Ali Salim1, Matthew Martin, Carlos Brown, Peter Rhee, Demetrios Demetriades, Howard Belzberg. 1. Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA 90033, USA. asalim@surgery.usc.edu
Abstract
BACKGROUND: The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25% of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC. METHODS: Retrospective analysis of potential brain-dead donors evaluated from January 1995 to December 2003 at nine American College of Surgeons-verified Level I trauma centers covered by a regional organ procurement agency. One center (Los Angeles County + University of Southern California Medical Center [LAC]) had an ADM protocol in place instituted January 1999; the remaining eight centers with no ADM protocol were grouped as Center A. The incidence of CVC and organ donation demographics were compared between centers and within LAC before (LAC-Pre) and after (LAC-Post) adoption of ADM. ADM consists of early identification of potential organ donors, a dedicated team that provides medical management, and aggressive fluid resuscitation as well as hormone replacement therapy with solumedrol and thyroxin. RESULTS: The incidence of CVC was significantly higher in LAC-Pre (odds ratio [OR] 15.0, p < 0.001) and Center A (OR 5.8, p < 0.001) compared with LAC-Post. The number of organs harvested per potential donor for LAC-Post (2.4) was significantly higher than LAC-Pre (2.0, p = 0.02) and Center A (2.1, p < 0.01). CONCLUSION: An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.
BACKGROUND: The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25% of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC. METHODS: Retrospective analysis of potential brain-dead donors evaluated from January 1995 to December 2003 at nine American College of Surgeons-verified Level I trauma centers covered by a regional organ procurement agency. One center (Los Angeles County + University of Southern California Medical Center [LAC]) had an ADM protocol in place instituted January 1999; the remaining eight centers with no ADM protocol were grouped as Center A. The incidence of CVC and organ donation demographics were compared between centers and within LAC before (LAC-Pre) and after (LAC-Post) adoption of ADM. ADM consists of early identification of potential organ donors, a dedicated team that provides medical management, and aggressive fluid resuscitation as well as hormone replacement therapy with solumedrol and thyroxin. RESULTS: The incidence of CVC was significantly higher in LAC-Pre (odds ratio [OR] 15.0, p < 0.001) and Center A (OR 5.8, p < 0.001) compared with LAC-Post. The number of organs harvested per potential donor for LAC-Post (2.4) was significantly higher than LAC-Pre (2.0, p = 0.02) and Center A (2.1, p < 0.01). CONCLUSION: An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.
Authors: Michael M Rey; Lorraine B Ware; Michael A Matthay; Gordon R Bernard; Amy L McGuire; Arthur L Caplan; Scott D Halpern Journal: Crit Care Med Date: 2011-02 Impact factor: 7.598
Authors: Ali Al-Khafaji; Michele Elder; Daniel J Lebovitz; Raghavan Murugan; Michael Souter; Susan Stuart; Abdus S Wahed; Ben Keebler; Dorrie Dils; Stephanie Mitchell; Kurt Shutterly; Dawn Wilkerson; Rupert Pearse; John A Kellum Journal: Intensive Care Med Date: 2015-01-13 Impact factor: 17.440
Authors: Bernardino C Branco; Kenji Inaba; Lydia Lam; Ali Salim; Galinos Barmparas; Pedro G R Teixeira; Peep Talving; Demetrios Demetriades Journal: World J Surg Date: 2011-02 Impact factor: 3.352
Authors: Shelby Resnick; Mark J Seamon; Daniel Holena; Jose Pascual; Patrick M Reilly; Niels D Martin Journal: J Surg Res Date: 2017-05-12 Impact factor: 2.192