Organ Procurement in The Era of Organ Recovery Centers

Abstract: In 2001, Mid-America Transplant performed the first organ recovery in a hospital-independent organ recovery center (ORC) in St. Louis, Missouri. Since then, there has been a shift towards practicing donation in these out-of-hospital, OPO-affiliated surgical centers established to increase donation efficiency, allowing for donors to be transported from the hospital immediately following authorization and increasing donations without increasing the burden on hospital operating rooms and surgical teams, reducing the overall cost of transplant by 37%. Simultaneously, these centers present a new category of ethical dilemmas amidst a growing interest in donation after circulatory death and the use of new technologies capable of sustaining a donor’s circulation following declaration of death, namely, normothermic regional perfusion (NRP). NRP is a protocol which utilizes ECMO technology to reperfuse organs within the donor’s body following declaration of circulatory death, without a standardized duration of reperfusion. While ORCs are not authorized to withdraw life sustaining therapy or declare death, NRP protocols could allow for a declaration of death to occur in-hospital, and the transfer of the deceased and mechanically perfused donor body to an ORC. At an ORC, the condition of the deceased donor may be sustained without the limitations of a standard operating room, and outside of hospital guidelines. This presentation examines the challenges associated with the increased use of ORCs, highlighting concerns regarding conflicts of interest and technological advancements, to stimulate discussion on how to address the evolving landscape of organ donation while prioritizing respect to donors and donor families.