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Organ donation rates are rising nationwide as tiny federal effort pays off

NEENAH, Wis.—Danny Sadlon's last words to his stepmother were: "Adam oughta get his own damn car."

At dawn the next morning, hustling back from a Halloween celebration in Madison to get to his roofing job on time, Sadlon, 20, hit an oncoming car, killing its driver. Three days later, Sadlon died of head injuries, but that wasn't the end of his story. Nor is it the end in many similar tragedies, thanks to a nationwide surge in organ donations.

Today, an Omaha, Neb., man is off of dialysis thanks to one of Sadlon's kidneys. The other kidney, and Sadlon's pancreas, are enabling a Michigan woman to attend nursing school. A retired Chicago cop with emphysema is doing OK with Sadlon's lungs. A northern Wisconsin man who received Sadlon's liver can drive South and winter on the Gulf Coast again. And Charlie Pluth, a retired air-conditioning sales engineer from Madison who couldn't walk a block before he received Sadlon's heart, now can walk as far as he pleases.

Such transforming stories—unimaginable 50 years ago when transplants began—are commonplace now. A record 26,984 U.S. patients received transplanted organs last year. This year's numbers will be even higher, thanks to hospitals nationwide that have upped their donation rates with the help of an unsung little federal initiative.

More transplants mean increased demand for donated organs, however, as more doctors seek that option for dying patients. And that's intensifying the unique and wrenching pains and pressures that people who are waiting for organs—today nearly enough to fill the Rose Bowl—face. Families who've decided to donate loved ones' organs deal with different but equally exotic emotions, as do transplant recipients.

At first, "you feel so guilty," Pluth, 67, said of his November 2003 transplant. And at first, Danny Sadlon's stepmother, Dawn, who teaches autistic kids in Oshkosh, thought he should. She couldn't bear to think of Pluth and his family "having fun at Christmastime while we were crying our eyes out," she said.

"You look at people and realize that they're alive because your son is dead, " Dawn Sadlon recently told Sharlyne Agostine, a woman from Seymour who'd donated her own teenage son's organs in 1997.

Agostine's advice: "You have to recognize that and let it go."

Hospitals that are trying to increase organ donations usually look up the University of Wisconsin Hospital in Madison, whose organ-donation efforts cover the state except for the Milwaukee area. Last year, the system persuaded 78 percent of potential organ-donor families to donate their dying loved ones' organs, tying for the nation's highest rate with San Diego's Lifesharing Community Organ Donation. The national average was 56 percent. If the U.S. rate equaled Wisconsin's, almost no one who's on the organ transplant-waiting list would die. Instead, 6,529 died last year.

Wisconsin's story began 14 years ago when then-Gov. Tommy Thompson started promoting organ donation at the urging of Dr. Hans Sollinger, the university hospital's top transplant surgeon.

Today, driver's education in the state includes a mandatory half-hour on organ donation. Driver's licenses have a donation check-off. Stock-car drivers and local TV personalities promote organ donation. The governor confers medals on donor families at an annual governor's mansion ceremony. In Wisconsin, the civic virtue attached to donating organs is up there with donating blood.

But that doesn't ease the wait for a transplant.

"Someone has to die for you to live, so what do you pray for?" asked liver transplant recipient Linda Ourada, 55, a banker's wife from Appleton.

She used to drive two hours weekly to the hospital transplant clinic in Madison on what she called Liver Wednesday: That was when those seeking transplants got checkups.

Everyone hoped to do badly, Ourada said, because of the way the federally regulated priority system works. It requires that the sickest patient capable of taking a donated organ get the next transplant.

To estimate her chances, Ourada confided, "I'd try to do my urine test last. Then I'd put my sample up on the counter in a row with all the others. Dark urine is a sign of severe disease, you know, so I could bend down and judge where I stood by how dark my sample was compared to the others."

Then she'd go back to the waiting room to appraise the faces of the other patients.

"Really, you saw the same thing in every face," Ourada recalled. "Just give me another chance to keep going at it."

When President Bush summoned Thompson to Washington to head the Health and Human Services Department in his first term, Thompson took his enthusiasm for organ donations with him. It grew into the Organ Donation Breakthrough Collaborative, an HHS program that employs five people and cost $4 million last year.

Its strategy is simple: First, learn the secrets of the hospital trauma centers that promote organ donations most effectively. Then convince the country's 200 biggest hospital trauma centers to use them. While some organs, mainly kidneys, come from living donors, the major source is patients who die in hospitals.

The plan is working spectacularly. Long-flat organ donor numbers hit all-time highs nationally in each month since January 2004. The 11 percent increase kept 1,368 more transplant patients alive, according to Dennis Wagner, the director of the collaborative.

According to Jim Warren, who's been the editor and publisher of the industry newsletter Transplant News for 20 years, the collaborative is "the best thing the government's ever done" for organ donations.

Among its findings: Potential donor families who think that their loved ones received great care are more likely to donate. Minority families are more likely to give when members of the same minority group approach them. Requesters who begin their appeals assuming the families will consent are more likely to succeed than ones who simply ask whether the families want to donate organs.

