When it comes to registered organ donors, New York State’s motto, Excelsior, meaning “ever higher,” is poignantly apt. With just 30 percent of its eligible residents listed as donors—compared with the national average of 55 percent—New York has the lowest rate of organ donation nationwide, leaving much room for improvement. “We want to change the status quo,” says Luis F. Angel, MD, medical director of NYU Langone Health’s new lung transplant program at NYU Langone’s Transplant Institute.
Last January, Dr. Angel assumed an additional role as the director of the Preservation of Organ Donation Project, a pilot study designed to increase the organ-donor rate among NYU Langone patients. The three-year study—the first of its kind in the nation—is being conducted by a team of experts at NYU Langone’s Transplant Institute, which has performed more than 240 transplants for kidneys, livers, hearts, and lungs this year alone.
The study pairs a team of specially trained intensivists, nurses, and social workers with the medical team treating a gravely ill patient admitted to the Emergency Department or critical care unit. When the care team determines that brain death is imminent, the organ preservation team, acting as “designated requestors,” initiates a conversation with the patient’s family about potential organ donation.
Until now, only representatives from LiveOnNY, an organ procurement organization that recovers organs within its geographical territory and allocates them based on guidelines from the United Network for Organ Sharing, were allowed to discuss organ donation with a patient’s family.
However, a representative was not always available on short notice. This often resulted in precious time—and lives—being lost, because as soon as blood flow ceases, organs start to deteriorate, making them less viable for transplantation.
“By partnering with LiveOnNY to train our medical teams,” notes Dr. Angel, “we can begin this delicate conversation early on and in a way that’s more natural and intimate because the patient’s family is already comfortable with the care team.”
Candidates for heart and lung transplants are already three times as likely to receive a donor organ at NYU Langone than at other institutions in the New York metropolitan area and twice as likely compared with the national average.
By 2020, Dr. Angel anticipates that NYU Langone’s pilot study will result in 20 to 30 additional donors. “These critical care specialists understand the complex issues surrounding end-of-life care and organ donation, and they do it better,” says Dr. Angel. “If we can show that this model is feasible, we will share it with other institutions and potentially save a lot of lives.”
Why Organ Donation Lags in New York
New York State’s low percentage of organ donors has been attributed to a combination of factors unique to this locality. Nearly half the state’s residents—8.5 million out of 19.8 million—live in New York City, whose large multicultural population includes some ethnic and religious groups that have historically discouraged organ donation.
Until last year, only residents age 18 or older could register as donors, and before last year, New York was one of only four states that did not permit online registration. Moreover, many New York City residents have never applied for a driver’s license, a common venue for donor registration.
Because patients get priority access to organs donated within their region, New York State’s organ deficit results in a wait that’s typically twice as long as the average in other states. Each year, more than 10,000 Americans—500 of them New Yorkers—die while awaiting a transplant.
If New York State residents donated organs at a rate similar to the best-performing states, such as Montana and Alaska, there would be 100 to 200 more donors per year. A single donor can provide organs to as many as eight transplant recipients.
For Those Awaiting Lung Transplants, Fresh Hope
The shortage of donor organs is particularly acute for those in need of a lung transplant. About 1,500 Americans are currently on the waiting list for such a transplant—most because their lungs have been damaged by pulmonary fibrosis, chronic obstructive pulmonary disease, cystic fibrosis, and other chronic diseases—but less than 20 percent of the lungs evaluated among registered donors are viable for transplantation.
“Lungs are particularly vulnerable because they are directly exposed to the environment, and because they are often injured at the time of death due to pneumonia, lung collapse, and other conditions,” explains pulmonologist Dr. Angel.
Across the New York metropolitan area, Dr. Angel and the Donor Management Center at NYU Langone have partnered with LiveOnNY to optimize the medical management of potential donors, showing an early increase in the number of donor lungs viable for transplantation.
NYU Langone has performed 17 of these lifesaving procedures since the launch of its lung transplant program in February. Its surgical director, cardiothoracic surgeon Zachary N. Kon, MD, has research experience with a technique known as ex vivo lung perfusion that also promises to increase the number of viable donor lungs available.
The technique reconditions damaged organs that would otherwise be unsuitable for transplant by treating them for several hours with a solution of nutrients and oxygen. “In the near future,” says Dr. Kon, “we intend to use ex vivo lung perfusion so that we can consider an entirely new set of potential organ donors.”