Madhukar S Patel1, Salvador De La Cruz2, Mitchell B Sally3, Tahnee Groat4, Darren J Malinoski5. 1. Department of Surgery, Massachusetts General Hospital, Boston, MA. 2. Department of Family Medicine, Providence Milwaukie Hospital, Milwaukie, OR. 3. Surgical Critical Care Section, Veterans Affairs Portland Healthcare System, Portland, OR; Department of Surgery, Oregon Health & Science University, Portland, OR. 4. Surgical Critical Care Section, Veterans Affairs Portland Healthcare System, Portland, OR. 5. Surgical Critical Care Section, Veterans Affairs Portland Healthcare System, Portland, OR; Department of Surgery, Oregon Health & Science University, Portland, OR. Electronic address: darren.malinoski@va.gov.
Abstract
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Authors: Elizabeth A Swanson; Tony Adams; Madhukar S Patel; Salvador De La Cruz; Michael Hutchens; Kiran Khush; Mitchell B Sally; Claus U Niemann; Tahnee Groat; Darren J Malinoski Journal: J Am Coll Surg Date: 2020-06-17 Impact factor: 6.113
Authors: Ignacio Martin-Loeches; Alberto Sandiumenge; Julien Charpentier; John A Kellum; Alan M Gaffney; Francesco Procaccio; Glauco A Westphal Journal: Intensive Care Med Date: 2019-02-28 Impact factor: 17.440
Authors: Mitchell B Sally; Margaret Katherine Ellis; Michael Hutchens; Tahnee Groat; Elizabeth Swanson; Madhukar S Patel; Claus U Niemann; Darren J Malinoski Journal: Clin Transplant Date: 2019-06 Impact factor: 2.863
Authors: Jonathan Elmer; Bradley J Molyneaux; Kurt Shutterly; Susan A Stuart; Clifton W Callaway; Joseph M Darby; Amy R Weisgerber Journal: Resuscitation Date: 2019-10-22 Impact factor: 5.262