In Conversation with Kevin O’Connor, President and Chief Executive, LifeCenter Northwest
Please give us the key facts about the population you serve at LifeCenter Northwest?
Our Organ Procurement Organisation (OPO) serves over eight million people in the largest donation service area in the US, which covers Alaska, Montana, Washington and the northern part of Idaho – comprising 25% of the square mileage of the US. This creates some interesting challenges, especially in terms of transportation of clinical teams and organs to and from remote locations.
Can you share with us your donor activity for 2013?
In 2013, we had 162 organ donors with a utilization rate of 90% for kidneys and approximately 65% for livers. Our kidney utilization rate compares favourably to the US national average, which currently stands near 80%.
Of these 162 donors, about 35% were donors after circulatory death (compared with a national rate of around 15%), 10% were expanded criteria donors and 55% were standard criteria donors. In 2014 we had 195 organ donors, after the first 11 months. This will represent a record number of organs donors per year for LifeCenter Northwest. We are pleased with this progress but we still have tremendous opportunities for further improvement.
Eighty five percent of the organs transplanted from our donors are used at our five affiliated transplant centres. Importantly, as shown in the latest report from the US Scientific Registry for Transplant Recipients, all of our affiliated transplant programs have patient and graft survival rates equal to or better than expected, for all organs.
What type of deceased donors are you typically machine perfusing?
We routinely pump our DCD and ECD kidneys. In consultation with our transplant programs, we also pump selected SCD kidneys, for example, kidneys from a younger donor with acute renal injury.
What role do you think machine perfusion might have in the future, for example with livers?
I have been involved with machine perfusion for over 30 years since I was first introduced to it in Boston by Dr. Sang Cho. We have seen it evolve over that period and our goal today remains the same – to use every strategy and opportunity we can to maximise the benefit to the patient, and that includes new and better methods for preservation. It is clear to me that part of our approach will involve an increased use of machine perfusion, potentially at different temperatures for different scenarios. We already have an active machine perfusion programme for DCDs, which I believe will come to represent a large proportion of the deceased donation activity worldwide over the next 10 years. Currently, this is primarily a kidney programme (with the occasional liver, pancreas or lungs) and we know these organs have good outcomes. These donors are generally younger and their organs are not exposed to the pro-inflammatory cascade seen in brain death. If machine perfusion will allow us to increase our use of DCD livers, lungs and even hearts, that will be a very positive step forward. With the large area that we serve, machine perfusion may also give us an option to safely extend organ preservation time, giving us the opportunity to send organs over greater distances, where currently our travel ranges are limited by cold storage time. This will enhance our ability to share organs and therefore increase organ utilization.