancement in organ donation enhances the quality of transplanted organs and gives family members more time to cope with the sudden terminal brain injury of a loved one before saying good-bye.
The new Extracorporeal Membrane Oxygenation treatment, developed by University surgeon Robert Bartlett, gives surgeons and family members a little more time by supplying organ tissues with oxygenated blood. Other techniques require a rapid cooling of the organs to lessen the damaging effects of oxygen depravation.
“In hypothermic situations there is more of a rush, and the family isn”t taken into account. Time is not flexible,” Gravel said. “Using ECMO, the families are very much involved with the whole process the removal, the declaration and post-ECMO. There is no rush or pressure put on them.”
The new treatment also broadens the pool of possible non-heart beating donors to people suffering from severe brain injuries.
“There is a very small subset of people who are almost brain-dead, but don”t meet the legal and medical definition, though they surely won”t survive without life support,” said University Hospitals trauma surgeon Glen Franklin. “These are the people who are going to die when the family stops support. Families see the opportunity to donate as a way to provide closure and add meaning to their loss.”
Typically in non-heart beating donations, a person must be declared either brain-dead or dead by cardiopulmonary means before the patient becomes a candidate.
In the case of severely brain injured patients, the brain still shows some activity in a minority of neurons.
“The people receive some sort of catastrophic, irreversible injury to the brain, but still have a few functioning cells in the brainstem,” said Mark Gravel, director of University Organ Donor Services. “Their heart will continue to beat with support, so the family and acting physician must decide to withdraw treatment.
“It is not the transplant team that declares them legally dead,” he added.
To avoid ethical conflicts, transplant surgeons do not interact with donors” families. Advice on the decision comes from the patient”s general physician.
“I function as the go-between and have no knowledge of who may be waiting for those organs,” Franklin said.
If the family makes the decision to donate organs, the Gift of Life Program guides them through the procedure.
Richard Pietroski, chief operating officer of the Gift of Life, said the new procedure offers a highly effective alternative form of donation.
“Most families don”t get to experience the involvement of organ donation. But, to those families who are given the option to this form, they now have a feeling of something positive,” Pietroski said.
Like other non-heart beating donations, surgeons must wait until the patient is declared dead, which can potentially cause damage to the organs.
“Sixty minutes is the upper criteria,” said Gravel. “Once the person is removed from the ventilator, if they do not reach cardiopulmonary death within that time, we don”t go forward.”
“In most places, they don”t wait really long because of the amount of damage to the organ in that time period. The donation is sort of pointless,” he added.
Though University hospital has only performed a few of these transplants, doctors agree that families have been more receptive.
“Consent rates have been higher for this than for normal donation,” Gravel said. “People want something good to come out of a bad situation.”
Franklin agreed that consent rates were higher and felt the increase will continue.
“Most people are very open to discussing the concept if their loved one is in that category. More myths about donation need to be dispelled, and I think donation will continue to grow,” he said.
The treatment also gives hope to the approximately 2,500 Michigan residents waiting for organs.
“These families are so grateful. Their loved ones were so severely brain injured and desperately wanted to donate, but there was no option for them,” Pietroski said. “It gives them the option, and gives the people who need organs the gift that they need.”