T. J. Hathaway1, R. S. Mangus1 1Indiana University School Of Medicine,Surgery / Transplant,Indianapolis, IN, USA
Introduction:
An increasing number of rules and regulations govern interactions between learners and patients in the clinical setting. This strict oversight limits the amount of hands-on training available to medical students and residents alike. This paradigm has resulted in increased use of procedural labs with “virtual” experience. A potential source of human subjects available for clinical practice are the thousands of organ donors each year who consent to use of their body for education and research purposes. This study evaluates the potential surgical learning available from deceased organ donors with an intact cardiopulmonary system.
Methods:
The records of all deceased organ donors processed locally by the Indiana Donor Network over the last 18 months (Feb 2017-Aug 2018) were reviewed. Patient consent for research and education was documented. A list of proposed procedures was developed to predict the potential benefit of organ donors as a learning platform for medical students and residents. Limitations to this approach were identified.
Results:
During the study period, 242 of 255 (95%) donors consented for their bodies to be used for education purposes. A list of 27 potential procedures was developed. Simple procedures include endotracheal intubation, central venous catheter insertion, tube thoracostomy, and insertion other peripheral venous and arterial catheters. Complex procedures include more invasive and time consuming procedures such as splenectomy, prostatectomy, hysterectomy, bowel resection and anastomosis. Primary barriers to general adoption of this model for surgical education included extending time in the operating room, risks of contamination to transplant organs, additional cost of extra equipment, potential risks of travel to the donor hospital, and disfigurement of the donor body. After analysis of these factors, it was determined that a single learner could easily participate in 3-5 procedures per donor with implementation of a robust system and support from the attending surgeon. In the last 18 months at this center, 242 donors consented for use of their body for education purposes, suggesting 40-70 missed procedural opportunities per month. Approximately 90% of the available donations occurred in hospitals within a 30-minute drive of a medical education site in our state.
Conclusion:
Routine use of organ donors in the procedural education of medical students and residents could serve as a valuable resource throughout the world. The use of these opportunities will likely become more important as further limitations are placed on the clinical learning environment. In instituting this model, care must be taken to protect the donor and to be responsive to concerns from the donor’s family.