In conversation with Jeff Orlowski, President and Chief Executive of LifeShare Transplant Donor Services of Oklahoma
Please give us the key facts about the population you serve in Oklahoma?
Our Organ Procurement Organization (OPO) here in Oklahoma is pretty typical of OPOs in the USA. We have 77 counties, 117 hospitals, four adult transplant centers, one pediatric transplant center and serve a population of 3.8 million people.
Can you share with us your donor activity for 2013?
Up until 2013 our average organ donor number per year was 90. In 2014, we are beginning to reap the benefits of 2–3 years of significant effort on our team’s part; we are on pace to recover organs from 130 donors and transplant roughly 400 organs in 2014. In 2013, 18% of our donors were donation after cardiac death (DCD), 16% were expanded criteria donor (ECD) and the rest standard criteria donor (SCD).
What type of deceased donor kidneys are you typically machine perfusing?
Currently we pump all DCDs and most ECDs (occasionally centers request to transplant immediately when typing and crossmatch is completed prior to recovery) and for two of the four transplant centers, we are pumping almost all kidneys. To August this year, we have machine perfused 48% of all kidneys recovered. Of the 77 perfused, 60 have been transplanted.
How has this changed over the past few years?
I arrived in Oklahoma in 2012 and although there had been a history of pumping back in the 90’s, machine perfusion with the portable LifePort was in its infancy. We now have seven machines to support our service. Our pumping practice in the past 3 years has evolved primarily for three reasons:
Our medical teams have become more comfortable with the pumps and the process and have seen improved outcomes in terms of fewer post-transplantation dialysis sessions and shorter hospital stays. It has led two of our four renal centers to pump almost everything as they have seen their post-operative care become easier and outcomes improve.
Our high volume units can use the machines when they have back to back transplants without the concern of extending cold times e.g. a liver transplant followed by a kidney transplant.
Many of our so-called SCDs are not. We have a higher than average level of obesity, hypertension and diabetes in Oklahoma and see donors in their 40s with co-morbidities e.g., donors with acute renal failure.
What advice do you have for others?
Having machine perfusion is, without over simplifying it, another tool in our box. Our experience tells us that in doing machine perfusion there is a bit of extra work in the OR, there is a bit of extra work logistically and there is an additional up front cost but we have probably placed 24 more kidneys in the last 12 months than in the previous period. So it turns out that it costs no more to pump or not pump a kidney.
From a practical perspective, being able to send the machine on its own makes a difference and knowing that if the machine should stop working, the organ remains cold stored.
We are lucky enough to have a great new facility at LifeShare with a two room suite dedicated to machine perfusion which makes all our logistics easier.
Finally we have a highly committed Board of Directors and Medical Advisory Board who have embraced machine perfusion and made it part of the package that we can offer to our transplant centers.
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