The faltering solid organ donor pool in the United States (2001-2010)

Background Organ shortage is the greatest challenge facing the field of organ transplantation today. Use of more organs of marginal quality has been advocated to address the shortage. Method We examined the pattern of donation and organ use in the United States as shown in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database of individuals who were consented for and progressed to organ donation between January 2001 and December 2010. Results There were 66,421 living donors and 73,359 deceased donors, including 67,583 (92.1 %) identified as donation after brain death and 5,776 (7.9 %) as donation after circulatory death (DCD).Comparing two periods, era 1 (01/2001-12/2005) and era 2 (01/2006-12/2010), the number of deceased donors increased by 20.3 %from33,300 to 40,059while there was a trend for decreasing living donation. The DCD subgroup increased from 4.9 to 11.7 % comparing the two eras. A significant increase in cardiovascular/cerebrovascular disease as a cause of deathwas also noted, from38.1 %in era 1 to 56.1 %in era 2 (p <0.001), as was a corresponding decrease in the number of deaths due to head trauma (48.8 vs. 34.9 %). The overall discard rate also increased from 13,411 (11.5 %) in era 1 to 19,516 (13.7 %) in era 2. This increase in discards was especially prominent in the DCD group [440 (20.9 %) in era 1 vs. 2,089 (24.9 %) in era 2]. Conclusions We detect a significant change in pattern of organ donation and use in the last decade in the United States. The transplant community should consider every precaution to prevent the decay of organ quality and to improve the use of marginal organs.