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Where you die can affect your chances of becoming an organ donor

WASHINGTON (AP) – If Roland Henry died in another part of the country, his organs could have been recovered. And lives could have been saved.

But the local organ collection agency said no. There was no reason, no explanation for his family, although the Connecticut man, despite his advanced age, seemed to be a well-qualified donor: he died in a hospital of a respirator that was previously healthy until a car accident led to a stroke. 19659002] "It was devastating to learn that there was nothing that they considered worthy of donations. Nada. No kidney, no liver, no tissue, "recalls Henry's daughter Donna Cryer, president of the nonprofit Global Liver Institute and recipient of a liver transplant.

Henry's case shows the disturbing uncertainty in a government-operated transplantation system of contractors under attack for wasting potentially useful organs.

The Associated Press examined this system extensively and determined that some of these agencies secure deceased donors at half the rate of others – even if 113,000 people linger on the nation's waiting list for transplants are about 20 deaths per day.

"What we have is broken. We know that this will cost people's lives, "said Drs. Seth Karp, transplant chief of Vanderbilt University.

Under US transplantation rules, the country is divided into 58 zones, each of which uses an "organ procurement organization" to donate at death. These OPOs are matchmakers with a difficult task: Obtain donation approval Quickly collect organs and bring them to the right transplant center before they deteriorate, even if a hospital calls a potential donor at 3 am

. How good are you? do? It is almost impossible to say. OPO's self-report to the government is a subjective measure that they even refer to as flawed. This standard barely provides a way to directly compare and learn OPOs, which could be better, or hold bad performers accountable for missed opportunities.

"No one comes after them and says, 'You actually have 20 to 30% more and you could not have recovered,' said Kevin Longino, a kidney transplant recipient who heads the National Kidney Foundation.

That could come soon The Trump administration is planning a comprehensive overhaul tougher standards to make it easier to compare and improve OPOs One measure that will be considered: Identifying the entire pool of potential donors making up each OPO The AP modeled its own analysis of OPO performance from this study and found that even in comparing regions with similar pools of acceptable donors, there were significant differences in 2017. Philadelphia, for example, outperformed New York City OPO, which operates parts of Kentucky, was located near Missouri.

More importantly, the Anal yse shows that the biggest impact is on locations with a large population of potential donors. For example, OneLegacy was able to recapture 487 donors in Los Angeles in 2017, followed by Philadelphia's Gift of Life. However, the Los Angeles OPO also had the most potential donors. If OneLegacy met Gift of LIfe's higher donor rate, the AP would have calculated that 866 donors would have been won instead] There are also donors who are not perfect – older donors or those with certain illnesses – who are hard to handle for OPOs Mone added, added Mone. These organs can be life-saving for the right patient, but too often, transplant centers will not take the risk of preventing the OPOs from collecting them.

Still, with Organ Deficiency So Great That the Transplant Centers Fight Compared to sclerotic livers in court, more and more OPOs are saying that the death certificate-based standard will encourage more aggressive donor persecution.

"It's a denominator that can not be manipulated," said Ginny McBride, CEO of OurLegacy in East Central Florida. She was one of 17 OPO leaders who have recently written Medicare, which regulates non-profit organizations and reimburses organ acquisition costs to drive change.

And it could tell the government who they should certify and who not "to collect organs," she added.


Only about 2 percent of Americans die under circumstances that allow a donation. Dying before you reach a hospital and the organs can not be preserved. Even diseases such as cancer or infections can exclude a donation.

While young donors tend to be healthier, there is no age limit: Studies show that healthy organs from seniors like Henry, who was 78 years old, and even octogenarians, still work well. especially if they were passed on to an older recipient.

Last year, there were 10,721 deceased donors out of about 2.8 million deaths. Her organs resulted in 29,680 transplants.

However, a 2017 study by researchers from the University of Pennsylvania looked at deaths, donations, and health records and found that a better-functioning system could produce up to 28,000 more donated organs per year. [19659002] The objective evaluation of OPOs is key to this goal, but even if the estimate is too high, "every single donation we receive is another salvation that pays off," said Greg Segal the transplant Advocacy Group Organize. Whose father waited five years for a heart transplant.


The recent increase in overdose deaths has led to an increase in donors. Some OPO are aggressively seeking additional impulses.

