A Mission to Save More Lives Where we’ve been, where we are, and where we need to be Thomas A. Nakagawa, M.D, FAAP, FCCM Professor, Anesthesiology and Pediatrics Wake Forest University School of Medicine Pediatric Critical Care Medicine Wake Forest University Baptist Health, Brenner Children’s Hospital Winston-Salem, North Carolina Presenter has no financial disclosures

The current status of a national issue that continues to escalate The need for organs is clearly evident with a growing transplant waiting list that has now exceeded 112,000 people In ,168 people died waiting for a needed organ* 3,643 were removed from the wait list because they became too sick to transplant 109 deaths were children *OPTN data accessed May 16, 2011

The facts about donation and transplantation *OPTN data.

WAITLIST PATIENT BY ORGAN TYPE October 9, 2011 *OPTN data. Accessed October 9,

Rate (%)

Source of organs for transplantation

Region 5 data

Region 5 Jan June 2010 Jan 2011 – June 2011 Percent Change Total Donors % Organs Transplanted % OTPD % Consented Eligibles 69.2%69.8% Collaborative Conversion Rate 68.7%72.1%

Region 5 January - June 2010 January - June 2011 Percent Change Standard Criteria Donors % SCD Organs Transplanted % SCD OTPD % % of All Donors74.1%69.5% Extended Criteria Donors % ECD Organs Transplanted % ECD OTPD % of All Donors17.5%19.1% Donation After Cardiac Death Donors % DCD Organs Transplanted % DCD OTPD % % of All Donors

A local issue that continues to escalate 20,629 people are part of the national waitlist for California There were 3,222 transplants performed in the State of California in 2010 *OPTN data. Accessed October 9,

State of California –1,164 people died last year waiting for a needed organ *OPTN data. Accessed October 9,

DCDD donors UNOS. OPTN data Pediatrics patients < 18 years of age Adult DCDD donorsPediatric DCDD donors 2006: 645 DCD donors 77 pediatric 2007: 793 DCD donors 66 pediatric 2008: 847 DCD donors 73 pediatric 2009: 747 DCD donors 81 pediatric 2010: 939 DCD donors 72 pediatric All DCDD donors

939 DCDD donors in 2010 impacted 1,797 lives by providing additional organs for transplantation Renal and some liver grafts from DCDD donors have graft function and transplant recipient survival rates comparable with organs recovered from SCD donors Lungs from DCD donors are being recovered and transplanted with good success Many hospitals are working to establish policies and identify donors as we all work to find more organs for the growing number of people on the national transplant waiting list Success with DCDD organs

The facts about pediatric donation 1,766 children are waiting for a needed organ* Children make up 1.5% of the total national waitlist Approximately 150 children die annually waiting for a needed organ and another children are removed from the national waiting list because their condition deteriorates making them ineligible for organ transplantation Children less than 1 year of age have the highest death rate waiting for an organ *OPTN data. Accessed October 9,

Pediatric patients: birth to 17 years of age Data compiled from OPTN Pediatric patients: birth to 18 years of age

Data compiled from OPTN

The Current State of Pediatric Donation Organs transplanted per donor Adults3.09 Pediatrics4.06 All donors % of hospitals with more than 5 eligible pediatric donors had a 50% or less conversion rate 73% of hospitals with more than 5 eligible pediatric donors had 0 DCDD donors

PEDIATRIC* WAITLIST PATIENT BY ORGAN TYPE October 9, 2011 * Pediatric patients age 0-18 years of age 1,766 Children Waiting *OPTN data. Accessed October 9,

Important options for neonatal donation En bloc neonatal kidney transplants Liver cell transfusions as a bridge to transplant for smaller infants with end-stage liver disease Use of ABO incompatible hearts for transplantation into infants younger than 1 year of age DCD heart transplantation

Our role as champions for donation and transplantation The difference between life and death can mean the difference in one organ from one donor It’s not all about the “big programs,” it’s about all programs that are designed to save lives The impact of many small programs that recover organs from a few donors annually has a significant impact regionally and nationally The importance of tissue donation must also continue to be emphasized

Our role as champions for donation and transplantation Everyone of us in this room is a champion We have the capability to save more lives We will save more lives through our hard work dedication to recover more organs and provide better organs for transplantation

What roles and responsibilities do each of us play during organ donation and end-of-life care for patients and families? How can we maximize the opportunity to recover more organs for transplantation to reduce the number of people dying on the national wait list?

Listen, learn, and teach others Be bold: Share your thoughts and experiences Focus on what we can do, not what we can’t do Remember that our focus is the patient and the family We are here to save lives