Donor Care Units Optimize Organ Donation and Honor Donor Heroes

Bobby Nibhanupudy, MD
Medical Director, AdventHealth Transplant Institute
Abdominal Transplant Program and OurLegacy

While a single organ donor can save up to eight lives, the current need for organ transplants far outweighs the supply. In fact, more than 104,000 people are waiting for a lifesaving transplant in the U.S., including more than 5,000 Floridians, according to the United Network for Organ Sharing (UNOS). Of those, almost 600 are being cared for right here in Central Florida by our AdventHealth Transplant Institute, Orlando’s only solid-organ transplant program.

To help bridge the gap and save more lives, AdventHealth and OurLegacy, east Central Florida’s federally designated organ procurement organization (OPO), recently opened an innovative, centralized and family-focused donor care unit called the OurLegacy Center. It is the first of its kind in Florida and one of only 20 specialized donor care units in the U.S.

Growing Challenges in Organ Procurement

The Centers for Medicare and Medicaid Services (CMS) oversees the nation’s OPOs and establishes standards by which they are measured and recertified every four years. Their criteria include the number of donors, and the number of organs transplanted from those donors, as compared to the number of potential donors who die in an OPO’s service-area hospitals.

Historically, organ procurement has occurred at the donor hospital. However, several factors have made this approach increasingly challenging:

• Advanced organ preservation technologies, such as extracorporeal liver, heart and lung perfusion, require the use of biomedical equipment that can be cost prohibitive for smaller community hospitals.
• The rise in the incidence of chronic diseases in the potential donor population has made the process of maximizing organ yield more complex, requiring additional time-sensitive testing that places added pressure on donor hospitals.
• The staffing and travel demands of the procurement process can strain hospitals that already face significant workforce shortages and individual burnout.
• The COVID-19 pandemic exacerbated already limited resources.

Bottom line, despite everyone’s best efforts within the transplant community, we found that we were losing potential donors and needed to take a different approach. In its February 2022 report, “Realizing the Promise of Equity in the Organ Transplantation System,” the National Academy of Science, Engineering and Medicine (NASEM) recommended that OPOs create, establish and manage donor care units to better serve donors and families, increase cost-effectiveness, and foster innovation in organ rehabilitation and donor intervention research.

A New Model to Improve Outcomes and Care

The donor care unit (DCU) concept originated about 20 years ago at Mid-America Transplant, an OPO in St. Louis, Missouri, and has increased organ yield by approximately 20% while also decreasing organ procurement costs. This centralized model operates as a critical care and surgical unit dedicated solely to organ procurement, and all organ donors are transported to that unit from hospitals throughout the OPO’s service area.

Additional published outcomes on the effectiveness of this innovative approach include the following:

• Post-donation surveys consistently report high satisfaction with the DCU experience by donor families, with average results of 9.75 out of 10 for overall satisfaction.
• There have been no reported adverse effects to the donation culture within donor hospitals or any negative effect to donor families because of centralizing deceased donor care.
• Several reports by MidAmerica Transplant demonstrate a consistent and sustainable increase in organs transplanted, most notably a 71 percent increase in lung transplantation, when comparing two time periods (2001–2007 vs. 2009–2016).
• A subsequent study by the University of Pennsylvania of all U.S. donors receiving care in a centralized environment reported a higher number of lungs, livers and pancreata donated for transplantation.

Within the transplant community, we believe the DCU approach will also help address challenges with provider burnout, the transplant surgery pipeline and surgeon travel, allowing for increased daytime operating.

The New OurLegacy Center in Orlando – Honoring Donor Heroes and Supporting Their Families

Our new donor care unit, the OurLegacy Center, opened in September 2024. It was built off the successful St. Louis model while also embracing AdventHealth’s unique “whole person” approach to caring for both the donor hero and their family.

Once authorization for donation is obtained, OurLegacy’s medical director becomes the deceased donor’s attending physician, overseeing all treatment decisions, including transfer of the donor hero from the referring hospital to our facility. Donor hospital staff no longer need to accompany the donor, freeing up that human resource.

Donor families are given the option to say their good-byes at the referring hospital or move to our donor care unit. Either way, “honor walks” and flag raising ceremonies can take place, and all efforts are made to ensure that the organ donation process does not delay funeral ceremonies. OurLegacy provides the ambulance transfer of the donor hero, transports the family to our facility if they wish and incurs all costs.

Once at the OurLegacy Center, our 50-person dedicated staff provides critical care and surgical care services for the donor as well as support for the donor hero families. This includes chaplains, family service coordinators and other specialized teams who can help families with the grieving process. Within our unit, we provide private space for donor families, including sleeping accommodations, internet access, restrooms, televisions and landline use. Our goal is to provide them with more comfort in saying goodbye to their loved one and a special place where they feel cared for as well.

Enhancing the Organ Donation Process to Save More Lives

From dialysis to advanced heart and lung maneuvers, our donor management team has greater ability to physiologically rehabilitate donor organs than ever before. Now we also have a dedicated facility specifically designed to more efficiently, effectively and collaboratively do so while also more compassionately caring for our organ donor heroes and their families. We believe the OurLegacy Center will enable us to place more organs for transplantation, providing new hope for those awaiting transplants and ultimately, saving additional lives.