<TABLE border=0 cellSpacing=0 cellPadding=0 width="100%"><TBODY><TR>'Medical failures' lead to wasted organs
</TR><!-- headline one : end --><TR>Catch-all term includes potential donors' organs not used due to late identification of suitability </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Salma Khalik, Health Correspondent
</TD></TR><!-- show image if available --></TBODY></TABLE>
<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->THE ailing who need a life-saving organ transplant will mourn the number of organs going to waste.
In 2007, hospitals identified a total of 86 patients whose organs could have been harvested upon their deaths, but organs from only 26 were used. From them came 48 kidneys, 12 livers, four hearts and two lungs.
<TABLE width=200 align=left valign="top"><TBODY><TR><TD class=padr8><!-- Vodcast --><!-- Background Story --><STYLE type=text/css> #related .quote {background-color:#E7F7FF; padding:8px;margin:0px 0px 5px 0px;} #related .quote .headline {font-family: Verdana, Arial, Helvetica, sans-serif; font-size:10px;font-weight:bold; border-bottom:3px double #007BFF; color:#036; text-transform:uppercase; padding-bottom:5px;} #related .quote .text {font-size:11px;color:#036;padding:5px 0px;} </STYLE>FAILED LEADERSHIP
'The leadership of the ICU physician in this whole process is vital. However, many ICU physicians are uncomfortable identifying and referring potential organ donors.'
Annals, the publication of the Academy of Medicine
</TD></TR></TBODY></TABLE>What happened to the organs the other 60 patients could have provided?
While some would not have been used for valid medical reasons, a recent article in Annals, the publication of the Academy of Medicine, suggests 'medical failures' as the cause for most of this loss.
This is a catch-all term that includes, for one, the 'reluctance' of some intensive care (ICU) doctors to identify suitable donors early.
'The leadership of the ICU physician in this whole process is vital. However, many ICU physicians are uncomfortable identifying and referring potential organ donors,' it said.
The term also encompasses decisions made by patients' families to pull the plug on life support machines for heart and lung functions before the patients are brain dead, a move which lowers the quality of the organs. It is possible that some families may not have requested that life support be turned off had this been explained to them.
The study counted 34 patients in 2007 - eight more than the 26 who eventually donated one or more organs - whose organs could have been used if not for such 'medical failures'.
In the business of harvesting organs, time wasted as a result of potential donors being identified late adds critical hours to the time until organs are removed from the donor.
Organs too far deteriorated become unusable.
The better the quality of an organ, the higher the recipient's chance of transplant success.
The article also noted that the rate of organ harvest varied widely across hospitals.
Of the four public hospitals that identified at least 10 potential donors in 2007, the yield of usable organs varied from a low of 4.3 per cent to a high of 56.6 per cent at Tan Tock Seng Hospital (TTSH). The article did not mention the other hospitals by name.
One of the four authors of the article was from the National Organ Transplant Unit and the other three were anaesthetists at TTSH, from where 17 of that year's 26 eventual donors came.
The authors said the big difference between hospitals suggested that 'considerable room' still exists for 'improving the processes for identification and management of potential donors'.
They offered to share TTSH's know-how and best practices with other local hospitals.
The Health Ministry said that between 2006 and 2008, 553 people received transplants.
Another 175 were taken off the waiting list because they were either more than 60 years old, had developed medical complications which made them unfit for transplant, or had changed their minds. A total of 67 patients died waiting for suitable organs.
Associate Professor Chen Fun Gee, who heads the department of anaesthesia at the National University Hospital (NUH), noted that pulling off a successful transplant hinges on many factors, including teamwork and effort from a multi-disciplinary team of transplant coordinators, nurses, surgeons and specialists in intensive care medicine.
Associate Professor Lim Boon Leng of Singapore General Hospital (SGH), where 42 per cent of potential donors' organs were retrieved in 2007, said medical social workers are brought in 'very early' at SGH to support the family of a dying potential donor.
In another article in the same issue of Annals, doctors from the National University Health System and TTSH suggested using 'marginal' or not-so-perfect livers for transplant.
Such livers are now excluded as transplant possibilities here, although data elsewhere shows that if used, they can lower the number of deaths among liver patients.
One of the authors, NUH's Associate Professor K. Madhavan, said the length of time liver patients survive without a transplant depends on the nature of their illnesses, and ranges from days to a year.
