The shortage of organs for clinical transplantation

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The shortage of organs for clinical transplantation

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The shortage of organs for clinical transplantation

Abstract Organ shortage is the greatest challenge facing the field of organ transplantation today. A variety of approaches have been implemented to expand the organ donor pool including live donation, a national effort to expand deceased donor donation, split organ donation, paired donor exchange, national sharing models and greater utilization of expanded criteria donors.

Increased public awareness, improved efficiency of the donation process, greater expectations for transplantation, expansion of the living donor pool and the development of standardized donor management protocols have led to unprecedented rates of organ procurement and transplantation.

Although live donors and donation after brain death account for the majority of organ donors, in the recent years there has been a growing interest in donors who have severe The shortage of organs for clinical transplantation irreversible brain injuries but do not meet the criteria for brain death.

If the physician and family agree that the patient has no chance of recovery to a meaningful life, life support can be discontinued and the patient can be allowed to progress to circulatory arrest and then still donate organs donation after circulatory death.

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Increasing utilization of marginal organs has been advocated to address the organ shortage. Organ transplantation, Tissue donor, Tissue and organ procurement, Awareness, Living donors Introduction The greatest challenge facing the field of organ transplantation today is increasing the number of allografts available for transplant.

Organ transplantation has proven to be highly effective in the treatment of various forms of end-stage organ failure. As outcomes of transplantation have improved, the number of transplant candidates listed for deceased donor transplantation has increased dramatically over the years.

One of the main strategies to address the discrepancy between supply and demand in organ transplantation is expansion of the deceased donor kidney pool utilizing ECD and DCD donors [ 1 — 3 ]. This has been a major focus of the US Department of Health and Human Services organ donation breakthrough collaborative, which was initiated inwith the objective of increasing access to transplantable organs.

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In50, patients were added to transplantation wait list, while 28, patients received organ transplantation and patients died while waiting for a suitable organ [ 4 ]. A variety of approaches have been implemented to expand the organ donor pool including increased live donation, a national effort to expand deceased donor donation, split organ donation, paired donor exchange, national sharing models, and greater utilization of ECDs [ 56 ] Inmore than 28, patients received organ transplants from more than 14, deceased and live donors in the USA [ 47 — 13 ].

Despite the worthy effort of the Organ Donation and Transplant Collaborative and the marked increase in the number of deceased donors early in the effort, the number of deceased donors rose by a total of only 67 from to [ 5 ].

The shortage of organs for clinical transplantation

A recent study showed that the number of living donors has decreased since and donation after brain death DBD also decreased since The observed increase in DCD also explains, in part, the fewer organs per donor that are recovered and transplanted overall [ 61516 ].

If the physician and family agree that the patient has no chance of recovery to a meaningful life, life support can be discontinued and the patient can be allowed to progress to circulatory arrest and then still donate organs DCD. In the past 10 years, the number of deceased organ donors nationally has increased modestly, whereas DCD has increased fold with over cases of DCD reported in [ 71718 ].

We encountered parallel changes in this study with increasing the number of DCD donors from 3. On the other hand, we noted the decrease in living donation. Whether this represents addition of donors who would not have ever progressed to brain death or an exchange for DCD in cases that would have previously followed a DBD pathway still remains uncertain.

Saidi, et al [ 16 ], identified a significant change in resuscitative practices over time, with a striking rise in new surgical interventions such as craniostomy, craniotomy, cooling, etc, that have the potential to intercede in the progression to brain death.

These interventions were strongly associated with intent to donate via DCD.Many people who need transplants of organs and tissues cannot get them because of a shortage of donations.

The Shortage of Organs for Clinical Transplantation: Document for Discussion Most deceased donors are those who have been pronounced brain dead. Brain dead means the cessation of brain function, typically after receiving an injury either traumatic or pathological to the brain, or otherwise cutting off blood circulation to the brain drowningsuffocationetc.

Of the , Americans currently on the waiting list for a lifesaving organ transplant, more than , need a kidney, but only 17, people receive one each year.

Xenotransplantation, i.e., cross-species transplantation, using pig organs, could resolve the shortage of suitable donor organs [14,15]. If pig organs or cells could be transplanted successfully into human patients, the advantages would be numerous (Table 1).

Of all the problems foreseen in the pioneering days of organ transplantation, a shortage of donor organs was not even remotely considered as a barrier to progress.

Xenotransplantation Discussion Scenario What is xenotransplantation? Xenotransplantation involves transplanting animal organs, tissues or cells to replace failing organs or treat diseases in humans.

Clinical interest in xenogeneic transplantation has stemmed from the shortage of organs available for human transplantation, originally because cadaver donors were not often available before the concept of brain death was accepted in the s, and more recently because the extraordinary success of clinical allotransplantation has again created.

Crisis measures must include better detection and maintainence of donors. Of all the problems foreseen in the pioneering days of organ transplantation, a shortage of donor organs was not even remotely considered as a barrier to progress.

Challenges of Organ Shortage for Transplantation: Solutions and Opportunities