LifeCenter Northwest, which serves Washington, Alaska, Montana and Northern Idaho, doubled the number of organs transplanted by area donors last year to 878 (compared to 440 a year before the CEO) Kevin O & # 39 Connor is here.

It focuses on organs that are often considered to be too hard to recover – not those that originate from brain dead donors that occur most often, but to people who die when their heart stops beating. O'Connor made "dummy donations" to train donor hospitals and his own staff to handle these complex cases. Nationally, they make up about 19% of the donations; At LifeCenter it is 29%.

At LifeGift in Houston, where donors have grown by about 40% since 2013, CEO Kevin Myer has hired dozens of new employees to reach hospitals far away. The increase in donation "depends on how good your staff are and how many people you bring to hospitals and care for people who lose someone," Myer said.

And In Hawaii, Lung Transplants Are Not Offered In order to prevent the donors' lungs from being restored frequently, Legacy of Life is testing a new incubator to get the organs for long-distance transportation. The first pair was successfully transplanted in North Carolina more than 20 hours after the donation.


Today, OPO's Medicare report how many deaths they classify as "eligible". This should also include hospital transfers of brain-dead patients up to 75 years without disqualifying diseases. Comparing this denominator with the actual donors of the OPO measures its success.

"I'm always stunned by the variability," said Diane Brockmeier, director of St. Louis Mid-America Transplant Services, which supports the death certificate-based standard.

However, different OPOs can define authorization differently. There are no incentives to pursue each organ.

And sometimes there are breakdowns. Dr. Dorys Segev, a transplant surgeon at Johns Hopkins University, described "a very depressing and disappointing case" in which several patients were given the pledge to donate the organs of a young donor to withdraw the offers a few hours later. In another state, the OPO could not find a local surgeon to restore the organs – and did not give the surgeon the recipient the opportunity to fly himself.

Then there is the role of transplant centers, which are judged by how well their patients recover after surgery, without considering how many are on the waiting list. If local transplant centers do not reject perfect organs, OPOs may be reluctant to remove them because they may not find another recipient.

"The metrics lead to wrong behaviors," according to Longino of the Kidney Foundation Centers must also be held accountable. "If 60-year-olds are not given a functioning 60-year-old kidney, that's a problem and they are not."

A recent study suggests that US transplant centers are too picky. Surgeons in France regularly implant inferior kidneys from older donors than their American counterparts, with success. Medicare recently took a small step to counteract the reluctance of transplant centers.

On the donations side, many OPOs and patient groups see a reform value that accounts for the success of OPO based on the largest possible pool of donors, an easy-to-follow number. [19659002] But some OPO leaders are pushing for another measure, one that is limited only to the people on the respirators. Some Midwest OPOs are testing this approach.

"We are concerned that some of these broad, easy-to-calculate numbers do not convey a picture of a possible donation," said Susan Gunderson, CEO of LifeSource Upper Midwest OPO in Minneapolis.


More donors can not come fast enough for waiting patients, especially when it comes to distributing scarce livers. Nine days earlier this year, a new national policy meant that hospitals, which once received initial donations for nearby donated livers, sent the organs to sick patients up to 800 kilometers away, with pediatric donations for sick children , Then a federal judge put the new rules on hold .

In Pennsylvania, the toddler Evelyn Yargar got a new liver from a teenager who had died several states away during this window. A few days later, the organ could have gone to an adult instead. And because the surgeons at the University of Pittsburgh knew that the 14-month Evelyn needed only a small piece of this liver, which can grow into a fully functional organ, an adult in another state got the rest.

"I know it just does not understand why a child can not have any part of a donor's liver, "said Evelyn's mother, Bobbi Yargar of Charleroi, Pennsylvania. And when Medicare changes performance standards, OPOs will not be collecting more organs overnight.

"I do not think there are 30,000 organs lying around to be transplanted," warned Brockmeier, the head of Mid-America. However, she knows that her own OPO could improve and told others to "stop arguing about what the metric is and to decide what we will do to maximize the donation."

___ [19659002] AP's analysis used a mortality database from the Centers for Disease Control and Prevention to calculate deaths in inpatients under the age of 75 based on the causes consistent with a donation for each OPO except Puerto Ricos. Dividing the actual number of donors by these numbers gives you a similar success rate.


The Associated Press's Department of Health and Science Receives Assistance from the Department of Scientific Education of the Howard Hughes Medical Institute. The content is the sole responsibility of the AP.

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