IBJ Photo/Eric Learned Clinical Support Coordinator Morgan Schussler handles the phones at the Indiana Donor Network. The network receives more than 500 calls a week about news about available organs.
Jamie Jessen put on his headset and pressed a button on his workstation. Fort Wayne hospitals were also on the line. The hospital said an elderly woman in the hospital’s intensive care unit was in a weakened state and tissue could be available within hours.
“Is she on a ventilator?” Jessen, clinic support coordinator for the Indiana Donor Network, asked the hospital coordinator.
“no.”
“Does she have a heartbeat now?”
“yes.”
“Do you have a history of cancer or dementia?”
“no.”
After learning more information, Jessen wrote a memo warning the network that if the patient died, a team might need to be sent to the hospital to transport the patient to Indianapolis for tissue recovery. did.
The Indianapolis-based network is one of 56 federally designated organ retrieval agencies in the nation and typically responds to more than 500 calls a week from hospitals across the state, where organs and tissues are recovered. Alerts you that it is available or may become available soon.
And the organization, which serves 85 of Indiana’s 92 counties, is booming with record numbers of donor and transplant organ registrations. Last year, we donated 1,134 organs to hospitals, primarily in the Midwest, for transplantation to patients. This was a 17% increase over the previous year and the highest amount in the organization’s 37-year history.
Last year, the network registered more than 925,000 Indiana residents to become organ and tissue donors, bringing the total number of potential donors to 4.4 million.
“Our ultimate goal has always been to eliminate wait times for life-saving organ transplants,” said CEO Kelly Tremaine. “So we are trying to take every step in that direction.”
But the nonprofit organization, founded in 1987, now faces the possibility of major change like other national networks.
In September, President Joe Biden signed a bill aimed at overhauling the nation’s organ transplant system by increasing competition among contractors and paving the way for additional funding.
White House press secretary Karine Jean-Pierre told reporters that the new law allows a single private nonprofit organization to be the sole contractor to manage the nation’s organ procurement and transplant network for nearly 40 years. He said it would “dismantle the current monopoly system”. last fall.
He added that the legislation would allow the federal government to contract with outside vendors to provide “a more efficient system for the people we serve.”
The bill passed Congress with bipartisan support. Sen. Todd Young (R-Ind.), Sen. Chuck Grassley (R-Iowa), Sen. Ron Wyden (D-Ore.), Sen. Ben Cardin (D-Md.), Bill -Senator Cassidy (R-Louisiana) was one of the sponsors of the Senate version of the bill. Rep. Larry Bushong (R-Ind.) and Rep. Robin Kelly (D-Ill.) introduced the House version.
“Today is a monumental day in the effort to improve America’s organ transplant system,” Wyden, chairman of the Senate Finance Committee and one of the law’s sponsors, said in a statement last fall. “For too long, thousands of families have had to watch their loved ones struggle while waiting for organ transplants because of an inefficient and unaccountable system. That will begin to change, requiring accountability, know-how and improvements that will lead to more Americans receiving life-saving transplants.”
The Indiana Donor Network said it is “ready to work with partners in all countries” to provide organs to patients in need.
save more lives
The White House said the measure is aimed at shortening wait times and reducing the number of patients who die while waiting.
More than 103,000 people are on transplant waiting lists nationwide, and 17 people die every day waiting for an organ transplant, according to the U.S. Health Resources and Services Administration.
The United Network for Organ Sharing, the national nonprofit that manages the network and coordinates transplants, welcomed plans to reform the national system and called for a “more competitive and open bidding process.” He said he supports it.
Meanwhile, the Indiana Donor Network is strengthening its position to increase the number of donors and reduce wait times for transplants.
Last year, the network hired 107 people for a total of 327 people, its largest workforce to date.
Employees led more than 1,000 presentations in schools and communities. We also provided grief and counseling services to approximately 3,000 families of organ and tissue donors. and created a special department to educate hospitals about donations and transplants.
“I think we’ve pretty much grown every department in the last two years,” Tremain said.
Organ transplants are big business. Hospital costs for a liver transplant can cost more than $800,000, and more than $1.6 million for a heart transplant, according to a 2020 report from Seattle-based Milliman Research. The cost of multiple organ transplants can reach $2.6 million. This includes organ procurement, physician services, medications, laboratory tests, 30 days of pre-transplant medical care, and 180 days of follow-up care.
indiana transplant
There are only two hospital systems in Indiana that provide transplant services. Indiana University Health’s downtown hospitals (Methodist Hospital, University Hospital and Riley Hospital) performed 515 transplants last year. And Ascension St. Vincent’s flagship store on West 86th Street achieved his 101.
Lutheran Hospital in Fort Wayne announced last year that it would suspend transplant services due to low transplant volume.
