Organ donation organizations shift recovery efforts in-house
Ventilators keep their hearts beating and blood flowing.
The patients are brain dead, even though it might seem like they're sleeping. Often in the darkness of night, they arrive at buildings far removed from any hospital.
Welcome to the new direction of organ recovery, where donors are shipped to slick, multimillion-dollar buildings to have their organs and tissue removed for transplant.
The Pittsburgh region has joined a small but growing number of cities where organ procurement organizations do in-house surgeries to remove tissue from bodies.
O'Hara-based Center for Organ Recovery & Education in October began recovering tissue such as bone and skin in a $10 million addition to its building in the RIDC business park. Tissue donors are not hooked to breathing machines.
Within months, officials plan to begin recovering organs. Donor patients who die anywhere in the CORE region — which includes the western half of Pennsylvania, West Virginia and a small part of New York — could be sent to Pittsburgh for organ recovery.
“It's really been an improvement for efficiency for CORE to now bring the patients to our team and do the recovery right here,” said CORE President Susan Stuart.
The addition, named for former CORE President Brian Broznick, includes two operating rooms and two intensive care units.
When tissue removal is completed, the nonprofit organ procurement organization transports the bodies to funeral homes, crematoriums or wherever the families designate. It will do the same when organs such as livers and hearts are removed from donors.
Recovering organs and tissues in a central location, rather than hospital operating rooms, might cut costs and take advantage of the limited time that doctors have to act, proponents contend.
But critics, including some hospital officials, say the move is a way for the nation's 58 procurement organizations to gain more control over revenue from organ collections.
Fifty-one procurement organizations collected revenue of $1.2 billion and recovered more than 80,000 body parts in 2011, a Tribune-Review investigation revealed. Seven procurers are within hospitals, so their recovery information and budget spreadsheets were unavailable.
Procurement organizations say recovering organs is an expensive undertaking, and fees paid to surgeons and hospitals escalate annually. CORE paid nearly $800,000 in operating room fees in 2011, according to a report it filed with the federal Centers for Medicare & Medicaid Services.
“Sometimes, it becomes increasingly prohibitive in the hospital for us to pay for the OR time and do it in a way that we can afford to provide organs to recipients without compromising access,” said Charlie Alexander, CEO of The Living Legacy Foundation in Baltimore and former president of United Network for Organ Sharing, a Virginia nonprofit the government designated to oversee and track organ transplantation in the United States.
In addition to CORE, several other procurement organizations run their own operating rooms, said Stuart, who is president of the Association of Organ Procurement Organizations, a Virginia-based trade group.
The first was Mid-America Transplant Services in St. Louis, which built a facility to recover tissues in 1998. Officials spent $3 million in 2001 to expand the facility, which has two operating rooms and an intensive care unit where surgeons recover organs.
Diane Brockmeier, Mid-America's chief operating officer, said removing organs in its facility instead of the hospital cut costs in half. It allowed the organization to stabilize so-called standard acquisition fees it charges transplant centers for organs.
“Because we control the process, we have had the opportunity to recover more organs out of each donor,” she said, estimating Mid-America recovers organs from about 1,100 donors every year. “It has helped in increasing our yield or organ per donor.”
The organization collected $34 million in revenue from organ procurement in 2011. It posted a $10 million surplus that year, according to the latest available filings with the IRS. The nonprofit recovers organs in eastern Missouri, southern Illinois and northeast Arkansas.
Brockmeier said the surplus from collections largely pays for educational and bereavement programs.
Dr. Abhi Humar, chief of transplantation at UPMC, said advantages and disadvantages exist to procurement organizations having independent operating rooms.
One advantage is that those facilities might be better equipped to handle complex surgeries to remove organs because their surgeons and staff have more experience, he said.
“When you're going to a small peripheral hospital, they may never have done a procurement,” Humar said. “It's not unusual that we go out to these hospitals to remove organs, and, often, they happen in the middle of the night. There's not adequate staffing in the middle of the night.”
Donors whose organs are recovered in hospitals with transplant centers, such as UPMC Presbyterian in Oakland and Allegheny General Hospital in the North Side, will not be transported to the O'Hara facility, Stuart said. In those cases, the organs might go to recipients in the hospital where the donor died, which should lessen an organ's time outside a body.
“For that scenario, to send them out to another place doesn't make a lot of sense,” Humar said. “You can almost make it like a live-donor procedure.”
Editor's note: This is the second story in an occasional series on organ donations.