Organ transplantation has been much in the news the past few months and was
the subject of a three-day hearing in December, convened by the U.S.
Department of Health and Human Services (HHS). The catalyst for the
upsurge in attention was a proposed change in liver allocation policy.
While the equitable and efficient distribution of organs remains one of the
most difficult and contentious issues in the field of transplantation,
witnesses at the HHS hearing and journalists repeatedly pointed to the need
for more focus on organ donation. Consensus is strengthening around the
realization that designing a satisfactory allocation system in the face of
persistent organ shortages is futile, and therefore, solving the organ
donor shortage should be the principal focus of our efforts.
Fortunately there is reason for optimism about increasing organ donation.
It is now clear that at least half the answer to the organ donor shortage
lies within hospitals--the setting where severely injured or ill patients
and their families receive care and are asked to consider donation.
Specific steps and protocols have been identified that hospitals can use to
improve donation practices, and more hospitals are adapting these practices
to their needs and instituting them. Organ procurement organizations
(OPOs) and hospitals together are strengthening their coordination of the
complex and delicate donation process.
A strong foundation of systematic work has identified better donation
practices, and The Partnership is assisting hospitals and OPOs to adopt
these practices. Early work with a pioneering group of OPOs, including
Kentucky Organ Donor Affiliates, California Transplant Donor Network,
LifeSource Upper Midwest OPO, and the Washington Regional Transplant
Consortium, helped define the optimal donation process and provided
experience in implementing changed practices in hospitals. More recent
projects with several leading hospitals, including the University of Texas
Medical Branch at Galveston, Johns Hopkins Hospital, and the University of
Maryland Medical System, have shown the value of hospital commitment to
change. Throughout each phase of our work, research and evaluation
activities--guided by teams from the Harvard School of Public Health and
the Harvard Medical School--have shared key findings through professional
meetings and journal articles.
We are now moving from a research and development mode into an application
mode. The basic framework has been validated. Now it's time to figure out
what variations are necessary to respond to institutional differences, what
implementation models will make adoption of new practices both efficient
and effective, and what strategies for dissemination will allow these "best
practices" to become the norm.
That's part of what we'll be figuring out through our collaboration with
the University HealthSystem Consortium (see
story). Currently, we are working in five hospitals and planning to
include at least 16 more in the next several months. We know the process
of change won't be identical in each hospital, because each hospital is
unique. But we are confident there are core practices that can and should
be universally applied. Working with a dedicated group of highly capable
institutions to break new ground in establishing better practices is what
will make the project interesting, challenging and worthwhile.
This issue of Progress Notes, demonstrates how the same basic ingredients
can be adapted to meet the needs of hospitals and OPOs across the nation
and even across national borders. It's clear that there's a basic
"prescription" for increasing organ donation, but there's room for
flexibility in the way the "medication" isadministered. In Virginia, an
OPO--Virginia Organ Procurement Agency--has taken the basic framework and
administered it in two hospitals within a regional healthcare system (see story). The donation program at the
University of Nebraska Medical Center (see
story) is more hospital driven, centering on an acute bereavement team.
In Canada, where both the healthcare system and the transplantation system
are significantly different from the U.S., The Partnership's model is being
used to diagnose potential and to determine where there are opportunities
for improvement (see story). The solid
data produced by this project will be used by the Canadian transplant
community as it develops strategies and goals for increasing donation
rates.
The basic ingredients are the same, but the form can be adapted for each
hospital and each unique donation situation. The answer to the shortage of
organs for transplantation is at hand. We owe it to the 50,000 Americans
and thousands more around the world who wait for lifesaving transplants to
make these practices universal.
The following articles are contained in this issue of
Progress Notes: