Organ harvest

Organ procurement (previously but often still colloquially called organ harvesting) is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation. It is heavily regulated by United Network for Organ Sharing (UNOS) to prevent unethical allocation of organs. There are over 110,000 patients on the national waiting list for organ transplantation and in 2016, only about 33,000 organ transplants were performed. Due to the lack of organ availability, about 20 patients die each day on the waiting list for organs. Organ transplantation and allocation is mired in ethical debate because of this limited availability of organs for transplant. In the United States in 2016, there were 19,057 kidney transplants, 7,841 liver transplants, 3,191 heart transplants, and 2,327 lung transplants performed. Organ procurement (previously but often still colloquially called organ harvesting) is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation. It is heavily regulated by United Network for Organ Sharing (UNOS) to prevent unethical allocation of organs. There are over 110,000 patients on the national waiting list for organ transplantation and in 2016, only about 33,000 organ transplants were performed. Due to the lack of organ availability, about 20 patients die each day on the waiting list for organs. Organ transplantation and allocation is mired in ethical debate because of this limited availability of organs for transplant. In the United States in 2016, there were 19,057 kidney transplants, 7,841 liver transplants, 3,191 heart transplants, and 2,327 lung transplants performed. Organ procurement is tightly regulated by United Network for Organ Sharing (UNOS). In the United States, there are a total of 58 Organ Procurement Organizations (OPOs) that are responsible for evaluating the candidacy of deceased donors for organ donation as well as coordinating the procurement of the organs. Each OPO is responsible for a particular geographic region and is under the regulation of the Organ Procurement and Transplantation Network. The United States is divided into 11 geographic regions by the Organ Procurement and Transplantation Network. Between these regions, there are significant differences in wait time for patients on the organ transplant list. This is of particular concern for liver transplant patients because transplantation is the only cure to end-stage liver disease and without a transplant, these patients will die. One example that brought this disparity to light was in 2009, when Steve Jobs traveled from California, where wait times are known to be very long, to Tennessee, where wait times are much shorter, to increase his chances of getting a liver transplant. In 2009, when Jobs received his liver transplant, the average wait time for liver transplantation in the United States for a patient with a MELD score of 38 (a metric of severity of liver disease) was about 1 year. In some regions, the wait time was as short as 4 months, while in others, it was more than 3 years. This variation for a patient with the same illness severity has caused significant controversy over how organs are distributed. If the organ donor is human, most countries require that the donor be legally dead for consideration of organ transplantation (e.g. cardiac or brain dead). For some organs, a living donor can be the source of the organ. For example, living donors can donate one kidney or part of their liver to a well-matched recipient. Organs cannot be procured after the heart has stopped beating for a long time. Thus, donation after brain death is generally preferred because the organs are still receiving blood from the donor's heart until minutes before being removed from the body and placed on ice. In order to better standardize the evaluation of brain death, The American Academy of Neurology (AAN) published a new set of guidelines in 2010. These guidelines require that three clinical criteria be met in order to establish brain death: coma with a known cause, absence of brain stem reflexes, and apnea. Donation after cardiac death (DCD) involves surgeons taking organs within minutes of the cessation of respirators and other forms of life support for patients who still have at least some brain activity. This occurs in situations where, based on the patient's advanced directive or the family's wishes, the patient is going to be withdrawn from life support. After this decision has been made, the family is contacted for consideration for organ donation. Once life support has been withdrawn, there is a 2-5 minute waiting period to ensure that the potential donor's heart does not start beating again spontaneously. After this waiting period, the organ procurement surgery beings as quickly as possible to minimize time that the organs are not being perfused with blood. DCD had been the norm for organ donors until 'brain death' became a legal definition in the United States in 1981. Since then, most donors have been brain-dead. If consent is obtained from the potential donor or the potential donor's survivors, the next step is to perform a match between the source (donor) and the target (recipient) to reduce rejection of the organ by the recipient's immune system. In the United States, the match between human donors and recipients is coordinated by groups like United Network for Organ Sharing. Co-ordination between teams working on different organs is often necessary in case of multiple-organ procurement. Multiple-organ procurement models are also developed from slaughtered pigs to reduce the use of laboratory animals. The quality of the organ then is certified. If the heart stopped beating for too long then the organ becomes unusable and cannot be used for transplant.