UCH enjoys (mysterious) spike in tissue donations

Organ donations get the spotlight, but tissue donations also save, improve many lives
September 27th, 2016
Does your driver’s license have a heart? If not, register at www.donatelifecolorado.org.
Does your driver’s license have a heart? If not, register at www.donatelifecolorado.org.

Organ donations get most of the attention in the transplant world, and for good reason. In Colorado alone, nearly 2,700 people are waiting for a lifesaving donor kidney, liver, heart or for transplant. Nationwide, some 120,000 people fill the many waiting lists, according to the nonprofit Donor Alliance, the hub for such donations in Colorado and Wyoming.

But these solid organs, vital as they are to transplant patients here and around the country, are only part of the story. Vastly larger numbers of people – from babies needing heart valves to adults with damaged knees to those who have been severely burned – depend on skin, tendons, cartilage, bone, corneas and other donated tissues. Tissue donations are central enough to the Donor Alliance mission that its logo’s subheading reads, “Organ & Tissue Donation.”

While recipients ultimately depend on the generosity of donors, hospitals such as those of UCHealth play a big role, too. Donor Alliance earlier this month recognized University of Colorado Hospital with an “Ending the Wait” award recognizing “outstanding achievements in facilitating the gift of life through organ and tissue donation in Colorado.”

The hospital, which Donor Alliance described as “a leader in organ and tissue donation and transplantation,” was lauded for a 48 percent increase in tissue donations from 2014 to 2015. UCH had 96 tissue donors, second in the state to the 99 of St. Anthony Hospital in Lakewood. In addition, UCHealth’s Memorial Hospital Central and Memorial Hospital North contributed a combined 70 tissue donations; Medical Center of the Rockies 57; and Poudre Valley Hospital 41.

The 2015 numbers were up slightly for many hospitals. Exactly what drove the jump at UCH – which had 65 tissue donations in 2014 – is something of a mystery.

Numbers game

Donor Alliance LogoOrgan donations loom large in the public imagination, but tissue donations are no less important – a fact underscored by their presence in the Donor Alliance logo.
The hospital’s growth certainly played a role. In 2012, the year before Anschutz Inpatient Pavilion 2 opened, UCH had 35 tissue donations. One can attribute some of the near-doubling of UCH tissue donations by 2014 to the accompanying rise in hospital volume, says Kristy Plenter, a former UCH transplant licensed clinical social worker who is now Donor Alliance’s donation consultant working with UCH. More volume translates into more in-hospital deaths (roughly 60 percent of all deaths happen in hospitals), though the numbers don’t account for the sharp rise in tissue donations.

Donor Alliance’s work to get more people to consent to donating organs and tissues is also contributing to an increase in tissue donations. Tissue and organ donation is a formal process. With each death at a Colorado hospital, a nurse calls Donor Alliance, where call center staff check the person’s name against their database of those who have consented – typically through the driver’s license registration process (check your license; if there’s a little red heart on in the lower-right corner, you’re on the registry).

Through outreach at more than 200 events and other efforts, Donor Alliance helped add nearly a million names to their registry in 2015, according to Andrea Smith, the organization’s director of communications. Since 2012, tissue donations have grown 67 percent statewide, in no small part thanks to such get-out-the-consent efforts. Sixty-eight percent of Colorado adults are now on the registry, second only to Alaska, Smith says. Still, that doesn’t explain all of UCH’s 174 percent increase in tissue donors over the same period, even taking the hospital’s growth into account.

Gentle ask

Paige Quigley
Paige Quigley of the hospital’s Decedent Affairs team. Quigley and colleague Victoria Verderosa inquire about possible tissue donations with families of those not on the Donor Alliance registry and help to boost tissue donations.

Which brings us to the UCH Decedent Affairs team. If a newly deceased patient is not on Donor Alliance’s registered-donor list, Decedent Affairs counselors Paige Quigley and Victoria Verderosa, as “designated requestors,” gently inquire as to whether the family might be interested in donating their loved one’s tissues.

The question might be, “Have you ever had a discussion with your son about whether he wanted to be a donor?” Quigley said. She might follow up with some of the benefits that tissue recipients reap: skin to help burn patients heal, bones that help orthopedic patients walk, and corneas that restore sight to those who can no longer see. But these families have often been through a lot. If the answer is “no,” the conversation ends there, she said.

“I always say, ‘I respect ‘no’ as much as ‘yes,’” said Quigley.

About one in three families say “yes,” which 2015 Donor Alliance data show translated into 36 tissue-donation consents via Quigley, Verderosa, and the chaplains on the UCH Spiritual Care Services team, who are also designated requestors. That exceeded the tissue-donation referrals from 33 of the 81 Colorado hospitals Donor Alliance tracked in 2015.

Wide web

The good tissue donors do is hard to calculate. Unlike solid-organ donors, tissues go to tissue processors, a handful of which Donor Alliance works with. One of them, Centennial-based nonprofit AlloSource, lists a wide array of products for diverse procedures, including spinal grafts, osteobiologic grafts, cartilage restoration and tendons. Others specialize in heart valves; others repurpose veins and arteries. Smith estimates that a single tissue donor typically helps dozens of patients whose procedures have ranged from mastectomies to abdominal surgeries to anterior cruciate ligament repairs as well as serious, limb-saving repairs.

Allo Source Skin
Among other benefits, donated skin helps control infection and fluid maintenance while diminishing pain, according to AlloSource.

UCH patients receive as well as give. Jonathan Bravman, MD, a CU School of Medicine/CU Sports Medicine orthopedic surgeon practicing at UCH, said he uses “many allografts, on nearly a weekly basis,” examples being ligament reconstruction and cartilage restoration in addition to new approaches to fixing otherwise irreparable shoulder rotator cuff injuries and wear. He described the allografts derived from donated tissues as being “absolutely critical” to restoring function and bringing “significant benefit to a significant number of patients.
Skin processed by Centennial-based AlloSource, one of a handful of tissue processes with whom Donor Alliance works, saves the lives of burn patients.
“It is just an absolutely incredible gift, enabling us to do things for patients that essentially allow these gracious donors to live on, so to speak, through their extreme generosity,” Bravman said.

Mary Holden, RN, MS, the UCH Burn Center’s nurse manager, says skin allografts are vital in treating large burns. The donated skin buys time – up to about two weeks – for the patient’s own donor-site skin to heal for use as permanent skin grafts as well as for wound beds to heal enough for reconstructive surgery to work, she says.

Donated skin, Holden said, is “extremely important for us to save people’s lives.”

Why exactly UCH’s tissue donations shot up so much in 2015 remains a mystery, though the general rise in statewide donor registrations, the growth of the hospital, and the hard work of the Decedent Affairs team explains a lot of it. Perhaps a disproportionate number of those who passed away at UCH happened to have been registered organ and tissue donors. Regardless, families can take comfort in knowing that their loved ones’ final acts of generosity have improved and even saved the lives of so many others.

To join the Donate Life Colorado organ and tissue donor registry, visit www.donatelifecolorado.org.