Active Donor Management During the Hospital Phase of Care Is Associated with More Organs Transplanted per Donor

• DOI: 10.1016/j.jamcollsurg.2017.06.014
• Publication Date: 2017-07-21T20:43:57Z
• Authors: Madhukar S. Patel; Salvador De La Cruz; Mitchell B. Sally; Tahnee Groat; Darren J. Malinoski
• Keywords: Adult; Male; Tissue and Organ Procurement; Critical Care; Organ Transplantation; Middle Aged; 3. Good health; Hospitalization; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Prospective Studies; Referral and Consultation

BACKGROUND: Meeting donor management goals when caring for potential organ donors has been associated with more organs transplanted per donor (OTPD). Concern persists, however, as to whether this indicates that younger/healthier donors are more likely to meet donor management goals or whether active management affects outcomes.

STUDY DESIGN: A prospective observational study of all standard criteria donors was conducted by 10 organ procurement organizations across United Network for Organ Sharing Regions 4, 5, and 6. Donor management goals representing normal critical care end points were measured at 2 time points: when a catastrophic brain injury was recognized and a referral was made to the organ procurement organization by the DH; and after brain death was declared and authorization for organ donation was obtained. Donor management goals Bundle “met” was defined as achieving any 7 of 9 end points. A positive Bundle status change was defined as not meeting the Bundle at referral and subsequently achieving it at authorization. The primary outcomes measure was having ≥4 OTPD.

RESULTS: Data were collected for 1,398 standard criteria donors. Of the 1,166 (83%) who did not meet the Bundle at referral, only 254 (22%) had a positive Bundle status change. On adjusted analysis, positive Bundle status change increased the odds of achieving ≥4 OTPD significantly (odds ratio 2.04; 95% CI 1.49 to 2.81; p < 0.001).

CONCLUSIONS: A positive donor management goal Bundle status change during donor hospital management is associated with a 2-fold increase in achieving ≥4 OTPD. Active critical care management of the potential organ donor, as evidenced by improvement in routinely measured critical care end points can be a means by which to substantially increase the number of organs available for transplantation.