A transplant gives them a 90 per cent chance of surviving a year. Three in four make it past the fifth anniversary of their operation, while six in 10 survive 10 years. [email protected]
</TR><!-- headline one : end --><TR>Catch-all term includes potential donors' organs not used due to late identification of suitability </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Salma Khalik, Health Correspondent
</TD></TR><!-- show image if available --></TBODY></TABLE>
<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->THE ailing who need a life-saving organ transplant will mourn the number of organs going to waste.
In 2007, hospitals identified a total of 86 patients whose organs could have been harvested upon their deaths, but organs from only 26 were used. From them came 48 kidneys, 12 livers, four hearts and two lungs.
<TABLE width=200 align=left valign="top"><TBODY><TR><TD class=padr8><!-- Vodcast --><!-- Background Story --><STYLE type=text/css> #related .quote {background-color:#E7F7FF; padding:8px;margin:0px 0px 5px 0px;} #related .quote .headline {font-family: Verdana, Arial, Helvetica, sans-serif; font-size:10px;font-weight:bold; border-bottom:3px double #007BFF; color:#036; text-transform:uppercase; padding-bottom:5px;} #related .quote .text {font-size:11px;color:#036;padding:5px 0px;} </STYLE>FAILED LEADERSHIP
'The leadership of the ICU physician in this whole process is vital. However, many ICU physicians are uncomfortable identifying and referring potential organ donors.'
Annals, the publication of the Academy of Medicine
</TD></TR></TBODY></TABLE>What happened to the organs the other 60 patients could have provided?
While some would not have been used for valid medical reasons, a recent article in Annals, the publication of the Academy of Medicine, suggests 'medical failures' as the cause for most of this loss.
This is a catch-all term that includes, for one, the 'reluctance' of some intensive care (ICU) doctors to identify suitable donors early.
'The leadership of the ICU physician in this whole process is vital. However, many ICU physicians are uncomfortable identifying and referring potential organ donors,' it said.
The term also encompasses decisions made by patients' families to pull the plug on life support machines for heart and lung functions before the patients are brain dead, a move which lowers the quality of the organs. It is possible that some families may not have requested that life support be turned off had this been explained to them.
The study counted 34 patients in 2007 - eight more than the 26 who eventually donated one or more organs - whose organs could have been used if not for such 'medical failures'.
In the business of harvesting organs, time wasted as a result of potential donors being identified late adds critical hours to the time until organs are removed from the donor.
Organs too far deteriorated become unusable.
The better the quality of an organ, the higher the recipient's chance of transplant success.
The article also noted that the rate of organ harvest varied widely across hospitals.
Of the four public hospitals that identified at least 10 potential donors in 2007, the yield of usable organs varied from a low of 4.3 per cent to a high of 56.6 per cent at Tan Tock Seng Hospital (TTSH). The article did not mention the other hospitals by name.
One of the four authors of the article was from the National Organ Transplant Unit and the other three were anaesthetists at TTSH, from where 17 of that year's 26 eventual donors came.
The authors said the big difference between hospitals suggested that 'considerable room' still exists for 'improving the processes for identification and management of potential donors'.
They offered to share TTSH's know-how and best practices with other local hospitals.
The Health Ministry said that between 2006 and 2008, 553 people received transplants.
Another 175 were taken off the waiting list because they were either more than 60 years old, had developed medical complications which made them unfit for transplant, or had changed their minds. A total of 67 patients died waiting for suitable organs.
Associate Professor Chen Fun Gee, who heads the department of anaesthesia at the National University Hospital (NUH), noted that pulling off a successful transplant hinges on many factors, including teamwork and effort from a multi-disciplinary team of transplant coordinators, nurses, surgeons and specialists in intensive care medicine.
Associate Professor Lim Boon Leng of Singapore General Hospital (SGH), where 42 per cent of potential donors' organs were retrieved in 2007, said medical social workers are brought in 'very early' at SGH to support the family of a dying potential donor.
In another article in the same issue of Annals, doctors from the National University Health System and TTSH suggested using 'marginal' or not-so-perfect livers for transplant.
Such livers are now excluded as transplant possibilities here, although data elsewhere shows that if used, they can lower the number of deaths among liver patients.
One of the authors, NUH's Associate Professor K. Madhavan, said the length of time liver patients survive without a transplant depends on the nature of their illnesses, and ranges from days to a year.
A transplant gives them a 90 per cent chance of surviving a year. Three in four make it past the fifth anniversary of their operation, while six in 10 survive 10 years. [email protected]
