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A Mission to Save More Lives Where we ’ ve been, where we are, and where we need to be. Thomas A. Nakagawa, M.D, FAAP, FCCM Professor, Anesthesiology and Pediatrics Wake Forest University School of Medicine Pediatric Critical Care Medicine

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A Mission to Save

More Lives

Where we’ve been, where we are, and where we need to be

Thomas A. Nakagawa, M.D, FAAP, FCCM

Professor, Anesthesiology and Pediatrics

Wake Forest University School of Medicine

Pediatric Critical Care Medicine

Wake Forest University Baptist Health, Brenner Children’s Hospital

Winston-Salem, North Carolina

Presenter has no financial disclosures

the current status of a national issue that continues to escalate
The current status of a national issue that continues to escalate
  • The need for organs is clearly evident with a growing transplant waiting list that has now exceeded 112,000 people
  • In 2010
    • 7,168 people died waiting for a needed organ*
    • 3,643 were removed from the wait list because they became too sick to transplant
    • 109 deaths were children

*OPTN data accessed May 16, 2011

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WAITLIST PATIENT BY ORGAN TYPE

October 9, 2011

*OPTN data. Accessed October 9, 2011

www.OPTN.org

a local issue that continues to escalate
A local issue that continues to escalate
  • 20,629 people are part of the national waitlist for California
  • There were 3,222 transplants performed in the State of California in 2010

*OPTN data. Accessed October 9, 2011

www.OPTN.org

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An additional sobering fact

  • State of California
    • 1,164 people died last year waiting for a needed organ

*OPTN data. Accessed October 9, 2011

www.OPTN.org

dcdd donors
DCDD donors

Adult DCDD donors

All DCDD donors

Pediatric DCDD donors

2006: 645 DCD donors 77 pediatric

2007: 793 DCD donors 66 pediatric

2008: 847DCD donors 73 pediatric

2009: 747 DCD donors 81 pediatric

2010: 939 DCD donors 72 pediatric

UNOS. OPTN data. 2011

Pediatrics patients < 18 years of age

success with dcdd organs
Success with DCDD organs
  • 939 DCDD donors in 2010 impacted 1,797 lives by providing additional organs for transplantation
  • Renal and some liver grafts from DCDD donors have graft function and transplant recipient survival rates comparable with organs recovered from SCD donors
  • Lungs from DCD donors are being recovered and transplanted with good success
  • Many hospitals are working to establish policies and identify donors as we all work to find more organs for the growing number of people on the national transplant waiting list
the facts about pediatric donation
The facts about pediatric donation
  • 1,766 children are waiting for a needed organ*
  • Children make up 1.5% of the total national waitlist
  • Approximately 150 children die annually waiting for a needed organ and another 50-60 children are removed from the national waiting list because their condition deteriorates making them ineligible for organ transplantation
  • Children less than 1 year of age have the highest death rate waiting for an organ

*OPTN data. Accessed October 9, 2011

www.OPTN.org

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Data compiled from OPTN

Pediatric patients: birth to 17 years of age

Pediatric patients: birth to 18 years of age

the current state of pediatric donation
The Current State of Pediatric Donation
  • Organs transplanted per donor
      • Adults 3.09
      • Pediatrics 4.06
      • All donors 3.10
  • 24% of hospitals with more than 5 eligible pediatric donors had a 50% or less conversion rate
  • 73% of hospitals with more than 5 eligible pediatric donors had 0 DCDD donors
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PEDIATRIC* WAITLIST PATIENT BY ORGAN TYPE

October 9, 2011

* Pediatric patients age 0-18 years of age

1,766 Children Waiting

*OPTN data. Accessed October 9, 2011

www.OPTN.org

important options for neonatal donation
Important options for neonatal donation
  • En bloc neonatal kidney transplants
  • Liver cell transfusions as a bridge to transplant for smaller infants with end-stage liver disease
  • Use of ABO incompatible hearts for transplantation into infants younger than 1 year of age
  • DCD heart transplantation
our role as champions for donation and transplantation
Our role as champions for donation and transplantation
  • The difference between life and death can mean the difference in one organ from one donor
  • It’s not all about the “big programs,” it’s about all programs that are designed to save lives
  • The impact of many small programs that recover organs from a few donors annually has a significant impact regionally and nationally
  • The importance of tissue donation must also continue to be emphasized
our role as champions for donation and transplantation1
Our role as champions for donation and transplantation
  • Everyone of us in this room is a champion
  • We have the capability to save more lives
  • We will save more lives through our hard work dedication to recover more organs and provide better organs for transplantation
questions to run on
Questions to run on
  • What roles and responsibilities do each of us play during organ donation and end-of-life care for patients and families?
  • How can we maximize the opportunity to recover more organs for transplantation to reduce the number of people dying on the national wait list?
bold request
Bold Request
  • Listen, learn, and teach others
  • Be bold: Share your thoughts and experiences
  • Focus on what we can do, not what we can’t do
  • Remember that our focus is the patient and the family
  • We are here to save lives