Roger Brown of the UNOS Organ Center, which coordinates organdonation and transport Sarah Walor photo
What happens when the heart a patient needs is 2,000 miles away from the operating room and can't be flown in time for the surgery?
It's a scenario that the Richmond-based UNOS can sometimes face in coordinating dozens of organ donations each day throughout the United States. Formally known as the United Network for Organ Sharing, the nonprofit today must deal with changing air-travel security regulations — a result of the terrorist attacks of Sept. 11, 2001 — which can slow down the transfer of vital organs used in organ-transplant surgeries.
Gigi Spicer, director of the Virginia Transplant Center at Henrico Doctors' Hospital, hit a snag three years ago when UNOS called her to say a donor kidney on its way to Richmond couldn't be placed on a plane at the departure city. No one at the airport could clear the organ through security — the only person trained in the necessary Transportation Security Administration rules was not on duty.
UNOS connected Spicer with a courier who "found another airport with a connecting flight to Richmond where the people had been trained," she says. "We got the kidney, and it was transplanted in a timely matter."
Roger Brown, assistant director at the UNOS Organ Center, says his organ-placement specialists relay information from surgical teams with the donor patient to transplant teams elsewhere "so they can make informed decisions about whether to accept or decline those organs. When they say yes, that starts the transportation process."
UNOS mainly transports kidneys, pancreases and livers because they have a longer shelf life than hearts and lungs. A recovered pancreas or liver has a 12-hour transportation window. Kidneys can go beyond 24 hours. "Hearts and lungs only have between four to six hours from the time they are recovered to be transplanted," Brown says.
Organs are transferred nationally and regionally by commercial airlines, charter planes and ground transportation. The majority of organs placed by UNOS are shipped by commercial airlines; federally designated organ-procurement organizations mainly use private air services, which don't face the same challenges as commercial aircraft.
UNOS relies on a network of national courier companies that specialize in the transportation of organs. After being contacted by UNOS, the couriers weigh all the variables — contingency traffic, flight patterns and flight times — before scheduling the process.
Since the 2001 attacks, the organ-transport routine has changed in several ways. For example, before the attacks, couriers could run boxed organs to the plane's gate. "As long as it got to the aircraft before it took off, you could get it on the plane," Brown says, adding that today "the organs have to be tendered to one of their personnel an hour before the plane takes off. An hour gives them the time to get it correctly on the plane and run it through their mechanisms."
Brown recalls one incident when a courier couldn't pick up an organ because it wasn't ready at the desired time. The long lockout time caused it to miss the last flight out. "We had to drive the organ to an alternate airport," he says. "It resulted in a five-hour delay because of the lockout, but it was still successfully transplanted. In the old days, we could have gotten it to the airport at the last minute and run it to the gate and put it on the plane."
The airlines, as well as UNOS' couriers, also must deal with new federal codes regarding baggage and transportation. Prior to 9/11, an organ package could be carried in the plane's cabin, "often, directly in the cockpit with the pilots, which really saved on time," Brown says. "The package was the last thing on the plane and the first off."
Organs now travel with the baggage under the plane in one of the heated bays. "It can take some time to get the organs offloaded," Brown says. "Generally, we have them offloaded in 30 minutes."
Federal regulations can change at any moment. In the last six months, for instance, new rules have barred the use of preservation pumps — because of the lithium batteries used to power them — while transporting some kidneys. "We would keep the kidneys on a pump so they were being actively preserved," Brown explains. "Now we have to use static preservation or wet ice."
Still, UNOS has found ways around the challenges. "We are moving just as many and probably more organs as we did before 9/11," Brown says. "We have to move them differently, and that has made us think a lot more and come up with other solutions. We are more creative with the airports we use and city selections when we work with connections."
UNOS organ-placement specialist Tim Ernst sees the airlines as a partner in the process. "They treat the organs like gold. I have even had airline employees stay late on Saturday night because they knew a kidney was arriving so they could get it to a courier. It's amazing to me and a mark of tremendous service how many organs airlines handle and get them there perfectly."