The Donation & Transplantation Symposium

October 15, 2013

The Current State of Organ Donation and Transplantation

Thomas A. Nakagawa, M.D, FAAP, FCCMProfessor and Section Head, Pediatric Critical Care Medicine

Director, Pediatric Critical Care Medicine and Respiratory Care Wake Forest University Baptist Health, Brenner Children’s Hospital

Winston-Salem, North CarolinaAssistant Medical Director, Carolina Donor Services

Durham, North Carolina

• We have achieved and sustained a 75% conversion rate nationally

• We continue to transplant more organs annually• We continue to engage more partners to save

more lives• We have continued to increase organ recovery

from donors following circulatory determination of death

CELEBRATING OUR SUSTAINED SUCCESS

(OPTN Data, September 2013)

Conversion Rate 2009 – 2012 (Jan-Dec)

2009(Jan-Dec)

2010(Jan-Dec)

2011(Jan-Dec)

2012(Jan-Dec)

0%

10%

20%

30%

40%

50%

60%

70%

80%66% 68% 73% 71%

% C

onve

rsio

n Ra

te

Organs Transplanted Per Donor

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012414262.85

2.9

2.95

3

3.05

3.1

3.15

3.2

3.25

3.16 3.17

3.23

3.15

3.06

3.06

3.05

2.99

2.99 3.

03

3.1

3.08

3.02

3.02

Se-ries1

Adults 3.09Pediatrics 4.06All donors 3.08

-DCDD donors-

Organ Donors, Organs Transplanted & OTPD2006 vs. 2013 (Jan-Aug)

2006 (Jan-Aug)

2013(Jan-Aug)

0100200300400500600700800900

1000

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

297 287

922 9483.10 3.30

Donors Transplanted Organs OTPD

OTP

D

2013 (Jan-Aug) Donors – Decreased 3%2013 (Jan-Aug) Transplanted Organs – Increased 3%

Continued Growth of DCDD

UNOS. OPTN data. 2013, Pediatrics patients < 18 years of age

Adult DCDD donors Pediatric DCDD donors

2006 645 adult 77 pediatric 2007 793 adult 66 pediatric 2008 847 adult 73 pediatric 2009 747 adult 81 pediatric

2010 939 adult 72 pediatric2011 1053 adult 115 pediatric2012 1102 adult 124 pediatric

(OPTN Data, September 2013)

DCD Donors 2009 – 2012 (Jan-Dec)

2009(Jan-Dec)

2010(Jan-Dec)

2011(Jan-Dec)

2012(Jan-Dec)

0

50

100

150

200

250

300

350

400

450

4%

5%

6%

7%

8%

9%

10%

11%

24 25 33 39

382349

417 391

6%

7%

8%

10%

DCD Donors Total Donors % of Total

# of

DC

D D

onor

s

% o

f Tot

al

Growing National Organ Transplant Waitlist

0

20000

40000

60000

80000

100000

120000

140000

1997 1999 2001 2003 2005 2007 2009 2011

Wait list Transplants Deaths Donors

• 120,188 people are currently on the national waiting list.

• 16, 669 organ transplants have been performed from 8,215 donors* through July 2013

• 3,450 people have died waiting for a needed organ*

• 2,973 people were removed from the waiting list because they became too sick to transplant*

Current State of Organ Donation & Transplantation

www.UNOS.org. Data obtained October 14, 2013 * Data through July 2013

• 28,052 organ transplants from 14,013 donors were performed in 2012

• 16, 669 organ transplants have been performed from 8,215 donors* through July 2013

• 3,450 people died waiting for a needed organ*• 2,973 people were removed from the waiting

list because they became too sick to transplant*• 2012: 46,000+ corneas transplanted

Facts About the Current State of Organ Donation and Transplantation

www.UNOS.org. Data obtained October 14, 2013 * Data through July 2013

A National Issue That Continues to Escalate

October 23, 2012 Growing transplant waiting list exceeding 112,000In 2011:• 7,370 died waiting for a

needed organ*• 4,519 removed from wait list

because they became too sick to transplant

• 92 deaths were children*OPTN data accessed October 14, 2013

October 15, 2013 Growing transplant waiting list exceeding 116,000In 2012:• 7,040 died waiting for a

needed organ*• 4,794 removed from wait list

because they became too sick to transplant

• 104 deaths were children

• An average of 18 people die every day in the US waiting for a needed organ

• Although the number of people that died waiting for an organ last year was decreased, more people were removed from the waiting list because their condition deteriorated to a point where they were too sick to transplant

• In California, an average of 3 people die everyday waiting for a needed organ

Waiting for an Organ That Never Came

02004006008001000120014001600

*OPTN data. Accessed October 14, 2013 www.OPTN.org

575 deaths through June 2013

2012: 1,109 people died waiting for a needed organ transplant

California Data

The Solution:Recover more organs

for transplantation

Reducing the Number of Deaths Among Those Waiting for a Transplant• Transplant 2 more people every day

2 more organs, 1 additional donor 243 transplant programs Reduce deaths on the waitlist to 6,303 (~10% decrease)

• Continue to improve care with advancing technology for patients with end-organ failure

More time on the waiting list• Education programs to help keep people off the waitlist

• Ensure we never miss opportunities for donation

• Preserve the option of donation for every person and their family facing end-of-life issues

• EducationHealthcare professionalsPublic

• Donor registries

Recovering More Organs for Transplant

Donor Designation in the U.S.

108,963,103 as of 12/31/12

• 108,963,103 designated donors nationwide• 24 states have signed up more than 2 million

designated donors• In 31 states, donor designation share is at least

50% of the adult population• The number of donor designations

increased 7.5% over the last 12 months

Summary: Donor Designations, Q4 2012

• In the 50 states, DC and Puerto Rico, 41.1% of recovered organ donors, 46.2% of recovered tissue donors, and 50.2% of recovered eye donors were authorized by state donor registries

• Donor designation rate increased year-over-year in 16 of 28 states reporting

Donor Designation Highlights – Q4 2012

Impact on Donation, 2007-2012

Designated Donors Among Recovered Donors

• The process of donation begins when a critically ill or injured patient is identified as a potential donor with a timely referral to the organ procurement organization (OPO)

• Medical management of the potential organ donor requires knowledge of the physiologic derangements associated with this patient population

• This process of donation relies on collaboration between the critical care team and the OPO to optimize organ recovery for transplantation

Donation is a Process

Donation is more than just a question

Donation is a conversation

• Identification of the potential donor• Declaration of death in a timely manner• Consent from the family • Management of the donor• Recovery of organs and tissues

Success in Maximizing Organ Recovery

Tissue Donors2009 compared to 2013 (Jan-Aug)

2009(Jan-Aug)

2013(Jan-Aug)

1150

1200

1250

1300

1350

1400

1450

0%

1%

2%

3%

4%

5%

6%

1,360

1,426

Increased 5%

# of

Tis

sue

Dono

rs

• Be open• Listen, learn, and teach others• Be bold: Share your thoughts and experiences• Focus on what we can do, not what we can’t do• Determine what we as a community of health

care professionals can do to decrease and eventually eliminate deaths on the waiting list

Bold Request

"Sometimes our light goes out but is blown again into flame by an encounter with another human being.

Each of us owes the deepest thanks to those who have rekindled this inner light."

– Albert Schweitzer