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Non-utilization of hearts and lungs after consent for donation: a Canadian multicentre study

[La non-utilisation des curs et des poumons d’adultes consentant au don d’organes : une étude multicentrique canadienne ]

Karen Hornby, BScN^*, Heather Ross, MD FRCP, Shaf Keshavjee, MD FRCS, Vivek Rao, MD FRCS and Sam D. Shemie, MD

^* From the Division of Critical Care,
Pediatric Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec; and the
Cardiac Transplant Program,
Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.

Address correspondence to: Dr. Heather Ross, NCSB 11C-1203, 585 University Ave, Toronto, Ontario M5G 2N2, Canada. E-mail: heather.ross{at}uhn.on.ca

Purpose: To identify reasons why hearts and lungs from consented adult organ donors are not transplanted and identify changes in practice aimed at increasing their utilization rates. A greater potential may exist in Canada to improve utilization rates for hearts and lungs given their comparatively suboptimal rates (kidneys 85%, livers 84%, hearts 35% and lungs 23% reported in 2001).

Methods: Four Canadian organ procurement organizations participated. All adult organ donation cases for the calendar year 2002 were reviewed and included if consent for organ donation was obtained. An organ donation framework was established to highlight key areas where organs are lost from the transplantation stream. Organ donor cases were analyzed through this framework.

Results: A utilization rate of 39% (42/107) for heart and 28% (29/105) for lung donors was found, comparable to Canadian and international rates. Organ function was the most frequently cited reason for non-utilization, followed by donor characteristics and logistical issues. Suggestions for alternate management, potentially resulting in organ utilization, were made in 20 of 65 (31%) hearts and 28 of 156 (18%) lungs. Variable practices, around consent for individual organs and offering of organs consented, remained significant barriers to successful transplantation.

Conclusion: Target areas for changes in practice included consenting and offering of all organs. Management of "marginal" organs should include resuscitation and reevaluation thus allowing potential organ rescue and utilization. Although there is considerable pressure to increase organs for transplantation, any such mechanism will not be judged successful unless recipient graft survival rates remain acceptable.

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