Support from top hospital officials also helps. So does communication about organ donation among intensive care nurses, doctors and others from the moment a potential donor enters the hospital.

"It's not rocket science; it's just good management," said Tom Beyersdorf, the executive director of Flint-based Gift of Life Michigan, where the statewide donation rate rose 30 percent last year. Michigan now recovers organs from two-thirds of its potential donors.

Some of the biggest increases in organ donation are in big-city hospitals. Among them: Henry Ford Hospital in Detroit, Harris Methodist Fort Worth Hospital and the Washington Hospital Center in the nation's capital.

The numbers are watched closely because only about 13,000 deaths a year involve people with organs in good enough condition to transplant. Since each donor's organs can extend multiple lives, as in Sadlon's case, a potential donor is considered a precious opportunity.

When it comes to organ donations, nobody does it better than Theda Clark Medical Center in Neenah, which serves a population of about 500,000 from a leafy downtown campus about two hours north of Milwaukee. Theda Clark, where Sadlon died, holds the U.S. record for consecutive organ-donation consents: 21 in 2003. (The runner-up is Fort Worth's Harris Methodist, with 20.) Since then, Theda Clark's consent rate is 97 percent.

Its secret is nurses such as Peg Grambsch, 42, the outgoing, sturdy, intuitive veteran intensive-care nurse who runs Theda Clark's organ-donation program. Most hospitals rely on doctors to ask for organ donations. Or they depend on outside coordinators—usually former trauma nurses or paramedics—who link trauma centers to hospitals that do transplants. But Theda Clark has the nurse who has worked most closely with a dying potential donor ask the patient's family to make the donation.

It takes courage, time, sympathy, straight talk and Kleenex. That's especially true when the head injuries that often make a patient a promising organ donor aren't visible.

"It's heartbreaking," Grambsch said. "You know they're not going to survive. But how can the family let go? They look fine lying in the bed."

She said the key was to translate the doctor's prognosis into layman's language, then help the family cope. It's a conversation that starts once the doctor has told the family there's no hope.

"They hear that, but often they don't take it in," Grambsch said.

"A mother who asks, `When does he get to go home?' doesn't get it," she continued. "Once they realize that he'll never talk, never open his eyes, never do anything, then they get it."

Toward the end of a conversation that can take hours, Theda Clark's nurses will say something like: "I know this is an awful time for you, but there's a chance to do something good."

Grambsch sighed. "We work so hard to try and save the patients. Then we work with their families. It's a tragic thing and a positive thing at the same time: If we can't save that person's life, let's save some others."

Her intensive-care unit employs 50 nurses. "Not one would not want to approach a donor," Grambsch said. "It's part of the personal practice that they do.

"They take it really personal if they get a no, actually."

University of Wisconsin Hospital transplant surgeons, borne by helicopter or ambulance to Theda Clark, flush and clean the organs they remove, then pack them in ice and insulated boxes and rush them to the transplant center's waiting patients. Organs the hospital can't use are rushed to patients awaiting them at other transplant centers.

Who gets an organ among the 89,000 patients who are waiting for them depends on which organ it is—a recovered pancreas is highly perishable, for example—plus such factors as blood type, body size, gravity of illness, age and distance. Priorities vary moment to moment. A terminal case may show up and go to the head of the line. Or maybe the person at the head of the line misses the call. That happened to Lisa Weinlader, a high school Spanish teacher in suburban Madison, who was riding in a school bus that killed her cell phone's reception.

Weinlader later got her liver transplant from Sharlyne Agostine's strapping son, Jason.

Recipients and donor families can write each other anonymously via the regional organ-procurement agency. It deletes the signatures and sends the letters along. Or, if both sides agree, the agency passes along the contact information.

That's how Charlie Pluth and Dawn Sadlon came to meet at an organ donation seminar in Stevens Point in March 2004.

Pluth, who admits he's a talker, recalled recently that he couldn't speak as he crossed the room toward her.

"I was overwhelmed," Dawn Sadlon said.

"She came across the room with her head down, "Pluth said.

In tears, they hugged. Then Pluth asked: "Would you like to feel your son's heart?"

She would, Dawn Sadlon said.

"It was my Danny," she concluded, "living and carrying on and being the good person that he was when he was alive."

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Some useful Web sites:

Identify your local organ-donor agency via the Association of Organ Procurement Organizations, at www.aopo.org. Click on "Member Organizations."

To learn more about being an organ donor, go to The Organ Procurement and Transplantation Network, at www.optn.org.

To learn more about transplants, by organ, go to the United Network for Organ Sharing, at www.unos.org. Explore the "Data" section.

To learn more about the federal initiative to promote organ donations, go to the Organ Donation Breakthrough Collaborative, at http://organdonation.iqsolutions.com. Click on "About the Collaborative."

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(c) 2005, Knight Ridder/Tribune Information Services.

PHOTOS (from KRT Photo Service, 202-383-6099): ORGANDONORS

GRAPHIC (from KRT Graphics, 202-383-6064): 20050727 ORGAN DONORS

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