Minnesota transplant centers seek to reduce delays, deaths through donor units

Minnesota's organ donor agency is hoping to increase transplant surgeries and save more lives by having organs procured at the state's two largest transplant centers.

LifeSource on Monday announced a reorganization under which deceased donors would be transferred to the University of Minnesota Medical Center in Minneapolis and Mayo Clinic in Rochester.

Transfers to special donor care units at these sites could reduce delays and missed opportunities that occur when organs are procured at community hospitals where donors die, said Kelly White, chief executive of LifeSource. The organization manages organ procurement in Minnesota, the Dakotas and western Wisconsin.

"The gift of organ donation is so scarce here," she said. "Every opportunity counts for us."

Minnesota set records in 2022 when centers conducted 1,078 transplants and 179 people donated organs upon their deaths. The number of people who died awaiting transplants in Minnesota also declined from 206 in 2014 to 111 last year, but White said a streamlined procurement process could drive that number lower.

Transplant recipients are matched under a federal system to organs based on whether they have the same blood type and physiology as donors, whether they are at greater need than others on the waiting list and whether they are close enough to receive the organs in time.

What happens next is a scramble. Specialists rush from transplant centers to hospitals to procure kidneys, hearts, lungs and other organs that have been matched to their patients. The travel alone can cause delays, especially if the hospitals are remote or the transplant recipients are in other states.

Community hospitals aren't as equipped to deal with problems that can leave organs unusable, such as fluid buildup in the lungs when patients die, said Dr. Andrew Adams, executive medical director of solid organ transplantation for M Health Fairview.

"With the advent of donor care units ... we can recondition the lungs to bring them back to an optimal status and now those lungs can be used for transplant," he said.

Donor care units were first tried in St. Louis two decades ago, and research found that they lower costs and increase the number of organs procured per donor. A federal report last year recommended that all 57 U.S. procurement organizations open these units.

About half of deceased donors will be transferred at first to the new units, according to LifeSource's estimates. Abbott Northwestern Hospital and Hennepin County Medical Center have active transplant programs in Minneapolis and can procure organs on their own.

Grieving relatives also can refuse the transfers, although Adams said many find comfort and closure in having deceased loved ones moved elsewhere. Logistical delays in procurement at community hospitals can prolong the time that brain-dead patients stay on life support, extending relatives' grief or prompting them to refuse donation.

"Organ donation, from the time they get declared brain dead to the time when organ procurement occurs, sometimes that can be two, three, four days," Adams said. "That puts the donor family almost in a limbo, like a holding pattern, where they are unable to move forward with the grieving process."

Mayo already had been transferring in deceased donors this year at LifeSource's request to help hospitals that had no open surgery suites or lacked experience in organ procurement. The U hospital will phase-in the donor care role before opening a dedicated unit on its West Bank campus next April.

Another benefit of the donor care units is that they will free up surgical and bed space in Minnesota hospitals that have struggled with overcrowding, said Dr. Julie Heimbach, director of Mayo's transplant center.

"That has come to a head, especially with the pressures that have been placed on hospitals through COVID," she said.

The units can procure organs and send them to transplant centers or the centers can still send their specialists to do that work, she added.

Researchers have looked for other ways to increase or hasten transplants. Allina Health and LifeSource have tested drone flights to reduce organ transport time. U of M researchers last month reported success in freezing and thawing organs in rats, which could one day dramatically increase the shelf life of human organs for transplant.

Heimbach said it would help for now if more people signed up as donors.

About 70% of Minnesota adults have committed to be organ donors through their drivers licenses or other documents, compared to about 60% nationally, according to LifeSource.

Less than 1% of deaths present opportunities for donation, though. Most donations involve brain death, which occurs when cardiac events or traumatic injuries leave patients with no brain function or ability to breathe independently. Even in that rare form of death, donors can be rejected if they have cancer or their organs have been damaged.