Perhaps more than any other hospital service, organ transplant programs rely on high production volumes and market share to offset large fixed costs.
As a result, hospitals that perform transplants typically don’t see short-term profits, said Ed Abel, retired director of medical operations at Blue & Co., an Indianapolis-based accounting and consulting firm.
“They’re doing it because by providing these services, they can take the health system to a new level,” he says. “This requires a significant team of highly trained clinicians. Because once you have established a reputation for organ transplantation, people know that you are good at a very complex field. , we would like to port it to other fields as well.”
Last year, Indiana University Health ranked fourth in the nation for pancreas (32) and intestine (9) transplants, and ninth for liver (189).
Kidneys, hearts, and lungs were ranked lower, probably because of the high number of transplants for these organs across the country. Major hospitals such as the Mayo Clinic and the University of California, San Francisco Medical Center performed more than 400 kidney transplants last year, compared to 205 at IU Health, according to the Organ Procurement and Transplant Network.
The Indianapolis-based hospital system said demand for transplants is high, but one factor limiting growth is a shortage of personnel, including highly trained transplant nurses.
“It’s very labor-intensive to perform the large number of transplants that we do,” said Dr. Jonathan Fridell, chief of abdominal transplantation at IU Health. “And we tried our best and things worked out well, but it takes a very dedicated team of nurses to make this work. … We’re constantly looking.”
make a match
The Indiana Donor Network has expanded its staff to more than 300 people, up from about 100 a decade ago. That includes teams of jet pilots and road drivers who will rush nurses and technicians to hospitals across the state to test donors and bring them back to Indianapolis.
Only about 15 percent of the organs recovered by the Indiana Donor Network remain in Indiana for transplant. The rest will be sent to transplant centers and hospitals in other states. “The goal is to get organs to the sickest patients within a radius of about 500 miles,” Tremaine said.
National computers match organs for transplantation based on a complex formula that combines donor and candidate information. However, the process can be arduous. With traditional organ donation, if a person is declared dead, they must be hospitalized and put on a ventilator. When a person experiences cardiac death, which means the heart stops working and is unable to function again, the organ has typically begun to fail due to lack of blood flow and cannot be removed and reused.
Depending on how a person dies, such as death from trauma, workplace accidents, or other circumstances that result in immediate death, they often cannot become an organ donor.
According to the Indiana Donor Network website, “a potential donor’s medical condition at the time of death determines whether they are eligible to donate and what organs and tissues are available for donation.” “Only 3 out of 1,000 people are medically qualified to be organ donors.”
equipment upgrades
The network is spending millions of dollars updating and expanding its facility on Guion Road, just off Interstate 65 at West 38th Street.
For many years, all offices were located in one low-rise building on the property. Several years ago, the Indiana Donor Network purchased a nearby four-story building from the relocating AAA Hoosier Motor Club for $2.2 million. The donor network spent approximately $16 million to renovate and modernize the building with new elevators, staircases, offices, and meeting rooms for administrative offices and space for community events and education.
In 2020, we updated our original building, just a few dozen steps from our new headquarters, as our Organ and Tissue Recovery Center. The network estimates it will cost $3.3 million to purchase and install medical and diagnostic equipment, and additional renovations will cost an additional $2.5 million once the upgrade is complete next year.
Strolling through the Organ and Tissue Recovery Center is like visiting a small hospital. This includes a CT scanner and other imaging equipment for examining donated organs, as well as a sterile area.
There is also a five-bed intensive care unit, where brain-dead patients on ventilators are kept until they are transferred to one of two large operating rooms, where surgeons can retrieve organs and tissues. .
“This is an organ recovery room,” Steve Johnson, the network’s chief operating officer, said as he led an IBJ reporter and photographer through the large operating area. “The only difference between this and a regular operating room is the size. We have a lung team, a liver team, a kidney team. That means we have a team of surgeons for each individual organ. This There are a lot of people in the room who have to work together.”
There are no donors in the clinic on this day. The organ recovery room and ICU are empty.
In another room, 12 kidney perfusion pumps keep blood circulating to the removed kidneys, allowing doctors to continuously monitor the organ’s status.
Nearby, a new machine called the LifePort Liver Transporter was used for the first time last year under research approved by the U.S. Food and Drug Administration. The liver was donated by a 90-year-old woman in Indiana and was transplanted into a patient in Cincinnati.
The Indiana Donor Network sounds optimistic that it can continue increasing donations and transplants for the eighth year in a row thanks to new technology, increased staff and modernized facilities. In about 10 years, the number of organs sent to hospitals for transplant has more than doubled.
“The growth has been incredible,” Johnson said. “It’s because Indiana has grown so much. It’s because we get the word out, we embrace our communities, and we build good relationships and trust within our communities and among our health care providers.”
