Most donated organs aren’t preserved in time to be usable. Tennessee’s first ‘donor care unit’ is trying to change that.

This year, a Nashville hospital became the first in the state to create a special unit for organ donation.

St. Thomas Ascension West and Tennessee Donor Services established the wing this fall. They’re joining a trend. Hospitals across the country have been creating similar units or building freestanding ones. The idea: organ removal is resource-heavy and high stakes. Organs become unusable quickly, but specialized staff and space can hedge against that damage.

Angela Owens, the hospital’s nursing director, explained how the five rooms operate.

“Each room set up just like an ICU wing,” she said. “The ventilator system is set up here, and we have a warmer. Everything is ready to go for the patient when they come in.”

It’s set up like an intensive care unit because it is just that — intensive. Chief Nursing Officer Amir Hamad explained why.

“If you were going to focus on a person’s lungs, it’s not like, you know, ‘They’re on a ventilator; all is good,'” he said. “You’ll have to hyperventilate a lung to open it up fully. You’ll have to make sure there’s no disease … within the lung.”

He said the staff has to evaluate each of the organs like this, or there can be dire consequences for the transplant patient down the line. He used the heart as an example.

“You don’t want to transplant a heart that has a blockage,” he said, “You transplant them and then they have a heart attack shortly thereafter.”

So the process of removing, evaluating and preserving the organs themselves is difficult. Workers also have to care for the donor’s body more generally so that the organs don’t deteriorate before they can be removed. They have to maintain the right temperatures and fluid balances. They have to make sure hormones stay balanced. The staff is still providing intensive care for the donor throughout the process.

Another reason this care comes with high stakes: there is more demand for organ transplants than there are organs available. Hospitals performed more than 30,000 transplants from January to October of this year, and still the country’s organ transplant waitlist has more than 100,000 people on it.

Some of this gap exists because there aren’t enough donors. Hamad noted that becoming a donor is as easy as checking a box when getting a drivers license.

“That check mark on that page is so incredibly important,” he said. “And I don’t think a lot of us take that into account as deeply as we should … It’s hard for any of us to think about what happens when we’re, you know, no longer here. But it’s made easier by thinking, ‘Hey, I can help seven people live.'”

But the journey from donor to transplant patient is also an issue.

Organs have a tendency to get lost. Policies enacted after the September 11 attacks require organs to be flown in cargo holds. The country’s central organ donation agency, the Network for Organ Sharing or UNOS, maintains this is one of the reasons so many organs get lost. A U.S. Senate committee released an investigation into that agency last year.  It found UNOS had a lost-in-transit rate for organs that was 15 times higher than airlines’ lost-in-transit rate for luggage.

And finally, obtaining these organs in a timely manner is difficult. It’s common for organs to become unusable before they can make it into the system, which is the problem that specialized donor care units like the one at St. Thomas Ascension West are trying to combat.

Federal statistics show that on average, hospitals recover fewer than four organs per donor. And that number counts each of the two kidneys separately.

One of the driving forces behind opening these units is getting those numbers up by protecting resources for donor care. Hospitals around the state are consistently struggling with nursing and other staff shortages, and because of the pandemic, they’re spending billions of dollars more than they’re bringing in.

Most hospitals rely on the ICU for donor care. That can create conflicts during emergencies, when demand for ICU beds and staff surge. With a separate unit, donor care doesn’t have to compete for those resources, which is one of the reasons that the Organ Donation and Transplantation Alliance has encouraged more hospitals to build them.

Hamad explained these logistical and resource challenges affect the number of viable organs a hospital can obtain from a donor.

“You may have a donor who decides to give,” he said, “And at one of these outlying facilities against stretched resources, we may be able to capture kidneys, right?”

But, he explained, a dedicated donor care unit makes it more likely that more of the donor’s organs will be usable for transplants.

“You have very structured approach — it’s research based — and it may be the difference between kidneys; or kidneys and a heart; or kidneys and a heart and lungs; or kidneys, heart, lungs, pancreas.”

And that can mean the difference between life and death for patients waiting for a transplant.