Overview
The progress in immunology, surgical techniques, and technological advancements in recent years of vascularized organ transplantation has made transplantation a routine treatment for organ dysfunction since its introduction in the 1950s. With rising numbers of patients being added to organ transplant waiting lists, the imbalance between organ supply and demand is ever increasing. The lack of suitable organs for all who could benefit leads to longer waiting times and greater morbidity and mortality. To overcome this imbalance, much attention is being directed towards increasing the available donor pool.
Donation after circulatory death (DCD) and expanded criteria donor organs that were previously discarded are now routinely utilized
to cater to the 108,655 candidates in the United States who are currently on the waiting list.
However, in 2018, 4,994 organs were recovered for transplant but were ultimately discarded. Of these organs, kidneys had the highest and intestines had the least number of discards.
Increased utilization of these discarded organs could help narrow the expanding gap between supply and demand (Figure 1).
Yearly number of organ transplants, patients on waiting list, living and deceased Donors. Source of data: Organ Procurement and Transplantation Network (https://optn.transplant.hrsa.gov/).
While much attention has been focused on identifying other sources of organs for transplant, such as stem cell-derived organs and xenografts, the mainstay of organ supply comes from deceased donor donation (DDD) (ie, cadaveric donors). Approximately 30% of all nationwide DDDs come from trauma patients. Evaluation of trauma patients as potential organ donors is critical to maximize the organ usage for transplantation. The circumstances and mechanism of death in organ donors from 1998 to 2020 are shown in Figure 2.
Circumstances of clinical grain death in organ donors for 1998-2020. [MVA = Motor Vehicle Accident]. Source of data: Organ Procurement and Transplantation Network (https://optn.transplant.hrsa.gov/).
Between 1998 and 2020, motor vehicle accidents (MVAs) resulted in 36,791 donors, with an average of 1,363±135.5 each year. Furthermore, within donors in the age group of 18-34 years, the mechanisms of death of 16,187 were anoxic injury and of 32,242 were head trauma. Of these donors, 6,424 were related to homicide, 17,714 to MVA, 6,857 to non-MVA, and 9,050 to suicide. By contrast, the contribution of living donors on the overall donor pool with respect to organ/multiorgan transplantation performed in the United States between 1998 and 2020 is represented in Figure 3.
Comparison of donor type to organ/multi-organ transplantation for 1988-2020. Source of data: Organ Procurement and Transplantation Network (https://optn.transplant.hrsa.gov/).